The Possible Hazards of Pill Substitution
09 Jul 2008
A 22 year old student says, "I’ve been on the birth control pill (BCP) for several years. Now my pharmacist wants to give me a generic BCP rather than my regular one. What should I know about these other pills?" It’s a good question, and parents should also be concerned about substitution.
Brand name birth control pills are those produced by established pharmaceutical companies that have spent years of research and millions of dollars to develop the pill. But once their patent expires other companies can make a copycat version.
The Society of Obstetricians and Gynecologists of Canada (SOGC) reports that it welcomes the increased choice of less expensive options. But adds that to qualify as an equivalent to existing brands generic pills must meet a "blood standard". At the present time generic formulations have no "Pearl Index" rating, the effective standard for evaluating the effectiveness of a contraceptive method.
The SOGC also believes that substitutions should not be made by a pharmacist without notifying both the patient and her health provider. And that switching from a brand name to a generic BCP or vice-versa, can have negative results.
Possibly Shakespeare had a valid point when he wrote, "A substitute shines brightly as a king, until a king be by."
So what are the possible pitfalls of substitution? It’s been said that it’s not wise to change horses in mid stream as you may end up swimming to save your life. Similarly switching from a familiar BCP to a generic product can trigger unforeseen problems, especially with the lowest dose BCPs available today. One of the major traps made by young women is stopping the pill altogether.
Today there are few side effects to birth control pills. But the patient who is free of symptoms on a brand pill, then develops problems on a substitution pill, all too often she stops the medication. She then makes the next grievous error and fails to use other means of contraception. The result is often unwanted pregnancy.
Familiarity with a product also plays an important role in compliance whether we’re dealing with our favourite soap, TV program or BCP. So patients who identify with a brand name are more likely to stay on it which is the ultimate goal to prevent needless pregnancies.
To achieve compliance it’s also wise to avoid confusing the medical consumer. For instance, in the U.S. some brand name birth control pills now have five generic copycat versions! This means different coloured pills and different packaging set the stage for possible mix ups.
For many years brand name companies provided starter packages to doctors. This allows physicians to explain how the pill works and why it’s important to take the pill at the same time each day. Equally important, the pill is immediately available to the patient as many are already sexually active.
But cost can be a factor as generic pills are less expensive. To overcome this problem one pharmaceutical company has instituted "An Alesse Assist Card Program" that enables women to stay on their brand name pill. This card pays the minimal difference in price between the price of Alesse and the generic version (approximately $3.00 per package). Women can obtain the card at www.rxhelp.ca or through their family physician.
But what’s the single most important message for teenagers and others? Over the years I’ve seen many unwanted pregnancies in my practice and the problems they create. So women who are sexually active should use the BCP whether it’s a brand or generic version. And also remember that neither of these pills prevents sexually transmitted disease.
There’s also a tendency to ignore the many other benefits of the BCP. It’s been available for nearly 60 years and has stood the test of time. If everything in life was as safe at "the pill" it would be a wonderful world.
Women on the pill are exposed to only half the risk of uterine and ovarian cancer of other women. This is a huge advantage as ovarian cancer is difficult to diagnose. Pill users also have fewer pelvic operations, benign breast cysts, menstrual pain, and troublesome bleeding. Add this all up and birth control pills have added a new and positive dimension to the lives of women.
