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Confusing Brand Names: Nightmare of Medical Profession

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Confusing Brand Names: Nightmare of Medical Profession Original Article www.jpgmonline.com Confusing brand names: Nightmare of medical profession Rataboli PV, Garg A Department of Pharma- ABSTRACT cology and Therapeutics, Objective: India has more than 20,000 registered pharmaceutical manufacturers. Consequently, there is a Goa Medical College, Bambolim, Goa 403202, flood of brand names to choose from. We conducted this study to analyse and sort out the multitudinous India brand names thronging the Indian market, and identified those that could create a possible confusion. Materials and Methods: Recent issues of drug formularies like Indian Drug Review, Drug Index, and Monthly Correspondence: Index of Medical Specialities-India were checked and all the brand names given were included. Some other Amit Garg, MD brand names that are available with the pharmacists but are not included in these indexes were also included E-mail: [email protected] in the study for analysis. Observations: Potentially confusing brand names were sorted out and categorised according to the severity of damage they can cause if misinterpreted by the pharmacist or the patient. Subgroups were made according to the brand name, the generic name, and the manufacturers of the drug. Conclusion: Several brand names are strikingly identical, similar looking (orthographic), or similar sounding (phonological). Preventing this possible confusion is not the work of any one person involved. We describe the Received : 09-08-04 role of prescribing doctors, dispensing pharmacists, consumer patients, and the manufacturing companies to Review completed : 30-09-04 prevent “wrong prescribing” due to similarities in brand names. Accepted : 22-12-04 PubMed ID : 15793332 J Postgrad Med 2005;51:13-6 KEY WORDS: Identical; look-alike; sound-alike; confusing; brand names rescribing drugs with their brand name is an essential the patients, doctors, pharmacists, and the drug manufacturers were P part of medical practice. The recent issues of the In assessed. dian Drug Review (IDR) lists more than 8000 brand names of drugs.[1] Many additional brand names not listed by drug for- Observations mularies like IDR, Monthly Index of Medical Specialities Confusing brand names according to the category are listed in Ta- (MIMS)-India, or Drug Index are also available. This plethora bles 1-12. The confusing brand names were broadly divided into three groups: identical, orthographic, and phonological. These of branded formulations has the potential for creating confu- groups were then reclassified into twelve categories based on the sion amongs the practising doctors, pharmacists and patients. nature of the drug group, dosage forms, and the drug manufactur- Many brand names have been confused due to illegible hand- ing companies. writing, poor pronunciation and other factors. Numerous case reports and studies have thrown light on the confusion over Discussion similar drug names.[2-9] Considering this confusion, we under- took a study to categorise the available confusing brand names in the Indian market with an aim to inform the medical pro- The twelve categories of confusing brand names listed above fession. present a bird’s eye view of the difficulties posed by the pre- scribers and dispensers due to exactly identical, look-alike and Materials and Methods sound-alike names. Needless to say, the names mentioned above are just the ‘tip of the iceberg’ and there could be many Recent issues of commonly used drug formularies i.e. Indian Drug more confusing brand names available in the Indian and the Review (IDR) (May-June, 2004) and Monthly Index of Medical Spe- world drug market. cialities (MIMS)- India (June 2004) were referred to and the brand names included in them were analysed. Some other brand names Categories I, II, IV, VII, VIII, and XII pose a very high danger available with the pharmacists but not included in these two formu- to the prescribing doctors, pharmacists, and patients. A slight laries were also checked. Same name (identical), similar-looking (or- thographic), and similar-sounding (phonological) names that could deviation of legibility on the part of the prescribing doctor or cause confusion among the prescribing doctors and dispensing phar- lack of observation and careless attitude of the dispensing phar- macists were sorted out.