Warn patients that generic pills look different

Generic formulations of drugs using active pharmaceutical ingredients are an immense cost savings to patients and healthcare systems.

On the other hand, questions remain as to whether generics are truly equivalent to brand name pharmaceuticals. Are the pharmacokinetics the same? Are they bioequivalent? While this is a difficult topic to research clinically, I would argue that the vast majority of brand name and corresponding generic drugs are indeed equivalent (though there may be some rare exceptions).

That said, there is a hidden danger about switching your patient from brand name pharmaceutical to a generic that you may not have considered: the pill will look different.

When I started my medical training, I made certain blanket assumptions about how patients used medications. I assumed that they read the pill bottle, both the drug name and the dose, and obediently followed the many labels affixed to the bottle by the pharmacist. I found little evidence to the contrary, initially, but I soon started to get rather unexpected questions that made me question this assumption.

For example, when I would take medication histories, patients quite often forgot the name of the drug they were taking. They asked me, “what’s the orange oval pill?” or “I take a really small pill for my thyroid” followed by a hand gesture meant to approximate the size to the pill. This happened so often that I needed an app, similar to a PDR, that helped me identify pills based on color, shape, and size (this data was never covered in medical school). I later found that people have unusual methods for remembering how to take their medicines day-to-day and week-to-week. The complexity of the ritual increases with the number of prescribed and over-the-counter medicines.

My difficulties with this issue are certainly anecdotal. There is not a lot of data describing this problem—but there is some. Researchers from Tel Aviv University published a study that focused on errors that arose from substituting therapeutic equivalents. Based on responses to a questionnaire, 81% of physicians and 70% of pharmacists recalled patients having problems of “uncertainty, confusion, misidentification, and mainly cases of medication mistakes” with therapeutic equivalents. While this study does not fully describe the degree, scope, or severity of the problem, it certainly raises it as an important issue. Plus it tells me I’m not alone.

Fortunately there is a simple, inexpensive fix for the problem. In fact, it is free. Warn the patient that the generic pill will be different when you make the switch. You do not need to tell them the shape, the color, or the size of the new pill; just tell them that it will be different. I look at it from the physician’s perspective, but it is also the pharmacist’s responsibility. Both professionals need to add that one sentence to their patient instruction spiel. The risk? Perhaps you may appear to be insulting the intelligence of your patients, but that is a small price to pay for clarity.

Michael Todd Sapko is a medical writer and consultant. He writes for Healthline.com.

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