The Ativan Paradox: A Researcher’s Guide to Lorazepam, Brand Names, and the Hidden Truth of the Generic Switch

Part I: The Question That Changed Everything: A Researcher’s Introduction

In the world of medical research and clinical practice, certain principles are taught with the force of law.

For years, one such axiom guided my understanding of pharmacology: brand-name drugs and their generic equivalents are, for all intents and purposes, identical.

The science of bioequivalence, I learned, was the great equalizer.

It ensured that a generic medication would deliver the same active ingredient to the bloodstream at the same rate and in the same amount as its pricier, branded counterpart.¹

Any patient-reported differences, the conventional wisdom suggested, were likely attributable to psychological factors—the power of expectation, or its negative twin, the nocebo effect—or other unrelated clinical variables.³

This was the clean, logical framework I carried into my work, a confidence in the textbook that felt as solid as the data it was built upon.

That confidence was shattered by a case I could neither explain nor ignore.

The patient was a man in his late 50s who had been successfully stabilized on brand-name Ativan for a severe, long-standing panic disorder.

For years, the medication had been his lifeline, allowing him to function, work, and live without the constant shadow of debilitating anxiety.

Then, his insurance plan mandated a switch.

The pharmacy dispensed generic lorazepam.

I reassured him, echoing the doctrine I knew so well: “It’s the exact same medicine, just made by a different company.

You won’t notice a thing.”

I was wrong.

Within a month, he was back in my office, his stability in ruins.

The panic attacks had returned with a vengeance, and his world was shrinking again.

My reassurances had failed him, and more troublingly, my scientific framework had no answer.

He was taking the same molecule, at the same dose, on the same schedule.

According to the data, he should have been fine.

Yet, he wasn’t.

This was not a subtle shift; it was a clinical relapse.⁴

I was confronted with a profound disconnect between the population-level statistical models that govern drug approval and the stark reality of an individual’s suffering.

The central mystery wasn’t whether generics were “bad,” but

why a medication certified as “equivalent” could produce such a dramatically different outcome in a real human being.

This question forced me to look beyond the textbook and into the complex, nuanced world that exists between a pill and a patient.

Part II: Lorazepam Unveiled: The Molecule, Its Mission, and Its Many Identities

To understand the paradox, one must first understand the molecule at its center.

Lorazepam is a potent and widely used medication belonging to a class of drugs known as benzodiazepines.⁷

A Clinical Snapshot: What is Lorazepam and How Does It Work?

At its core, lorazepam is a central nervous system (CNS) depressant, meaning it slows down brain activity.⁸

Its primary mechanism of action involves enhancing the effects of a neurotransmitter called gamma-aminobutyric acid, or GABA.¹⁰

GABA is the brain’s main inhibitory or “calming” chemical.

By making GABA receptors more receptive, lorazepam effectively turns up the volume on the brain’s natural calming signals, leading to sedation, a reduction in anxiety, and muscle relaxation.¹¹

Its pharmacokinetic profile—how the body absorbs, distributes, and eliminates it—is key to its clinical utility.

When taken orally, lorazepam is absorbed efficiently, with about 90% of the drug becoming available to the body.¹²

It begins to work relatively quickly, typically within 20 to 30 minutes, with its full sedating effects peaking around two hours after administration and lasting for approximately six to eight hours.⁷

This profile makes it particularly effective for managing acute episodes of anxiety or insomnia, rather than for long-term, continuous treatment.

