Objective: Generic drugs similar in appearance to their brand-name counterparts have both advantages and disadvantages.  This study aimed to investigate patient preferences regarding the appearance of generic drugs.
Design: A cross-sectional survey.
Methods: We conducted a web-based survey between 2013 and 2014.  Patients aged ≥40 years who reported taking prescription drugs for >6 months were asked to provide their opinions on the appearance of generic drug formulations and press-through packages (PTPs).  Medical doctors and pharmacists were asked as to what type of appearance of generic drugs would be suitable as well as whether the appearance of these drugs and PTPs should be similar to that of their brand-name counterparts.
Results: A total of 911 patients, 238 pharmacists, and 81 medical doctors responded to the survey.  Most of the patients (45.3%) surveyed reported that the similarity in the appearance of generic drug formulations and PTPs to those of their brand-name counterparts was not important, whereas only 15.6% of patients preferred generic drug formulations and PTPs similar in appearance to their brand-name counterparts.  In contrast, most of the medical doctors (53.1%) and pharmacists (88.2%) reported that the appearance of generic drug formulations and PTPs should be similar to that of their brand-name counterparts.
Conclusion: Patients’ opinions on the appearance of generic drugs differ from what medical doctors and pharmacists perceive them to be.  Therefore, health care professionals should select generic drugs with an appearance as per the individual patient’s preference.

Objective: Both acyclovir (ACV) and valacyclovir (VACV) can cause drug-induced encephalopathy, which occurs primarily in patients with renal impairment because of delayed drug metabolism. Here, we report a case of ACV-associated encephalopathy precipitated by the addition of nonsteroidal anti-inflammatory drugs (NSAIDs).Patient: A 97-year-old woman with a 1-d history of altered consciousness was admitted to our hospital. After treatment with ACV and VACV for herpes zoster, NSAIDs were introduced for pain 5 d prior to admission. VACV and NSAIDs were subsequently administered by her primary care physician 3 d before admission.Results: The patient presented with altered consciousness and acute kidney injury, leading to a suspicion of ACV-associated encephalopathy. Her consciousness improved rapidly with hemodialysis. We diagnosed ACV-associated encephalopathy based on a significantly elevated ACV blood level of 32.7 µg/dL.Conclusion: The addition of NSAIDs during ACV or VACV administration may precipitate ACV-associated encephalopathy. When combining ACV or VACV with NSAIDs for the treatment of herpes zoster, careful monitoring of consciousness level and renal function is recommended.