Thomas L. Schwartz, MD; Jose L. Massa, MD; Sanjay Gupta, MD; Sadiq Al-Samarrai, MD; Patrick Devitt, MD; and Prakash S. Masand, MD
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Background: Approximately 50% of pharmacy
prescriptions in the United States are filled with generic drugs,
which have improved substantially in quality owing to increased
governmental regulations. The remaining medicoeconomic question
regards whether or not brand-name medications are worth the
price. This study evaluates these questions for the brand-name
mood stabilizer divalproex sodium and its generic counterpart,
valproic acid.
Method: We conducted a retrospective chart
review of all patients who had been taking divalproex and had
been switched to valproic acid at 2 local mental health
facilities in 1997. Data collected from the inpatient- and
day-treatment charts for these 28 patients included dose,
duration, side effects, and efficacy (determined using
retrospective chart review and the Clinical Global Impressions
scale [CGI]) of divalproex sodium compared with valproic acid
treatment.
Results: t Tests for dependent samples
revealed that valproic acid was administered at higher doses than
divalproex sodium, but these treatments did not differ in
efficacy on the basis of CGI scores. Fisher exact test analyses
revealed a trend toward more nausea with valproic acid; also, the
combination of nausea, abdominal discomfort, and diarrhea
occurred more often in valproic acid treated patients. There
were no differences in the discontinuation of either medicine
because of side effects, or in the use of medications to treat
gastrointestinal side effects. Efficacy was similar for valproic
acid and divalproex sodium. There was no single, significant side
effect increase for valproic acid; however, when grouped
together, gastrointestinal side effects were statistically
significantly increased in valproic acid treated patients. This
appears clinically insignificant because of the lack of
difference in drug discontinuation rate or gastrointestinal
medication use.
Conclusion: Given these results and that
valproic acid is much less expensive than divalproex sodium,
valproic acid appears to be a satisfactory substitution for
divalproex sodium in the treatment of frequently hospitalized
psychotic patients.
Prim Care Companion J Clin Psychiatry 2000;2(2):45-48
https://doi.org/10.4088/PCC.v02n0203
© Copyright 2000 Physicians Postgraduate Press, Inc.