The U.S. Food and Drug Administration (FDA) has approved lorazepam for several specific indications ¹⁰:

• Short-term management of anxiety disorders: For the relief of symptoms of anxiety, often for a period not exceeding four months.¹²
• Anxiety-related insomnia: For difficulty sleeping caused by underlying anxiety or situational stress.⁸
• Pre-anesthetic medication: Administered before surgery or medical procedures to calm patients, reduce anxiety, and induce amnesia, so the patient has little memory of the event.⁹
• Status epilepticus: The injectable form of lorazepam is a first-line treatment for this life-threatening condition, which is characterized by a continuous seizure or a series of seizures without recovery in between.¹⁰

Beyond these official uses, clinicians also prescribe lorazepam “off-label” for a variety of conditions where its calming effects are beneficial, including the rapid tranquilization of agitated patients, management of alcohol withdrawal syndrome, panic disorder, and severe vertigo associated with conditions like Meniere’s disease.¹⁰

However, its power comes with significant risks.

Lorazepam is a Schedule IV controlled substance, indicating a potential for abuse and dependence.¹⁵

The FDA has issued its most serious “boxed warning” for all benzodiazepines, highlighting several critical dangers ¹³:

1. Risks from Concomitant Use with Opioids: Combining lorazepam with opioid medications can lead to profound sedation, life-threatening respiratory depression, coma, and death.¹³
2. Abuse, Misuse, and Addiction: The use of lorazepam exposes individuals to the risk of developing a substance use disorder, which can lead to overdose or death, especially when combined with other medications, alcohol, or illicit drugs.¹³
3. Dependence and Withdrawal Reactions: Continued use, even as prescribed, can lead to physical dependence. Abruptly stopping or reducing the dose too quickly can cause severe and potentially life-threatening withdrawal symptoms, including seizures.¹¹ For this reason, treatment is typically limited to 2 to 4 weeks, and discontinuation should always be done gradually under a doctor’s supervision.⁷

Lorazepam’s Global Brand Portfolio: A Cross-Market Comparison

The name on the bottle can change dramatically depending on where you are in the world.

While the active ingredient remains lorazepam, the brand names, available formulations, and prevalence of generics vary across different English-speaking countries.

This can be a significant source of confusion for patients who travel, move, or research their medication online.

The most globally recognized brand name for lorazepam is Ativan.¹⁷

However, other brands and a vast array of generic products exist.

The following table provides a consolidated overview of lorazepam’s identity in five key markets.

Country	Common Brand Name(s)	Generic Availability	Common Formulations	Key Sources
United States	Ativan, Loreev XR, Lorazepam Intensol	Widespread	Tablet, Extended-Release Capsule, Oral Solution, Injection	20
United Kingdom	Ativan	Widespread	Tablet, Liquid, Injection	17
Canada	Ativan	Widespread	Tablet, Injection	26
Australia	Ativan, Lorazepam (Viatris/Mylan)	Widespread	Tablet	18
New Zealand	Ativan	Widespread	Tablet	19

In the United States, patients may encounter the original brand, Ativan, an extended-release version called Loreev XR designed for once-daily dosing, or a concentrated liquid form known as Lorazepam Intensol.²⁰

Generic lorazepam tablets are ubiquitous and are the most commonly dispensed form.²¹

In the United Kingdom, while Ativan is the known brand name, the National Health Service (NHS) predominantly encourages prescribing by the drug’s generic name, or International Non-proprietary Name (INN).¹⁷

Therefore, a prescription will most often simply read “lorazepam.”

Canada follows a model similar to the U.S., with Ativan being the primary brand name and generic versions being widely available and prescribed.²⁶

In Australia, Ativan is the main brand, but generic versions, such as those from the manufacturer Viatris (formerly Mylan), are also common.²⁹

All forms are Schedule 4, meaning they are prescription-only medicines.²⁹

New Zealand also uses Ativan as the key brand name.¹⁹

Notably, this market has experienced documented supply issues with the Ativan brand, underscoring the critical role that generic manufacturers play in ensuring continuous access to the medication for patients.³³

Part III: The Doctrine of Equivalence: How Global Regulators Define “The Same”

The entire system of generic medicine rests on a single, powerful principle: bioequivalence.

To the regulatory bodies that act as gatekeepers for public health—the FDA in the U.S., Health Canada, the MHRA in the U.K., and the TGA in Australia—proving bioequivalence is the key that unlocks market access for a generic drug.

