Therapeutic risks resulting from aut-idem substitution of certain drugs have been discussed by both specialist groups and patient organizations for some time. Opioid analgesics for the treatment of chronic pain are considered particularly critical.
Pain experts have long been calling for all WHO level III sustained-release opioids to be fundamentally excluded from aut idem substitution. In their experience, every exchange - including switching between opioid analgesics with identical active ingredients - carries the risk of new risks for the patient, which must be accompanied by the doctor and which correspond to the requirements of a new setting. Even with the same active ingredient and the same amount of active ingredient in different preparations, there are noticeable differences for the patient in terms of bioavailability, kinetics and therapeutic equivalence, which can lead to considerable complications in pain medicine treatment in the context of aut-idem substitution.
The “Coalition Against Pain”, an association of professional associations active in pain medicine, has often drawn attention to the serious problems caused by the obligation to exchange strong pain medications... <<