Generic confusion

By John Connole
Saturday, 17 November, 2012

Medication misadventure continues to be a major issue for Australia’s health system, and the latest figures available paint a sobering picture of the extent of the problem in Australia, and the cost it is having on the health system.

Approximately 200 million prescriptions are dispensed each year at a cost of about $8.3 billion to the health system. However, it is estimated that in Australia, some 190,000 medicine-related hospital admissions occur each year and the associated cost of these to the public health system is in the vicinity of $660 million a year.

What is staggering is that figures released during National Medication Safety Week recently showed that between 23 to 73 per cent of adverse drug events are preventable.

One area where some misadventures can occur is through generic medicines’ use. As 40 per cent of patients aged over 70 years receive more than five medicines, they are increasingly vulnerable to medication errors.

A Medical Journal of Australia report points to the study Generic substitution of commonly used medications: Australia-wide experience, 2007–2008, also published in the MJA which shows increasing brand substitution due to the proliferation of generic medicines adds to the potential for confusion and the likelihood of medication misadventure.

Pharmacists have a vital role to play in reducing medication misadventure, particularly in relation to generic confusion where some issues can be addressed before they become problems.

I believe it is important for patients to try to return to the same pharmacy for their medicines, the pharmacy where their records are kept, where the same generics are generally dispensed and where staff know them and can better help with their medication management.

Another important step is for consumers to visit their pharmacist as soon as possible after any hospitalisation that has required a change in their medicines regimen. On discharge they may be given medicines of a different generic brand and often confusion arises at this time when a patient is very vulnerable.

Pharmacists can also help by making better use of advisory labels such as the one for use on a generic medicine which clarifies when a change is being made from an existing medicine to a new brand. This specific label can be very useful to consumers, and also helpful to pharmacists when counselling patients.

The Australian Pharmacy Council (APC) at its meeting in 2008 discussed the use of generic medicines and said, “Some particularly troubling reports have been received due to consumers not being given clear and adequate information. One such incidence involved an elderly woman who had been using a brand name heart medication and had this replaced with a generic brand of the same medication when next having her prescription filled. The patient was advised that the generic brand medication ‘does the same thing’ but misunderstood this to mean that it strengthened her existing medication and made the result even better. Consequently she took generic branded medication in the prescribed dose and continued taking brand name heart medication. The result was hospitalisation for the elderly woman as a consequence of the medicine misadventure.”

The APC’s report of its meeting went on to remind all pharmacists that, “They must draw the patient’s attention to the name of the active ingredient every time a dispensed medication is handed out. In addition, pharmacists have a responsibility to ensure that all relevant pharmacy staff are competent to carry out this function”.

To further help reduce the risk of medication misadventures, PSA’s Guidelines for Pharmacists on PBS Brand Substitution, which will be updated this year, point to a number of steps pharmacists must take when dealing with generic medicines.

These include:

  • Pharmacy staff should be trained to assist the pharmacist in informing and educating consumers about generic medicines.

  • Pharmacists should have systems in place to ensure that all have the opportunity to request a generic equivalent.

  • Brand substitution may only occur after consultation with and agreement of the patient and if the prescriber has not indicated on the prescription, “no substitution”, or equivalent.

  • Where substitution is allowed and the patient is offered or enquires about alternate brands, the pharmacist and the patient should discuss the safety and suitability of alternate brands for that patient.

  • The patient’s health should always be the pharmacist’s prime consideration in any brand substitution decision.

  • Decisions to substitute one brand for another should not place patients at risk.

  • Pharmacists should endeavour to be consistent in the selection of brands for patients on long-term therapy in order to avoid patient confusion. If this is not possible then the patient should be consulted.

  • Pharmacists should encourage (or offer to assist) patients to have their medication regularly reviewed to check for duplication of different brands of the same medicine.

  • Pharmacists should discuss brand substitution issues with their local prescribers to maintain and improve professional relationships and minimise the chances of any conflict or misunderstanding.

Grant Kardachi

Grant Kardachi


Pharmaceutical Society of Australia

Grant Kardachi was elected President of the PSA, after serving as Vice-President and a Board Member for three years. He is a community pharmacist who recently sold his business interests but is still accredited to undertake medication reviews and sits on the Australian Association of Consultant Pharmacy (AACP) Board.

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