Understanding this doctrine is essential to unraveling the paradox of the generic switch.

The Foundation: The Principle of Bioequivalence (BE)

In the simplest terms, bioequivalence means that two drug products are expected to have the same clinical effect and safety profile.³⁵

A generic manufacturer doesn’t need to repeat the massive, expensive clinical trials that the original brand-name company conducted to prove the drug works.

Instead, they must prove through scientific testing that their version behaves in the human body in the same way as the original.³⁶

This proof is established by measuring two key pharmacokinetic parameters in a group of healthy volunteers who take both the generic and the brand-name drug on separate occasions ²:

• Cmax (Maximum Concentration): This is the highest concentration that the drug reaches in the bloodstream. It’s a measure of the rate of absorption.
• AUC (Area Under the Curve): This represents the total exposure to the drug over time. It’s a measure of the extent of absorption.

For a generic to be approved, the manufacturer must demonstrate that its Cmax and AUC are statistically equivalent to the brand-name product’s.

This leads to the most widely cited—and most frequently misunderstood—standard in pharmacology: the 80% to 125% rule.

This rule does not mean that a generic pill can have 20% less or 25% more active ingredient.

The amount of active ingredient must be identical.³⁷

Instead, it is a statistical boundary.

When scientists compare the ratio of the generic’s performance to the brand’s, the 90% confidence interval for that ratio must fall entirely within the 80% to 125% window.²

In practice, the average difference between most generics and their brand-name counterparts is much smaller, often only around 3% to 4%.²

This statistical range is considered tight enough to ensure that there is no clinically significant difference in performance for the vast majority of patients.

The Gatekeepers: A Comparative Look at Generic Drug Approval

While the core principles of bioequivalence are harmonized globally, the specific regulatory pathways, terminologies, and legal frameworks differ from country to country.

This creates a complex but largely aligned international system for ensuring the safety and quality of generic medicines.

The post-Brexit landscape, in particular, has introduced new dynamics, with the U.K.’s MHRA developing reliance procedures that leverage the work of other trusted international regulators to maintain patient access to medicines.³⁹

This demonstrates a broader trend of regulatory cooperation, even as national agencies maintain their sovereignty.

The following table compares the generic drug approval frameworks in the key markets, demystifying the agencies and processes that govern the medications patients receive.

Regulatory Body (Country)	Key Legislation/Act	Submission Acronym	Core Requirement	Key Sources
FDA (United States)	Hatch-Waxman Act (1984)	ANDA (Abbreviated New Drug Application)	Prove bioequivalence to the Reference Listed Drug (RLD).	1
Health Canada (Canada)	Food and Drugs Act	ANDS (Abbreviated New Drug Submission)	Prove bioequivalence to the Canadian Reference Product (CRP).	41
MHRA (United Kingdom)	Post-Brexit Framework	National Procedure (NP) / Reliance Procedures	Demonstrate bioequivalence to the reference product.	39
TGA (Australia)	Therapeutic Goods Act 1989	Registration on ARTG	Prove bioequivalence to the Australian innovator product.	35

In the United States, the landmark Drug Price Competition and Patent Term Restoration Act of 1984, known as the Hatch-Waxman Act, created the modern pathway for generic drugs.¹

A company files an

Abbreviated New Drug Application (ANDA), which relies on the safety and efficacy findings of the original brand-name drug, known as the Reference Listed Drug (RLD), and primarily contains data proving bioequivalence.³⁶

In Canada, the process is similar.

A manufacturer files an Abbreviated New Drug Submission (ANDS) with the Health Products and Food Branch (HPFB) of Health Canada.⁴¹

The submission must demonstrate that the generic is bioequivalent to the specific

Canadian Reference Product (CRP).⁴³

In the United Kingdom, the Medicines and Healthcare products Regulatory Agency (MHRA) now operates independently of the European Medicines Agency (EMA) post-Brexit.

