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The tyranny of the majority and the interchangeability of drugs

In this issue of Acta Psychiatrica Scandinavica, Cohen and Loonen (1) challenge the assumptions of many that extended-release formulations and immediate-release formulations of drugs are not only interchangeable, but that immediate-release drugs should be used preferentially due to lower costs. The authors point out that at least for one agent, carbamazepine, head-to-head studies of extended release versus immediate release show superiority of extended release for both efficacy and tolerability. These authors also argue that when extended-release formulations reduce the frequency of dosing, they enhance compliance, and therefore improve outcomes; thus, Cohen and Loonen submit that the rational weighing of the evidence favours the use of extended-release formulations.