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Editors Selection IGR 14-1

Medical Treatment: Properties of generic latanoprost solutions

Comment by Louis Cantor on:

71551 The physical properties of generic latanoprost ophthalmic solutions are not identical, Kolko M; Koch Jensen P, Acta Ophthalmologica, 2017; 95: 370-373

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The authors are to be congratulated for investigating an important clinical topic. While generic formulations exist in order to reduce cost and increase access to therapy, generic ophthalmic medications may pose a number of challenges, which may be especially problematic when treating a chronic ocular disease. The authors highlight a number of variations in formulation and physical properties of several generic latanoprost products when compared to the reference legend drug, or brand product. Within the US there are at least eight generic formulations for latanoprost available. In addition, an individual patient may receive a different generic formulation when obtaining refills, further compounding these issues.

Despite these reported variations between generic formulations, the majority of patients appear to still respond as well as to the branded product, but clinically there are notable exceptions, in terms of efficacy or tolerability

While the US FDA and other international organizations have guidance which is intended to ensure that generic and branded formations are equivalent, differences continue to be reported. Despite these reported variations between generic formulations, the majority of patients appear to still respond as well as to the branded product, but clinically there are notable exceptions, in terms of efficacy or tolerability. In addition, in a cost-effectiveness model, if 'costs' related to poor compliance, disease progression, additional office visits and other factors are considered, the actual cost of the drug may not be the key factor driving costs long term. Therefore, as a matter of practice, I recommend that a patient be scheduled for a follow-up visit within one to two months any time we make a switch from a branded to generic formulation.

I recommend that a patient be scheduled for a follow-up visit within one to two months any time we make a switch from a branded to generic formulation. In addition, I instruct patients to contact our office to schedule an earlier appointment any time they obtain a refill with a different looking bottle or label, as this suggests their pharmacy has just switched them to a different generic product. As physicians, our challenge is to ensure that each patient is receiving their optimal individual therapy.

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