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Correspondence
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Volume 333:1289-1290 November 9, 1995 Number 19
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Effect of a Prior-Authorization Requirement on the Use of Nonsteroidal Antiinflammatory Drugs

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by Smalley, W. E.
To the Editor: Smalley et al. (June 15 issue)1 effectively demonstrate that prior-authorization requirements are cost effective with regard to expenditures for nonsteroidal antiinflammatory drugs (NSAIDs). They correctly state that NSAIDs are similar in efficacy, but they incorrectly claim equivalence in safety.

Two of the listed generic preparations (fenoprofen and phenylbutazone) have higher rates of severe organ toxicity than other NSAIDs.2,3 Fenoprofen causes interstitial nephritis more frequently than other NSAIDs that are either in the same chemical class as fenoprofen or in a different class.3 Phenylbutazone is well known to have a much higher risk of causing potentially irreversible bone . . . [Full Text of this Article]

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