A company can file a National Procedure (NP) application for approval just in Great Britain.⁴⁰

Alternatively, it can use reliance pathways, such as the International Recognition Procedure (IRP), which allows the MHRA to take into account the assessments of trusted overseas regulators to accelerate its own review process.³⁹

The fundamental requirement remains proof of bioequivalence to the reference product.⁴⁴

In Australia, the Therapeutic Goods Administration (TGA) oversees the process.

Generic medicines must be registered on the Australian Register of Therapeutic Goods (ARTG) before they can be supplied.⁴⁶

The application must include data proving the generic is bioequivalent to the Australian innovator (brand-name) product.⁴⁵

The TGA has specific, detailed guidelines for conducting these bioequivalence studies.⁴⁷

Part IV: Unraveling the Paradox: When “Equivalent” Isn’t Identical

The case of my patient who relapsed on generic lorazepam was a clinical anomaly that the doctrine of bioequivalence couldn’t explain.

The turning point in my understanding—the epiphany that solved the mystery—came not from a pharmacology textbook, but from a simple, everyday analogy.

The Epiphany: The Coffee Brewing Analogy

Imagine trying to brew the exact same cup of coffee every single morning.

The active pharmaceutical ingredient (API)—in this case, lorazepam—is like the coffee bean.

Regulatory agencies ensure that every generic manufacturer uses the exact same high-quality bean.

However, the final cup of coffee is affected by more than just the bean.

It’s influenced by the inactive ingredients, or excipients.

These excipients are the binders that hold the tablet together, the fillers that add bulk, the coatings that make it easy to swallow, and the dyes that give it color.

In our analogy, they are the brewing method: the fineness of the grind, the temperature of the water, the type of filter paper, even the time the water is in contact with the grounds.

You can start with the identical coffee bean, but if you change any of these “inactive” variables, you will get a cup of coffee with a different strength, flavor, and aroma.

Similarly, while generics must contain the identical API, manufacturers use their own proprietary blends of excipients.

And while these ingredients are pharmacologically inert, they can subtly influence how quickly the tablet disintegrates, how fast the API dissolves, and ultimately, the rate at which it is absorbed into the bloodstream.⁶

For most people and most drugs, these differences are too small to matter.

But for a sensitive individual on a sensitive medication, a change in the “brewing method” can lead to a clinically noticeable difference in the final effect.

The Science Behind the Switch: Deconstructing the Differences

This analogy provides an intuitive framework for understanding the specific scientific factors that can lead to variations in patient experience when switching between different versions of the same drug.

The Critical Role of Excipients

While regulatory bodies like the TGA carefully review excipients for safety, their impact on a drug’s pharmacokinetic profile is the key variable.³⁵

Different filler and binder compositions can lead to slight differences in tablet hardness and dissolution rates.

These subtle physical differences, stemming from different manufacturing processes, are the most likely source of the small variations in absorption that, while still within the 80%-125% bioequivalence window, can be felt by some patients.⁴⁸

The “Generic-to-Generic” Switch Problem

This is perhaps the most critical and least understood aspect of the paradox.

The bioequivalence standard mandates that Generic A must be equivalent to the Brand.

It also mandates that Generic B must be equivalent to the Brand.

It does not require Generic A and Generic B to be tested against each other.⁴⁹

It is therefore theoretically possible for one generic to be at the higher end of the bioequivalence range (e.g., 120% of the brand’s absorption) while another is at the lower end (e.g., 85%).

Both are legally and scientifically “bioequivalent” to the reference brand.

However, a patient who is stable on the first generic and is then switched by their pharmacy to the second could experience a clinically significant drop in their drug exposure.⁴⁹

This is not a failure of the system, but an inherent statistical property of it that can have real-world consequences for a minority of patients.

Narrow Therapeutic Index (NTI) Drugs

This issue is magnified for drugs with a “narrow therapeutic index” (NTI).

