Once-Weekly Prozac Approved by FDA. The formulation contains 90 mg. of the active ingredient, fluoxetine, in a time-release formula, and is intended for patients whose depressive symptoms have stabilized but need continued maintenance drug therapy to prevent a relapse. The truth of the matter, however, is that fluoxetine has such gradual rate of metabolism and elimination from the body that the plain old original Prozac formulation, which is usually 20 mg., can be given less frequently than daily — in some cases as infrequently as once a week — for many maintenance purposes, and (as scandalous as its price seemed when it first entered the marketplace in the early ’80’s) is considerably less expensive. Eli Lilly’s last decades of profit were built upon Prozac’s cash cow, but it has seen its market share erode with the introduction of subsequent (and in some cases superior) antidepressants, and the company will take a big hit in August when it loses patent protection over Prozac and a generic fluoxetine is launched by a competitor. A new formulation like Prozac Weekly will regain them proprietary rights.

In a similar maneuver, they’ve recently released the product Sarafem for premenstrual tension symptoms. This is plain old fluoxetine as well! The clinical literature has long noted benefit from SSRIs for PMS symptoms whether the sufferer is depressed or not, and many of us have long prescribed Prozac for that indication. There’s nothing different about Sarafem [except its ability to support Lilly’s stock prices?]

This is the second psychiatric instance of a new pharmaceutical marketing trend that seems particularly disingenuous from my vantage point. Here was the first — have you seen any of the TV ads for Zyban, marketed as a smoking cessation aid? The ads tell you it’s “not for everyone,” in particular mentioning that you shouldn’t take it if you’re taking the antidepressant Wellbutrin. They don’t explain why, but the reason is a simple one — Glaxo Wellcome’s Zyban is identical to Glaxo Wellcome’s Wellbutrin; they’re both, generically, bupropion, in the same 150 mg. sustained release form, at virtually the same price.

In my opinion, there is no justification except the attempt to increase market share through deceptive marketing for one company to push the same pharmaceutical under different brand names for different indications. Instead, the product labelling of their existing product should be changed to reflect any added indications they receive from the FDA. I have already seen several cases in which patients have been prescribed Zyban by their primary care MDs while receiving Wellbutrin from mental health practitioners, either because of a lack of crosstalk among the parties or ignorance on the part of one practitioner of the ingredients in the other prescription. And the potential medical consequences of such inadvertent “doubling up” of bupropion dosing, including seizures, are nontrivial! TV advertising which prompts patients to develop brand recognition of medications and ask for products from their physicians by brand name is part of the problem. I find that, over the last decade, there’s been erosion in patients’ understanding of the concept of generic equivalents of medications. Unless there’s a good reason to prefer a particular company’s brand (and there rarely is), I do all my prescribing by the generic name of the medication.