Generic drug names: Fertile groud for errors?

August 8, 2005

Confusion over look-alike drug names continues to worsen as more and more medications reach pharmacy shelves. While much of the attention has focused on brand-name drugs, mix-ups over generic names also result in serious medication errors, posing a threat to patient safety.

"Generic drug names are more similar to one another than brand names," said Bruce Lambert, Ph.D., associate professor of pharmacy administration, University of Illinois at Chicago. "The current system intentionally imposes similarities by using standard stems."

According to research, there are still more reported name-related errors between brand-name drugs than generic names. The United States Pharmacopeia reported that there were 4,530 reports in 2003 of actual and potential medication errors of brand-name drugs through its Medication Errors Reporting (MER) program. In addition, there were 3,519 reports of generic look-alike or sound-alike drug names, up from 2,582 the previous year.

The need for clear, useful drug names is becoming ever more important as more compounds are entering the same drug class. Yet it is widely known that generic drug names are not subject to the scrutiny and rigorous testing that brand drug names undergo.

"While USAN's expert committee undertakes internal analysis prior to assigning or approving generic names, the review is cursory in comparison to the methods used to evaluate brand names," said Michael Cohen, R.Ph., M.S., Sc.D., president and founder of the Institute for Safe Medication Practices.

Lambert commented that "there is nowhere near the amount of time and money spent on generic names that there is on brand names. Because of the involvement of the Food & Drug Administration in reviewing brand names, it appears, at least at the moment, that brand names are going through a more careful screening process than are generic names."

Stephanie Shubat, M.S., USAN's program director, acknowledges that the organization has a growing amount of work for only four full-time staff members and volunteer expert members to manage. This year alone, the council has received 138 submissions for generic name applications. In an average year, USAN receives an average of 100 such applications.

In recent years, USAN has focused attention on pronunciation of names. The growing use of audio prescription orders has led them to standardize pronunciation with help from USP.

Recent mix-ups ISMP recently received two reports from pharmacists about new generic-name mix-ups to be aware of: flavoxate (Urispas) and fluvoxamine (Luvox). A prescription was written for Urispas 100 mg, but the pharmacy technician was not familiar with the generic name and the computer system did not provide the information. Even after looking up the drug names, the technician still accidentally chose fluvoxamine. The patient received the wrong product and became dizzy and disoriented and was taken to the emergency department, where the blooper was discovered.

A hospital pharmacist separately reported a similar mix-up when fluvoxamine 100 mg, instead of flavoxate 100 mg, was stocked in the automated dispensing cabinet. To address the problem, the hospital is using tall-man lettering such as fluvoxAMINE and flavoxATE to distinguish the two names.

Separate cases were reported of mix-ups involving fluoxetine (Prozac, Sarafem) and duloxetine (Cymbalta). Both antidepressant drugs are manufactured by Eli Lilly, come in 20-mg capsules, and have overlapping dose ranges.