These are medications where the difference between a therapeutic dose and a toxic or ineffective dose is very small.³⁵

Anticonvulsants and some psychotropic drugs fall into this category.

For NTI drugs, even minor fluctuations in blood concentration can push a patient out of their optimal therapeutic window, leading to either a loss of efficacy (like a return of seizures or panic attacks) or the emergence of new side effects.⁵¹

While lorazepam is not formally designated as an NTI drug by all authorities, its powerful effects on the central nervous system mean that many patients are highly sensitive to changes in dosage and blood levels.

The Human Factor: Beyond the Pill

Finally, the psychological component cannot be dismissed, but it must be placed in its proper context.

A change in a pill’s appearance—its color, shape, or size—can create anxiety and a negative expectation, a phenomenon known as the nocebo effect.³

This anxiety can, in itself, manifest as real physical symptoms, especially in a patient being treated for an anxiety disorder.

However, the crucial point is that this psychological factor exists

alongside, and does not invalidate, the potential for real pharmacokinetic differences.

To tell a patient it’s “all in your head” is to dismiss the complex interplay between the mind and the body, and to ignore the subtle but real science of drug formulation.⁴

The patient’s experience is the ultimate data point, and it often reflects a combination of these physiological and psychological factors.

Part V: A Patient’s Guide to Navigating the System

My investigation into the paradox of the generic switch led me to a new paradigm.

The ultimate goal of therapy, especially for chronic conditions managed with psychotropic medication, is not just to find an effective drug, but to achieve and maintain stability.

The real answer to the mystery is that consistency is paramount.

Unplanned, frequent, and unmonitored switches between different manufacturers—be it from brand to generic, or from one generic to another—introduce a needless variable into a patient’s treatment, one that can disrupt a hard-won equilibrium.

Empowerment Through Knowledge: Your Practical Toolkit

This new understanding is not just theoretical; it translates into a practical toolkit that can empower patients and caregivers to become active partners in managing their treatment and advocating for their own therapeutic stability.

1. Become the Expert on Your Medication: Your medication has more than one name. It has the active ingredient (lorazepam), the brand name (e.g., Ativan), the dose, and, crucially, the manufacturer. When you pick up a refill, look at the label on the bottle. It will list the generic manufacturer (e.g., Teva, Mylan/Viatris, Sandoz, etc.). Keep a simple log of which manufacturer’s version you are taking. If you notice a change in how you feel, check to see if the manufacturer changed with your last refill.⁵²
2. Communicate with Precision: If you experience a problem after a switch, communicate it to your doctor and pharmacist with data. Instead of saying, “This generic isn’t working,” provide a more precise report: “For the past six months, I was stable and doing well on the lorazepam made by Manufacturer A. My pharmacy just switched me to the version from Manufacturer B, and in the last two weeks, I have experienced a return of my panic attacks and insomnia.” This transforms a vague complaint into actionable clinical information.³
3. Understand “Dispense as Written” (DAW): Most prescriptions have a box or line for the prescriber to indicate “Dispense as Written” (DAW) or “No Substitution.” This instructs the pharmacist not to substitute a generic if the brand is prescribed, or not to substitute a different generic if a specific one is requested. If you and your doctor find that a particular version of lorazepam (either the brand or a specific generic) keeps you most stable, discuss whether using this option is appropriate for you. Be aware that this may result in a higher co-pay, but for some, the cost is worth the stability.⁴
4. Partner with Your Pharmacist: Your pharmacist is a vital and often underutilized resource. They are typically unaware that a patient is sensitive to manufacturer changes unless it is reported. Have a conversation with them. Explain that you have found you do best on a consistent formulation and ask if they can make a note in your file to try and consistently order the same generic manufacturer for you. While supply chains can make this difficult, many pharmacies will make the effort for a patient who communicates the need clearly.³
5. Advocate, Don’t Assume: If you experience a clinical setback after a switch, do not suffer in silence assuming nothing can be done. Report it. The issue may be easily resolved by switching back to the previous version that worked for you. This is not about an emotional attachment to a brand name; it is about finding the specific, complete formulation—the active ingredient plus the unique blend of excipients—that works best with your individual physiology.⁴

Conclusion: My New Answer

If I could go back in time and speak to that patient who relapsed, my conversation would be entirely different.