[10] They were then divided into twelve cat- macists can cause serious damage or injury to the patient. Dis- egories and the risk-benefits of wrong prescribing and dispensing to pensing Celin (vitamin C) instead of Celib (celecoxib) to a J Postgrad Med March 2005 Vol 51 Issue 1 13 Rataboli et al: Confusing brand names Table 1: Look-alike brand names, different generic names, Table 4: Sound-alike brand names, different generic names, different manufacturer (Category I) different manufacturers (Category IV) Brand names Generic names Manufacturer Brand names Generic names Manufacturer Tibitol Ethambutol PCI Abzole Albendazole Euphoric Pharm Pvt. Ltd. Tobitil Tenoxicam Ranbaxy Lab Ltd. Abzorb Clotrimazole Crosslands Research Labs. Trip Nortriptyline Pfizer Ltd. Edegra Sildenafil Sun Pharm India Ltd. Triz Cetrizine Indoco Remedies Ltd. Allegra Fexofenadine Hoechst Marion Roussel Pronim Nimesulide Unichem Lab Ltd. Hemsi Ferrous fumarate Serum International Pronil Fluoxetine PIL Pharmacia India Ltd. Hemsyl Ethamsylate Indoco Remedies Farizym Enzymes Infar Maladine Mepacrine Unicure Remedies Pvt Ltd. Fasigyn Tinidazole Pfizer Ltd. Mala-D OCP - Celib Celecoxib Unichem Lab Ltd. Allerzine Cetirizine Jenburkt Pharm Ltd. Celin Vitamin C Glaxo Smithkline Alergin Ephedrine + Theophylline Cipla Ltd. Dan Diclofenac Unison Pharm. Xental 400 Pentoxiphylline Targof Pure Drugs Ltd. Dax Cefadroxil DWD Pharm. Zentel 400 Albendazole Glaxo Smithkline Eltocin Erythromycin IPCA Lab Ltd. Lyser-D Diclofenac + Comed Chem Pvt. Ltd. Eltroxin Thyroxine Glaxo Smithkline Serratiopeptidase Glyred Gliclazide Novartis Nizer-D Nimesulide + U.S.V. Ltd. Glyrep Metformin Emcure Pharm Ltd. Pseudoephedrine Azoo Azithromycin Group Pharmaceuticals Oceph Cefixime Emcure Pharm Ltd. Azox Alprazolam Aarpik Remedies Ocef Cephalexin Osper Acein Enalapril Targof Pure Drugs Ltd. Enzide Enalapril Cadila Pharm Ltd. Acem Clarithromycin Emcure Pharm Ltd. N-Side Nimesulide Citadel Five Pvt Ltd. Normace Enalapril Unisearch Normax Norfloxacin IPCA Table 2: Look-alike brand names, different generic names, same manufacturer (Category II) Table 5: Look-alike or sound-alike brand names, different Brand names Generic names Manufacturer generic names, different manufacturers, different dosage forms PD-Mox Amoxycillin Parenteral (Category V) PD-Rox Roxithromycin Parenteral Brand names Generic names Manufacturer Clomine Clomipramine PIL Clozine Chlorpromazine PIL Betanate (ointment) Clobetasol Cosme Healthcare Bioclox Clarithromycin Biochem Betanase (tablet) Glibenclamide Zydus Medica Biodoxi Doxycycline Biochem Piplar (drops) Pipenzolate Lark Lab. Ltd. Zyrof Rofecoxib Zydus Ciplar (tablet) Propranolol Cipla Ltd. Zyrop Erythropoietin Zydus Adiflox (ointment) Ciprofloxacin Intas Pharm Pvt. Ltd. Adilox (capsule) Ampicillin + Cloxacillin Albert David Ltd. Table 3: Look-alike brand names, same generic name, different manufacturers (Category III) Table 6: Identical brand names, one with an additional letter different generic names, same manufacturer, different dosage Brand names Generic names Manufacturer forms (Category VI) Ceftrion Ceftriaxone Claris Life Brand names Generic names Manufacturer Ceftron Ceftriaxone Inga Lab. Pvt. Ltd. Ena Enalapril Menarini Raunak Ph. Ltd. Vorth (tablet) Valdecoxib Gracewell Enam Enalapril Dr.Reddy’s Lab Ltd. Vorth-P (injection) Parecoxib Gracewell Diclofen Diclofenac Biochem Taxim (injection) Cefotaxime Alkem Lab Ltd. Diklofen Diclofenac Stadmed Pvt. Ltd. Taxim-O (tablet) Cefixime Alkem Lab Ltd. Taxim-O Cefixime Alkem Lab Ltd. Axim-O Cefixime Kee Pharm Ltd. Table 7: Identical brand names, one with additional letter Oflex Ofloxacin Finecure different generic names, same manufacturer, same dosage form Oflox Ofloxacin Protec (Category VII) Aflox Ofloxacin Anikem Lab Brand names Generic names Manufacturer patient with arthritis or taking Tobitil (tenoxicam) in place of Acnesol (gel) Erythromycin Systopic Lab Ltd. Tibitol (ethambutol) can not only cause failure of treatment Acnesol-CL (gel) Clarithromycin Systopic Lab Ltd. but can cause aggravation of disease and often serious toxicity. though the names are look-alike or sound-alike, there is less Although Category III listed above appears harmless to the likelihood of ‘prescription-dispensing error’ as the drug dos- consuming patients, it is of definite concern to the practition- age forms of the two preparations are different. ers and manufacturers. A new manufacturing company often competes with a reputed brand by giving a similar name to its Category IX will do no harm if the names are interchanged in drug. Categories V, X, and XI are interesting but harmless. Al- topical preparations like Acnesol (erythromycin) and Acnesol- 14 J Postgrad Med March 2005 Vol 51 Issue 1 Rataboli et al: Confusing brand names Table 8: Identical brand names, one with an additional letter, reports to USP’s MER Program.[11] different generic names, different manufacturers (Category VIII) Practitioners and pharmacists often report confusion between Brand names Generic names Manufacturer look-alike and sound-alike brand names, between similar ge- Clomin Dicyclomine + Paracetamol Core Health Care neric names, and between similar brand and generic names. Clomine Clomipramine PIL To add to this, doctors’ illegible
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