1. Vir Vikram Sharma
M.Pharm. PhD (Pursuing)
Assistant Manager,
In-Charge Pharmacy
DMC&H, Ludhiana, Punjab
E-mail ID - vir_vikram17@yahoo.com
virvikram76@gmail.com
Contact No.- +91-98157-86666

2. DAYANAND MEDICAL COLLEGE AND
HOSPITAL

3. DEFINITION
 Some proprietary (brand name) and non-proprietary
names (generic name) sound or appear to be
similar to other drugs when written or spoken.
 These confusing drug names are one of the main
causes of medication error. There are many sound
and look alike drugs that would result in medication
error. These errors may cause harm or even death
to patients.
 According to the results from United States
Pharmacopoeia, around 1400 commonly used
medications were involved in such errors.

4.  A group of medicines that have similar actions often
have similar sounding brand names. The generic
medicine is one that contains identical amounts of
the same active ingredient, in the same strength
and in the same dosage form.
 When doctor writes a prescription they will
nominate the medicine to be used –usually the
originate brand name for the drug required.
 Certain drugs have names that may appear similar
when carelessly written; liable to confusion.
Problems are likely if the strengths and doses of the
two preparations are similar.

5.  Doubts should be resolved by checking with the
prescriber.
 Most cases, mistakes have occurred, because the
item was dispensed without a second thought. A
large number of them have similar sounding or
similar looking names, which is a reason for major
concern among the prescribing physicians.
 All these factors should clearly be borne in mind by
the drugs controller while a brand name is
approved. Therefore no two drugs should differ by
an alphabet, syllable, suffix or prefix. There should
be absolute clarity and differentiation of any two
drugs whether the name are spoken or written

6. ORIGIN OF THE PROBLEM

7. SOURCE OF ERROR
 The main reasons for improper dispensing of
confusing brand names, may be due to negligence or
due to lack of knowledge of registered pharmacist or
due to less number of pharmacist during rush hours.
When brand names of two or more drugs are similar.
 Faulty dispensing would result from one of the
following situation:
 Illegible handwriting of the prescribing physician (reading &/or
writing error).
 Incorrect dispensing by the pharmacist due to over sight
(similar looking name).
 Incorrect reading of the brands name by the patient while
ordering the medicine by phone, which is a common practice
in some cities in this country (similar sounding name)

8. ERROR PRONE DRUG PAIRS
 Error prone medication pairs that can easily cause confusion while
prescribing, dispensing and administration/consumption were sorted
out. Also real life experiences of medication errors and near misses
due to error prone drug pairs were collected from the doctors and the
dispensers.
 1. LASA drugs-Similar brand names, different generic
composition (Category I)
 2. LASA drugs- Similar brand names, same generic composition
(Category II)
 3. LASA drugs- Similar brand names with additional letter
(Category III)
 4. LASA drugs- Similar brand names of the Antibiotics group
(Category IV)
 5. LASA drugs- Same drug, different Dosage forms
(Category V)
 6. LASA drugs- Same drug, different release characteristics
(Category VI)
 7. LASA drugs- Same brand name, different composition, different
country (Category VII)
 8. LASA drugs- Generic Drug pairs (Category VIII)

9. CONCEPTUAL FRAMEWORK TO REDUCE
ERROR
 Drug product inserted into complex care
environment.
 Drug product interacts with care environment and
care processes in identifiable (often surprising) and
predictable fashion.
 These interactions will be determined by specific
product characteristics and specific care processes
 Errors occur in predictable ways!
 Allows risk assessment
 Allows risk reduction
 Allows error prevention

10. RISK FOR ERROR AND ADE
 Error producing conditions
 Likelihood of error occurring
 Environment and processes of care
 Drug(s) involved
 Patient characteristic(s)
 Nature and type of error

11. ANY OR ALL CHARACTERISTICS OF A DRUG
PRODUCT CAN INCREASE OR DECREASE RISK, AND
MUST BE CONSIDERED IN RISK ASSESSMENT:
 Generic name, brand name
 Dose, strength(s), dose form, packaging
 Route, frequency, instructions
 Storage requirements
 Indications, patient population
 Likely care environment
 Other

12. The medical care “vortex”
Drug product
ERROR

13. IMPLICATIONS FOR RISK REDUCTION AND
SAFETY ENHANCEMENTS
 Predictable nature of errors allows risk assessment
and reduction.
 Predictable nature of errors allows product design
which can enhance safety.
 All drug product characteristics must be considered
in risk assessment and prevention.
 Care environment and processes must be
considered in risk assessment and prevention.

14.  Drug names, labels and packaging are
major contributors to medication errors
 Risk for error is determined by both drug
product characteristics and the care system
processes.
 Risk assessment must include multiple drug
characteristics (not just names)
 Risk of error within care system often readily
apparent
 The predictable nature of errors provides
opportunity for product naming and design
which reduces risk and enhances safety.