I would not offer hollow reassurances based on population-level data.

Instead, I would start by validating his experience.

I would say, “I believe you.

While the active drug is the same, different generic versions are made with different inactive ingredients, and it’s possible this new formulation isn’t being absorbed by your body in the exact same Way. Let’s work together to figure this O.T.”

We would check the manufacturer on his new bottle and compare it to the old one.

We would call the pharmacy.

We would discuss the possibility of requesting the specific version that had kept him stable.

The conversation would shift from one of dismissal to one of partnership and investigation.

The system of generic medicine is a public health triumph, saving patients and healthcare systems billions of dollars and dramatically increasing access to life-saving treatments.¹

It is safe, effective, and built on a foundation of rigorous science.

But for the individual patient, optimal care requires a layer of vigilance on top of that foundation.

It requires acknowledging that “bioequivalent” does not always mean “bio-identical” in its clinical effect for every single person.

It requires communication, partnership, and above all, a commitment to the principle that for those navigating the complexities of mental health, therapeutic consistency is not a luxury, but a necessity.

Works cited

1. A primer on generic drugs and bioequivalence – FDA, accessed on August 10, 2025, https://www.fda.gov/files/about%20fda/published/Generic-Drugs-and-Bioequivalence—Presentation.pdf
2. fact sheet choosing generic medicines | gbma, accessed on August 10, 2025, https://www.gbma.com.au/wp-content/uploads/2014/03/choosing.generic.-medicines.pdf
3. Changing to a Generic Drug – BPJ SE March 2007 – bpac NZ, accessed on August 10, 2025, https://bpac.org.nz/bpj/2007/march/changing.aspx
4. Name Brand vs. Generic – Anne Fenton, MD, accessed on August 10, 2025, https://commonsensemedical.com/forum/?p=112
5. Antidepressants: Brand Name or Generic? – Psychiatric Times, accessed on August 10, 2025, https://www.psychiatrictimes.com/view/antidepressants-brand-name-or-generic
6. Using Generic Antidepressants vs. Brand Name – WebMD, accessed on August 10, 2025, https://www.webmd.com/depression/features/generic-antidepressants-what-you-need-to-know_
7. About lorazepam – NHS, accessed on August 10, 2025, https://www.nhs.uk/medicines/lorazepam/about-lorazepam/
8. Lorazepam (oral route) – Side effects & dosage – Mayo Clinic, accessed on August 10, 2025, https://www.mayoclinic.org/drugs-supplements/lorazepam-oral-route/description/drg-20072296
9. Lorazepam (injection route) – Side effects & uses – Mayo Clinic, accessed on August 10, 2025, https://www.mayoclinic.org/drugs-supplements/lorazepam-injection-route/description/drg-20072326
10. Lorazepam – StatPearls – NCBI Bookshelf, accessed on August 10, 2025, https://www.ncbi.nlm.nih.gov/books/NBK532890/
11. Common questions about lorazepam – NHS, accessed on August 10, 2025, https://www.nhs.uk/medicines/lorazepam/common-questions-about-lorazepam/
12. Ativan Label – accessdata.fda.gov, accessed on August 10, 2025, https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/017794s044lbl.pdf
13. Ativan (lorazepam) Tablets WARNING: RISKS FROM CONCOMITANT USE WITH OP – BauschHealth Prescribing Information, accessed on August 10, 2025, https://pi.bauschhealth.com/globalassets/BHC/PI/Ativan-PI.pdf
14. www.ncbi.nlm.nih.gov, accessed on August 10, 2025, https://www.ncbi.nlm.nih.gov/books/NBK532890/#:~:text=Lorazepam%20is%20a%20benzodiazepine%20medication,and%20treatment%20of%20status%20epilepticus.
