Extended release products are a common method to deliver medications.  There are certainly advantages to having medications delivered via this method, but there are also certain instances where this may not be advantageous. I’ll discuss some of the challenges and benefits with these products with some examples.

1. The obvious benefit of extended release products is that you can reduce the frequency of dosing.  Whenever you ask a patient to take a medication numerous times per day, you are increasing the likelyhood of non-adherence.  A classic example of an extended release medication is diltiazem.  When immediate release is used, multiple doses per day are often required, but with the extended release versions, we can usually get that down to once a day.
2. In addition to adherence, many patient get frustrated with the polypharmacy and the sheer number of pills they have to take.  Reducing pill burden can be beneficial for some patients.  Switching metoprolol IR BID to metoprolol XL once per day is an example here. If you’re looking for more on beta-blockers, be sure to check out this podcast.
3. Cost can be a major disadvantage of extended release products.  Take Namenda XR as our example.  The generic, immediate release version is hundreds of dollars cheaper than the extended release formulation and some will argue that there is no to minimal clinical advantage of the extended release product.
4. Extended release formulations (or long acting drugs) can have a slower onset of action.  Fentanyl patches are an example here.  Because of the delivery method and very slow onset of action, this drug should not be used for acute pain.  Looking for more pearls on fentanyl? Check out this post.
5. In the event of adverse drug reactions, another potential disadvantage with extended release products is that side effects may linger for a much longer period of time compared to the shorter acting, immediate release product.  An example here would be Bydureon (extended release once weekly exenatide) versus the twice daily injection of Byetta.

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