A critical assessment of generic substitution for the obstetrician-gynecologist

In the past decade, generic drugs have increased in market share severalfold. There are drugs used in obstetrics/gynecology that are of concern with regard to generic substitution, because they are believed to be well tested and essentially not dangerous. The present review is mainly of the use of generics in oral contraception and assisted reproduction. It seeks to answer the question, whether cost advantages, great or slight, offered by the generics are well worth the attendant need for increased vigilance by clinicians and, possibly, taking care of increased side effects or even mishaps resulting from lack of effectiveness (or excessive "effectiveness"). The discussion is based on the concepts of bioavailability and therapeutic equivalence.