15. Lorazepam (Ativan) – Epilepsy Medication, accessed on August 10, 2025, https://www.cureepilepsy.org/understanding-epilepsy/treatments/epilepsy-medications/lorazepam/
16. Ativan (lorazepam): Side effects, dosage, uses, and more – Medical News Today, accessed on August 10, 2025, https://www.medicalnewstoday.com/articles/326015
17. Lorazepam: a medicine to treat anxiety and sleeping problems – NHS, accessed on August 10, 2025, https://www.nhs.uk/medicines/lorazepam/
18. Ativan – NPS MedicineWise, accessed on August 10, 2025, https://www.nps.org.au/medicine-finder/ativan-tablets
19. Benzodiazepines | Healthify, accessed on August 10, 2025, https://healthify.nz/medicines-a-z/b/benzodiazepines
20. Ativan, Loreev XR (lorazepam) dosing, indications, interactions, adverse effects, and more, accessed on August 10, 2025, https://reference.medscape.com/drug/ativan-loreev-xr-lorazepam-342906
21. Lorazepam (Ativan, Loreev XR): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing – WebMD, accessed on August 10, 2025, https://www.webmd.com/drugs/2/drug-8892-5244/lorazepam-oral/lorazepam-oral/details
22. Lorazepam (Ativan) | National Alliance on Mental Illness (NAMI), accessed on August 10, 2025, https://www.nami.org/about-mental-illness/treatments/mental-health-medications/types-of-medication/lorazepam-ativan/
23. Lorazepam – brand name list from Drugs.com, accessed on August 10, 2025, https://www.drugs.com/ingredient/lorazepam.html
24. Lorazepam – tranquilliser – Mind, accessed on August 10, 2025, https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers-a-z/lorazepam/
25. Lorazepam | Benzodiazepine Uses & Side Effects | YoungMinds, accessed on August 10, 2025, https://www.youngminds.org.uk/young-person/medications/lorazepam/
26. Benzodiazepines: About them, health effects, risks and withdrawal – Canada.ca, accessed on August 10, 2025, https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/benzodiazepines.html
27. Generic submissions under review – Canada.ca, accessed on August 10, 2025, https://www.canada.ca/en/health-canada/services/drug-health-product-review-approval/generic-submissions-under-review.html
28. Benzodiazepines, accessed on August 10, 2025, https://nwmphn.org.au/wp-content/uploads/2020/12/WVPHN0017_NEW_A4_opioid_medicines_flyers_v10-BLANK-1.pdf
29. Lorazepam (Mylan) – Healthdirect, accessed on August 10, 2025, https://www.healthdirect.gov.au/medicines/brand/amt,1478971000168101/lorazepam-mylan
30. Lorazepam Viatris – Medsinfo, accessed on August 10, 2025, https://medsinfo.com.au/api/documents/Lorazepam_Viatris_PI?format=pdf
31. ATIVAN – Consumer Medicine Information (CMI) summary – Medsafe, accessed on August 10, 2025, https://www.medsafe.govt.nz/consumers/cmi/a/Ativan.pdf
32. New Zealand Data Sheet – Medsafe, accessed on August 10, 2025, https://www.medsafe.govt.nz/profs/datasheet/a/Ativantab.pdf
33. Pharmac Update – Issuu, accessed on August 10, 2025, https://issuu.com/wboppho/docs/pharmac_update_3a322faa20a84c
34. Lorazepam 1 mg tablets restricted by supply issues – Pharmac, accessed on August 10, 2025, https://www.pharmac.govt.nz/news-and-resources/news/2022-07-15-media-release-lorazepam-1-mg-tablets-restricted-by-supply-issues
35. Frequently asked questions about generic medicines, accessed on August 10, 2025, https://www.nps.org.au/assets/fc20fd821a02cf80-8d2289edb5e3-ef59843b3f060818930abb15d5ff4853aaeed461243034ea30c5d77ac475.pdf