15. POSSIBLE SOLUTIONS
1. Identification of LASA medications: Create the
awareness of look-alike and sound-alike medicines in
the prescribers; if possible provide a detailed list of drug
names pairs in the local market
2. Prescriber’s role: Try to use legible handwriting while
prescribing, keeping in mind as if one was writing bank
cheques. Writing trade names (UPPER CASE)
accompanied by generic names, dosage form, strength,
directions and indication for use when possible.
3. Pharmacist’s/dispenser’s role: Provided that there is
dose and other details in the prescriptions he/she
should make use of his/her knowledge to identify the
drug prescribed. In case of uncertainty in medicine
names, they should not hesitate to consult the
prescribing doctor before dispensing

16. 4. Patient’s role: Literate patients can themselves check if
the dispensed product is the same as prescribed. Patients
who cannot read and write should better consult other
sources for verification before taking the medicines.
5. Hospital’s or institution’s role: Provide education on
potential LASA medicines. continuing professional
development for health-care professionals and annually
review the list of LASA medicines used in the institution.
Try and reduce the medical transcription by the nursing
staff and rather initiate dispensing only against a proper
prescription by a licensed doctor. Use of printed order or
electronic prescribing. the less important drug in the LASA
pair can be removed.
6. Manufacturer’s and regulatory agency’s role: The
manufacturers and regulatory agencies both should work
together hand in hand to avoid confusion right at the time
of naming their products.

17. PREDICTABLE PROBLEMS:
 Insulin brand names
•Humulin “Log” ordered instead of Humulin-L (Lente).
•Nurse thought Humalog” was to be given.

18. NAMES AND LABELS:
 NOVOLOG IS “REGULAR” (“R” )INSULIN, RIGHT?

19. DOSAGE FORM NAMES:
 OxyContin and MSContin

20. DOSAGE FORM NAMES:
 Just a matter of time……
XR

21. LEGIBILITY AND DRUG NAMES
Capoten or Cozaar?
Protonix or Protamine?
Unasyn or Vancomycin?

22. TECHNOLOGY-DRUG PRODUCT INTERFACE:
 Levophed for Lopressor

23. WHY DOSE, ROUTE, FREQUENCY AND
INDICATION ARE IMPORTANT:
Tricor for Tracleer
Error detected because dose was
different
Error NOT detected because dose
was the sameProscar in a
female??

24. EXAMPLES
 AMGIT (Metronidazole) ANXIT (Alprazolam)
 ALASPAN (Loratadine) ALSPAN (Hyoscine butyl Br.)
 LEVOZIN (Levocetrizine) LIVOGEN (Iron)
 ENTEXIN (Ofloxacin) INFEXIM (Cefixime)
 TOZAAR (Losartan) TAZAR (Piperacillin+Tazobactam)
 CETIL (Cefuroxime) CETIN (Cetirizine)
 AMTAS-10 (Amlodipine) ASTAT-10 (Atorvastatin)
 FLUNAZ (Fluconazole) FLUNAR (Flunarizine)
 PIOZ (Pioglitasone) PAAZ (Alprazolam)
 DAMOXY (Amoxycillin) DIAMOX (Acetazolamide)
 UMERAN (Diclofenac sodium) UMINORM (Metoclopramide)

25. EXAMPLES
 Epitab Phenytoin 100 mg
 Epitan Phenobarbitone 60 mg
 Ceftab Cefuroxime 250 mg
 Ceftas Cefixime 200 mg
 Wormnil Mebendazole 100 mg
 Wormonil Albendazole 400 mg
 Aquamide Furosemide 50 mg/Spironolactone 20 mg
 Aquazide Hydrochlorothiazide 12.5 mg

26. WHAT IS TALL MAN LETTERING?
• It is an error-prevention strategy used as part of a
multi-faceted approach to reduce the risk of look-
alike and sound-alike medicine name confusion and
errors.
• It is a typographic technique that uses selective
capitalisation to help make similar-looking medicine
names easier to differentiate.
• Its purpose is to help select or supply the right
medicine.

29. HOW DOES IT WORK?
Tall Man lettering combines lower-
and upper-case letters to highlight
the differences between look-alike
and sound-alike medicine names,
like fluOXETine and
fluVOXAMine, making them easier
for the eye to distinguish.

30. WHAT COULD TALL MAN LETTERING BE
USED ON?
• electronic drop-down medicine lists
• automated dispensing cabinet screens
• SMART pumps
• computer-generated pharmacy labels
• medicine shelf labels
• pre-printed order sheets

31. ON THE CLOSING NOTE
 It is very important that we circulate the list of confusing brand
names among the practicing doctors, pharmacists and also to
the drug manufacturers. Preventing confusion between
already marketed products typically involves collecting
voluntary reports of names involved in confusion errors,
posting warnings and alerts both electronically and in areas
where drugs are used.
 The fear of malpractice lawsuits and public embarrassment
has made the physicians and nurses reluctant to report
medication errors. It is more important to create the open
environment that encourages the reporting of errors than to
develop less meaningful comparative error rates.
 One possible approach to improving medical error reporting
involves the use of anonymous standardized reporting
systems. This type of system should also enable internal
tracking, trending and comparative analyses. We need to
have such systems in India.

32. Thank
you