New world of generics brings medical challenges

San Francisco-New medications for treating glaucoma may be on the horizon, but in 2012, prostaglandin analogues are still the leading class for lowering IOP and generics are taking on a more prominent role, said Andrew G. Iwach, MD.

“Tafluprost, a new prostaglandin analogue, may become available later this year, but other new promising molecules are in phase II clinical trials or earlier stages of development and may not come to market for several more years,” said Dr. Iwach, associate clinical professor of ophthalmology, University of California, San Francisco.

In 2011, latanoprost came off patent, and patents on certain formulations of bimatoprost and travoprost will expire in 2014. Increasing dispensing of generic medications is creating problems for practices because of the time being spent in communications with pharmacies and insurance companies, and it can also impact the patient directly.

Dr. Iwach cautioned that generics manufactured in other countries may not be equivalent to the products manufactured in the United States. In addition, generic bottles of different medications can look alike, causing confusion for the patient who is on a multi-medication regimen.

“These issues are creating new challenges,” he said. “Therefore, I always ask my patients to bring in their bottles when they come in for a follow-up visit because I want to see what they are using and where it is from, and I am particularly concerned if IOP control is suddenly lost or the patient has developed side effects that I can’t explain.”

If tolerability is an issue, clinicians should also consider the possibility of a preservative allergy. Dr. Iwach said that in his experience, the preservative in the solution can make a difference in certain patients. Fortunately, there are a number of alternatives, including products containing preservatives other than benzalkonium chloride or that are preservative-free.