Check your pills before leaving the pharmacy


ZTALMY, Quviviq and Pyrukynd. They may seem like exotic vacation destinations, or even the result of a bad typo, but they’re actually three of the world’s latest officially approved names for new pharmaceutical drugs (and are being launched to treat seizures, insomnia and anemia, respectively).

But why do so many of our drugs have strange names that are often difficult to read, pronounce and remember? In addition to the above, there are, for example, the anticancer drug talimogene laherparepvec and the blood thinner idarucizumab.

The basic answer is that they are all the product of an international system led by the United States, covering both their generic name (which describes the chemical action of the drug) and their brand name, which aims to create a scientific order among the more than 30,000 drugs currently available. and prevent dubious brand name subliminal advertising (more on that later).

More importantly, this system aims to ensure that medicines are prescribed safely by preventing completely different medicines with similar names from being confused with each other.

However, with hundreds of new names being created every year, such confusion always happens – and it can be fatal.

In 2016, for example, a Co Antrim pharmacist was convicted over a dispensing error that killed 67-year-old grandmother Ethna Walsh in 2014.

She was to receive steroids to relieve a serious lung condition, chronic obstructive pulmonary disease (COPD), which causes breathing difficulties.

The pharmacist, Martin White, should have given him the anti-inflammatory steroid prednisolone, but mistakenly provided propranolol, a beta-blocker that slows the heart.

Later that day Mrs Walsh took the pills she had been given and fell ill within minutes and died.

In what is believed to have been the first such case in Northern Ireland, White was sentenced to four months in prison, suspended for two years. He told the court that the drugs were side by side on a shelf and the names looked confusingly similar.

The drug names prednisolone and propranolol are notoriously prone to be confused. The sentencing judge said Ms Walsh’s death was caused by “a single momentary lack of concentration”.

In 2018, the UK medicines safety regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), published a bulletin for prescribers and dispensers warning of drug names that were highly susceptible to be confused with each other.

In addition to prednisolone and propranolol, these included: atenolol and amlodipine; clobazam and clonazepam; risperidone and ropinirole; sulfadiazine and sulfasalazine and amlodipine and nimodipine.

The potential risks become apparent when you consider, for example, that risperidone is an antipsychotic used to treat schizophrenia and bipolar disorder, while ropinirole is used for Parkinson’s disease and restless legs syndrome.

Pharmacists call these potentially dangerous name pairings “look-alikes, sounds.”

For years it has been known that such pairings – and the distribution errors they can cause – pose a serious risk, but their names remain unchanged.

In fact, more than 237 million medication errors are made every year in the NHS in England alone, contributing to more than 1,700 deaths a year, according to research from the University of Manchester in the journal BMJ Quality & Safety in 2020.

Confusion of drug names is a leading cause of these errors, suggested US research in the journal Social Science & Medicine in 2001. It found that one in four medication errors voluntarily reported in the United States Unis involved drug name confusion. If this were extrapolated to the UK, drug name mix-ups would total 59 million a year.

In the UK, criminal court reports of drug mix-up errors made by street pharmacies ceased in 2018 as a change in the law effectively decriminalised such errors.

Steve Brine, then Pharmacy Minister, told parliament the change “will improve incident reporting, increase transparency…and ultimately it will improve patient care and reduce the risk of harm”.

Medication mix-up errors are now supposed to be reported to the MHRA through its yellow card system. However, such reports since 2018 seem alarming.

An MHRA spokesman said since the rule change it has only received four yellow card reports which specifically mention a medication error due to similar product names.

Confounding drugs reported were: apomorphine, a drug for Parkinson’s disease, and morphine, a pain reliever; colchicine, a gout painkiller, and cyclizine, an anti-illness treatment; the sedatives loprazolam and lorazepam; and the different insulin formulations, Humalog, Humalog Mix 25 and Humalog Mix 50.

Yet, although the number of officially reported accidents is very low, problems clearly continue to occur in the community.

Last year, for example, a Kent coroner’s court heard how 82-year-old Rachel Sands died at Medway Maritime Hospital in Gillingham a month after a chemist mistakenly gave her the antidepressant fluoxetine in November 2020, instead of furosemide, which had been prescribed for water retention.

