All in the name of the right drug

MEDICAL MATTERS:Be careful not to end up with wrong medicine

LIKE ANY product, medicines are marketed by manufacturers. As a result, each drug has two names – a generic one describing the chemical structure and a proprietary or brand name invented by the company. And it’s even more complicated when you travel, because trade names differ from country to country. What may sound great in English could be positively risqué in Spanish, Italian or Japanese.

But what’s amusing on an advertising billboard or in a magazine could actually threaten the health of someone seeking to fill a prescription abroad. Foreign drugs may use identical or potentially confusing brand names for products with different active ingredients.

The National Medicines Information Centre warns visitors to France who take the commonly prescribed beta-blocker Inderal in Ireland that they could end up being given Indiaril inadvertently in France. It contains loperamide, a medicine for diarrhoea.

It could all be avoided if everyone used the scientific or generic name of a drug. But in many countries, the majority of prescriptions are written using the drug’s brand name, so it pays to be careful if you’re buying medication abroad.

The US Food and Drug Administration (FDA) has published a list of drug names that could lead to the dispensing of a completely different active ingredient while abroad. It found 18 products that use the same brand name as an FDA-

approved medication but contain a different chemical ingredient.

In 2005, a US citizen who travelled to Serbia ran out of Dilacor XR (generic name: diltiazem extended release), a drug used to treat high blood pressure. A Serbian pharmacist filled the prescription with digoxin 0.25mg because in Serbia, Dilacor, marketed by a local company, is a brand name for digoxin. But digoxin is used to treat heart failure as well as abnormal heart rhythms, and has a narrow therapeutic window. This means the level of the drug in the bloodstream must be kept within a strict band; digoxin requires blood testing for close monitoring in order to avoid serious adverse events. The patient was hospitalised with life-threatening drug toxicity after his return to the US.

Probably of more concern to Irish people visiting the US is the FDA finding that some

105 brand names there look or sound so much like foreign brand names that mistakes could occur. For example, Ambyen is a brand name for amiodarone, used to treat abnormal heart rhythms, in Britain. A supply of Ambyen in place of Ambien (zolpidem tartrate), a sleeping medicine marketed in the US, could have a serious adverse outcome.

Looking through the FDA list for potential pitfalls for Irish people travelling to the US, I came across Carace,a generic name lisinopril. Used to treat high blood pressure here, it could be confused by a pharmacist in the States with Carac, a cancer drug with the generic name fluorouracil. Another cancer drug, doxorubicin, is marketed in the US as Rubex, the name used in Ireland for the more benign ascorbic acid, used to treat vitamin C deficiency.

Throw in some poor medical handwriting and a pharmacist with less than acute vision and the elements are in place for these prescriptions to be wrongly dispensed in the US. Always check your medicines: if it doesn’t look right, ask the pharmacist to double-check.

I have also noticed a trend in the naming by companies of their new contraceptive products. Where once rather gynaecological monikers such as Logynon and Ovranette were the norm for contraceptive pills, there has been a move of late to a “softer” nomenclature by their manufacturers. One of the latest pills to hit the market is called Qlaira, phonetically similar to the name Clara. And Yaz, Yasmin and Yasminelle represent a definite attempt to feminise pill products with the ring of a woman’s name.

Could this be the beginning of a trend? If so, brace yourselves for some macho names for drugs approved for male conditions. Take one Tiger a day for a week? On second thoughts, maybe not.

mhouston@irishtimes.com