36. Bioequivalence Studies: How to Streamline Generic Drug Approval Process – ValGenesis, accessed on August 10, 2025, https://www.valgenesis.com/blog/bioequivalence-studies-how-to-streamline-generic-drug-approval-process
37. Bioequivalence Studies for Generic Drug Development | FDA, accessed on August 10, 2025, https://www.fda.gov/media/166152/download
38. Understanding Bioequivalence in Generic Drug Approval – Vici Health Sciences, accessed on August 10, 2025, https://vicihealthsciences.com/what-is-bioequivalence/
39. Behind the scenes: The approval process for UK medicines – Releaf, accessed on August 10, 2025, https://releaf.co.uk/blog/the-approval-process-for-uk-medicines
40. MHRA Drug Approval Process – UK Drug Registration & Licensing Guide, accessed on August 10, 2025, https://drugregulatoryaffairs.in/mhra-drug-approval-process/
41. The Drug Review Process | Article – SPharm, accessed on August 10, 2025, https://spharm-inc.com/the-drug-review-process/
42. Regulatory Approval Process for Drugs in Canada- A Challenging Task, accessed on August 10, 2025, https://rjptonline.org/HTML_Papers/Research%20Journal%20of%20Pharmacy%20and%20Technology__PID__2019-12-7-13.html
43. Access to Generic Drugs in Canada, accessed on August 10, 2025, https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/fact-sheets/access-to-generic-drugs.html
44. About generics – Medicines UK, accessed on August 10, 2025, https://www.medicinesuk.com/about-generics.php
45. Prescription medicines: registration of new generic medicines and biosimilar medicines | Therapeutic Goods Administration (TGA), accessed on August 10, 2025, https://www.tga.gov.au/prescription-medicines-registration-new-generic-medicines-and-biosimilar-medicines
46. Inquiry into approval processes for new drugs and novel medical technologies in Australia, accessed on August 10, 2025, https://www.health.gov.au/sites/default/files/2023-11/inquiry-into-approval-processes-for-new-drugs-and-novel-medical-technologies-in-australia.pdf
47. Guideline on the investigation of bioequivalence | Therapeutic Goods Administration (TGA), accessed on August 10, 2025, https://www.tga.gov.au/resources/resource/international-scientific-guidelines/guideline-investigation-bioequivalence
48. Brand vs. Generic Medication – Epilepsy Foundation, accessed on August 10, 2025, https://www.epilepsy.com/connect/forum-archive/medication-issues/brand-vs-generic-medication
49. Full article: Switching medication products during the treatment of psychiatric illness, accessed on August 10, 2025, https://www.tandfonline.com/doi/full/10.1080/13651501.2018.1508724
50. Switching among branded and generic medication products during ongoing treatment of psychiatric illness – BMJ Innovations, accessed on August 10, 2025, https://innovations.bmj.com/content/bmjinnov/6/1/39.full.pdf
51. Switching from Brand-Name to Generic Psychotropic Medications: A Literature Review | Request PDF – ResearchGate, accessed on August 10, 2025, https://www.researchgate.net/publication/49642524_Switching_from_Brand-Name_to_Generic_Psychotropic_Medications_A_Literature_Review
52. Switching among branded and generic medication products during ongoing treatment of psychiatric illness | BMJ Innovations, accessed on August 10, 2025, https://innovations.bmj.com/content/6/1/39
53. Generic formulations of psychotropic medications and treatment response – Journal of Psychiatry and Neuroscience, accessed on August 10, 2025, https://www.jpn.ca/content/jpn/42/2/E3.full.pdf
54. FDA Bolsters Its Generic Approval Process: Health Plans Reap the Benefits – PMC, accessed on August 10, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4106524/