Fast Five Quiz: Generic Medications

Mary L. Windle, PharmD


November 22, 2019

Drugs with an NTI require cautious switching with close patient monitoring at recommended intervals.

The concern about switching patients from a brand-name drug with an NTI to a generic formulation is relevant to several commonly used agents, including levothyroxine (LT4), warfarin, and certain antiarrhythmic, antiepileptic, and posttransplant immunosuppressant drugs.

Regarding LT4, the Endocrine Society issued a position statement setting forth its concerns over generic forms of LT4, noting that although generic forms of LT4 have been deemed bioequivalent by the FDA, these agents may actually deliver different amounts of LT4, potentially leading to clinically significant impacts.

Although patient age alone does not determine whether someone is a candidate for switching to a generic drug, high-risk patients often require increased monitoring vigilance. For example, when a high-risk patient is switched from branded to generic warfarin or from one generic version of warfarin to another, some experts recommend very close monitoring of the patient's international normalized ratio values.


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