Relationship status: “It’s Complicated.”

Facebook and the pharmaceutical industry have had an uneasy partnership in recent years. Many drug companies didn’t join the site until Facebook gave them a privilege that others do not have — blocking the public’s ability to openly comment on a page Wall.

But that’s about to change.

In a reversal by Facebook, most drug company pages will have to have open Walls starting Monday.

Companies are worried that open Walls mean risks, and many are reconsidering their engagement on Facebook. On Friday, AstraZeneca, which sells the antidepressant Seroquel, shut down a page devoted to depression. Johnson & Johnson said it will close four of its pages Monday. Other companies said they will monitor their pages more closely once the changes take effect.

The industry is concerned that users might write about bad side effects, promote off-label use or make inappropriate statements about a product, and that the comments could raise concerns from government regulators.

Facebook would not say what specifically prompted its change of heart. Andrew Noyes, manager of public policy communications for Facebook, said in an e-mail, “We think these changes will help encourage an authentic dialogue on pages.”

Facebook will allow companies to continue to block Wall comments on specific prescription product pages, but those are a minority of pharmaceutical company pages. Most of the open pages would be focused on companies themselves or on disease or patient-specific communities, which then have ties to the companies’ prescription products.

AstraZeneca’s “Take on Depression” page, which closed Friday, had more than 1,100 “likes” — people following the page and its updates.

“We’re very strongly committed to social media, but we have to make sure that the amount of time and resources spent on [monitoring it for problems] is appropriate,” said Tony Jewell, an AstraZeneca spokesman.

Johnson & Johnson will shut down two pages focused on attention deficit hyperactivity disorder — ADHD Allies and ADHD Moms — along with pages focused on rheumatoid arthritis and psoriasis. Combined, the four pages have more than 40,000 likes. Johnson & Johnson sells the ADHD drug Concerta, psoriasis drug Stelara and arthritis drugs Simponi and Remicade.

‘Difficult environment’

“The regulatory environment and changes in Facebook functionality are creating a much more difficult environment for managing these kinds of pages,” said Bill Price, a Johnson & Johnson spokesman.

Facebook has become an increasingly popular destination for patient communities, with many shifting over the past couple years from message boards and other Web sites to pages hosted by companies, according to Lisa Gualtieri, an assistant professor at the Tufts School of Medicine who studies social media and health.

Many companies hadn’t joined Facebook until the past year and a half, according to Steve Woodruff, a social-media consultant. “Pharmaceutical companies have been at the shallow end of the social-media pool,” Woodruff said, “because it’s such a highly regulated and conservative industry.”

Jonathan Richman, a group director for the marketing agency Possible Worldwide, said that companies are exaggerating the risks of an open Wall, and he is trying to persuade them to stay online. “Some companies are paralyzed by the idea of what could happen,” said Richman, who has consulted for AstraZeneca, Johnson & Johnson and GlaxoSmithKline, among others.

The industry “nightmare” is processing adverse event reports (AERs), said Joe Farris, co-founder of the Digital Health Coalition, a nonprofit group focused on online marketing of health-care products. Users might write on a company’s Wall about a specific product causing an unexpected reaction or injury. That information could qualify as an AER, and it must then be filed with the Food and Drug Administration, which uses the reports to monitor product safety.

Richman said that a flood of AERs is unlikely. “It’s not like people are waiting in the wings to submit adverse event reports,” he said, adding that he’s been told by companies of only a few previous instances in which potential AERs were seen in social media. “I don’t think we’re going to see a change in consumer behavior overnight.”

Companies also have ways of circumventing at least some of the problems of an open Wall. Page owners will be able to delete comments once they appear — like any other Facebook user — though that could mean 24-hour monitoring, by the company itself or a third party.

Pfizer, for example, will keep its pages online and “monitor to make sure no inappropriate comments are posted, and manage them if and when they occur,” said Andrew Widger, a company spokesman. Pfizer owns a hemophilia page with more than 2,400 likes and a multiple sclerosis page with more than 1,300. The company makes the hemophilia drugs Xyntha and BeneFIX and the MS drug Rebif.

Keeping pages open

Amgen will maintain its “Breakaway From Cancer” page, said spokeswoman Mary Klem, and the company is in discussions with Facebook about the change. Amgen sells the cancer drugs Neulasta, Neupogen and Vectibix. Novo Nordisk, which runs a hemophilia page and sells the NovoSeven RT treatment, is “unclear as to how the new Facebook policy will affect our current process” for comments, spokesman Ken Inchausti said in an e-mail. Both companies plan to monitor the situation.

Sanofi also has no plans to remove its pages from Facebook, said spokesman Jack Cox. The company runs a diabetes page with more than 1,500 likes and makes the insulin products Apidra and Lantus. According to Dennis Urbaniak, Sanofi’s U.S. vice president for diabetes, Facebook has become more than a marketing and branding tool.

“We’ve been able to get feedback that’s more genuine and relevant,” Urbaniak said. “We see [the page] as a way of getting to know patients better.” To avoid problems, the company avoids discussion of specific products and sets up “clear terms and conditions with the user” on its page, which also features safety information for its diabetes products.

Gary Kibel, a lawyer specializing in social media for regulated industries, said many of the potential problems with Facebook are “unique to pharmaceuticals.” The financial services industry comes closest but faces a less difficult situation. Facebook users might post Wall comments with insider information or promote certain stocks, but handling of those problems was largely addressed by the Financial Industry Regulatory Authority (FINRA), which released guidelines in 2010.

FDA guidelines

The FDA has not yet released guidelines for online engagement. A draft was expected by the end of last year, but was then delayed. The agency has said that it will not be providing platform-specific guidance, such as guidelines for Facebook Walls. Instead, it will provide higher-level principles for online communication.

“Policy and guidance development for promotion of FDA-regulated medical products using the Internet and social media tools are among our highest priorities,” FDA spokeswoman Shelly Burgess wrote in an e-mail. “Despite our limited resources and increasing workload, we remain committed to this area in terms of both time and human resources.”

Burgess was unable to provide a timeframe for the draft guidance, and that uncertainty has left the pharmaceutical industry concerned, said Jeff Francer, assistant general counsel for the lobbying group Pharmaceutical Research and Manufacturers of America (PhRMA).

“Companies always want to follow the law, but it’s up to regulators to ensure the laws are clear,” Francer said, noting how the urgent need for guidance has been highlighted by Facebook’s policy change.