The recommendations, which are published in the February issue of NKF's American Journal of Kidney Disease,were developed at a recent NKF conference on drug substitution in transplantation by more than 40 experts in organ transplantation, managed care and pharmacology, as well as patients and representatives of government agencies. Drug substitution may involve the substitution of one generation of a drug for another, the use of a different agent within the same class of drugs or the use of a generic formulation for a brand name product.
Possible advantages involve lower cost and better compliance.
Possible dangers include overdose, underdose and unexpected side effects. As the cost-saving potential and efficacy of generic drugs have become more widely recognized, substitution has become standard for many managed care providers. The introduction of new generic immunosuppressives could lead to substitution without the knowledge of patients or even their doctors. In the future, new immunosuppressive agents should be evaluated to determine whether they also meet these criteria. Health care providers should educate the patient about generic drugs and include him or her in the decision of whether to switch drugs.