His son, Rocky Troiani, explained how he discovered the error after returning from a four-day holiday on November 18.

“She was very confused,” he said. “She couldn’t communicate. She was shaking. She wasn’t the woman I left before I left.”

While the coroner’s inquest concluded that the drug mix was unlikely to have caused Rachel Sands’ death, her son said more needed to be done to avoid mistakes, especially with drugs that could be fatal if taken incorrectly.

Meanwhile, if generic drug names weren’t confusing enough, our drugs are also given a brand name.

A drug’s official generic name is assigned by the US Adopted Names Council and is based on its medical action. For example, a “caine” suffix, as in lidocaine, indicates a local anesthetic, while drugs ending in “mab” are targeted cancer therapies called monoclonal antibodies that recognize and attack specific proteins on cancer cells.

However, the brand name is developed by a pharmaceutical company to describe its version of a generic drug (these are the names such as Ztalmy, Quviviq and Pyrukynd).

Pharmaceutical companies create brand names to give their medicine an easily remembered identity – just like the rest of the marketing world.

To come up with these names, pharmaceutical companies employ brainstorming teams of consultants that include copywriters, linguists, “verbal identity specialists” and even poets.

Brand name approval comes to the United States via the Food and Drug Administration; in the European Union it will come via the European Medicines Agency and in Britain, now, from the MHRA.

About a third of names submitted by companies are rejected by regulators, according to Mike Pile, creative director of Uppercase Branding, a “verbal identity consultancy.” He says the names are generally rejected because they appear to be aimed at convincing patients of the effectiveness of their products.

So the authorities wouldn’t allow, as a hypothetical example, an asthma drug to be called ‘Breevbetta’.

Nevertheless, the evocative names pass clearly. The most famous, the erectile dysfunction drug Viagra, which sounds powerful, is a mixture of “vitality”, “dynamism” and “vigor” according to the brand’s commentators.

Meanwhile, Ambien, which is for insomnia, is a mix of ‘AM’ – morning – and ‘good’ – good.

Regarding drug name similarities, Ali Hansford, Head of Regulatory Strategy Policy at the Association of the British Pharmaceutical Industry (ABPI), said: “If concerns are raised about the name of a confusing drug, companies are working with regulators such as the MHRA to make the necessary changes.”

However, it is rare for perilous brand names to be changed once they have been launched at great expense in the global market. The few that were changed included, for example, the heartburn drug Losec, which was changed in 1990, by order of US authorities, to Prilosec because it looked too much like the diuretic drug Lasix.

And in 2016, the antidepressant Brintellix was renamed Trintellix, to reduce the risk of confusion with Brilinta, a blood thinner. In the UK, other ways to reduce the incidence of drug name confusion are being explored.

Last year, Victoria Steele, a pharmacist at LloydsPharmacy, reported that her distributors had reduced the number of errors where the drugs amlodipine and amitriptyline are confused by three quarters. While amlodipine is used to treat high blood pressure and coronary heart disease, amitriptyline is an antidepressant also used to reduce nerve pain.

She told a Community Pharmacy Patient Safety Group conference that confusion between amlodipine and amitriptyline during dispensing had previously accounted for half of Lloyd’s drug name confusion errors. She said steps taken to address the issue included moving amitriptyline to the area of ​​dispensaries whose drug names begin with “Y” and stamping drug boxes with a warning about name confusion.

Moreover, a very simple solution was proposed by a Scottish expert. Glasgow-based ophthalmologist Dr Magdalena Edington has warned in the journal BMJ Case Reports that a woman suffered chemical injuries and had to go to A&E after she was mistakenly prescribed erectile dysfunction cream for a eye dryness.

The woman received a handwritten prescription for Vita-pos, a liquid paraffin lubrication to treat severe dry eyes and corneal erosions.

However, her doctor’s handwriting was misread by a pharmacist, who mistakenly gave her Vitaros erection cream and the patient subsequently suffered from eye pain, blurred vision and inflammation. . As a result, she had to be treated at A&E with antibiotics and steroids.

Dr Edington insisted that prescribers “in future ensure that handwritten prescriptions are printed in block capitals to avoid similar scenarios”.

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