Brand Name Confusion

Use of brand names to identify medications can be confusing for healthcare professionals, much less patients!  When I think about the two name naming system in the U.S., it really doesn’t enhance patient care and leads to confusion.  Although the following case doesn’t involve look alike/sound alike, this gives me an opportunity to point out this nice reference of Confused Drug Names from ISMP – A 79 year old  nursing home resident was struggling with significant COPD and was currently taking Advair 50/250 twice daily, along with scheduled Duonebs 3 times daily and as needed.  Remember that Advair (fluticasone and salmeterol) is a combination inhaled corticosteroid and long acting beta-agonist.  When I came across this case, I read the recent progress note from the physician about the resident’s struggles and the physician felt that a long acting anticholinergic would be beneficial (Spiriva – tiotropium was specifically mentioned).

In looking over this resident’s medication list, he was continued on the Advair, but there was an order for Dulera (mometasone and formoterol).  You could imagine my confusion.  This was clearly a case of brand name mix-up as obviously Dulera and Advair work via the exact same mechanism or action.  Unfortunately, no one questioned this order, and the patient ended up paying for both for a significant period of time.  Brand name medication confusion is something that happens and we need to be aware of it, if something doesn’t seem right, step up and ask questions!

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5 Comments

  1. Tom Simpson, PharmD, MBA, CGP, FCSHP

    Even more important than the cost of the duplicative therapy are the potential AEs that could easily occur, both due to that duplicative therapy, as well as due to the patient not getting the intended drug, Spiriva .

    Reply
  2. Johanna Kristin Ellerup

    This is yet another site of clinical pharmacist intervention of the highest importance. Every part of the prescription process needs check posts and since only the pharmacist is the pharmacologist, our input is invaluable.
    Once during a discussion with the healthcare team, the subject of a patients recurrent seizures came up. Upon checking the list in front of me, I noticed that the patient was on 2 anti-epileptics and mentioned this as a possible cause. I was told that the 2nd agent was on board for behavioral modification NOT seizure control. Really?
    Being able to review and discuss the kinetics and personalized dynamics of the medication, especially in lieu of the current advancements, is a greater importance now than ever. We have never had the sheer quantity of medication available, the ease of availability (insurance to pay, pharmacies everywhere, etc), the medical advancements (genomic testing, research & development, etc), ease of distribution, etc that makes this time-period specifically important for clinical pharmacists as active members of the healthcare team.

    Reply
    • chri1599

      Very well put…thank you

      Reply
  3. Greg

    Actually, I would prefer to see all meds prescribed by the brand name only, ensuring the pharmacist chooses the correct generic substitution (as well as make sure the prescriber knows exactly what she/he is prescribing). Brand names often desribe a very specific doseage form. Think about the various forms of verapamil, diltiazem, fenofibrate, carbamazepine or methylphenidate(to name a few). Look at the levothyroxine equivalency chart in the orange book.

    Reply
    • chri1599

      Very good point… – Brand certainly easier to say and remember in most cases as well

      Reply

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Written By Eric Christianson

September 10, 2014

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