Why Drug Names Matter

Gabby
By GabbyPA Latest Reply 2013-01-01 10:38:26 -0600
Started 2013-01-01 10:38:26 -0600

By diaTribe.com
http://diatribe.us/issues/50/learning-curve

This is another huge article that is interesting to read. I had never considered a lot of the reasons names are given and changed along the way.

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By Alasdair Wilkins

On June 27, the FDA made its final decision on whether to approve Arena’s weight management drug “Lorqess;” later that day, it announced the approval of the drug, but with a new name: “Belviq.” Less than a month later, the FDA again had to decide whether to approve another weight management medication, this time Vivus’ Qnexa. Once again, the drug was approved, but under the new name Qsymia. The drugs had not been altered in any other way, and yet the FDA was only willing to give its stamp of approval to “Belviq” and “Qsymia,” not “Lorqess” and “Qnexa.” This begs the obvious question – “Why do some drug names prove acceptable, while others do not?” It’s a query that cuts to crucial issues about the relationship between patients, drug companies, and regulatory agencies. Indeed, while drug names might seem trivial, the core issue that concerns the FDA is one of safety. Companies fundamentally choose drug names for marketing and informational purposes, though the names that get approved by the FDA are those that are least likely to place patients in danger.

At first glance, that might seem extreme. After all, how much damage can a drug’s name really do? Well, when it’s the wrong drug name, the risk is substantial. The FDA’s Center for Drug Evaluation and Research (CDER) received 126,000 instances of medication errors between 2000 and 2009, many of which can be directly attributed to confusion between pairs of drug names that either sound or look alike. There are a number of reasons why such mistakes can creep into the process of prescribing medication. Let’s analyze just how drugs get their names, why errors occur, and what you need to know to ensure you get the right medication the next time you visit the pharmacy.
A Matter of Safety

First, prescriptions are often still handwritten as opposed to typed out, and some healthcare professionals don't always or ever take care to write neatly. Pharmacists might then have trouble deciphering the precise prescription, and even if the doctor or nurse's handwriting is legible, it’s still possible to mix up any two of the hundreds of FDA-approved drugs. And once a mistake has been made, a patient might not catch it straight away. For someone newly diagnosed with type 2 diabetes, it might not be immediately obvious that Amaryl is a trade name for the sulfonylurea glimepiride, a treatment for type 2 diabetes often used early in disease management (albeit one now used much less often in the United States), whereas Janssen’s Reminyl is used to treat dementia associated with Alzheimer’s disease. Indeed, according to Janssen subsidiary Ortho-McNeil, two deaths were reported in the early 2000s in cases where Amaryl was accidentally given to Alzheimer’s patients, which led to severe hypoglycemia. This prompted the FDA to take the highly unusual step of changing a drug’s name long after its approval.. Reminyl is now called Razadyne.

The Institute for Safe Medication Practices (ISMP) maintains an ongoing List of Confused Drug Names, which records hundreds of pairs of lookalike and soundalike drug names that have led to real, reported mix-ups. For instance, Merck’s DPP-4 inhibitor Januvia, designed for type 2 diabetes, appears three times on the ISMP’s list. One source of confusion is at least a close relative of Januvia – its own combined formulation with metformin, Janumet. This may sound like it wouldn’t hurt many patients who take it by accident (Janumet is just Januvia with the generic metformin added) but some patients cannot take metformin if they have certain medical problems such as kidney disorders, lung disease, or liver disease, all of which increase the risk of lactic acidosisBut Januvia has also reportedly been confused with Duramed Pharmaceuticals’ Enjuvia, which is a synthetic estrogen meant to treat the symptoms of menopause. Januvia has also been mixed up with Upsher-Smith’s Jantoven, a blood thinner also known and sold by its generic name warfarin. Beyond the obviously serious risks of taking Jantoven when one’s diabetes management depends on regular administration of Januvia, there’s another potentially major risk that could be caused by a mix-up – while Januvia is rated as a Category B drug, meaning it’s safe to take while pregnant, Jantoven is a Category X, meaning it should not be taken during pregnancy under any circumstances.

In a 2004 issue of its newsletter Medical Safety Alert, the ISMP published a story that serves as a harrowing example of the dangers of mixing up drug names. The ISMP reports that a person recently diagnosed with type 2 diabetes – and so potentially less likely to recognize a prescription error – was prescribed Takeda’s Actos at 30 mg daily. When the patient went to get the prescription filled, the pharmacist typed “ACTO” into the computer and clicked on the drug name that appeared on the selection screen, assuming it was Actos. However, the dispensed drug was actually Actonel, Warner Chilcott’s osteoporosis medication. It took over two full weeks before the error was noticed, and by that time the patient’s blood glucose levels had skyrocketed to 400 mg/dl. Of course, some people with diabetes do take months or even years to be diagnosed, so high numbers like that are far from uncommon – still, this was extremely unwelcome news for the patient, who likely thought the medication was getting his or her blood glucose under control.

Of course, all of these are instances of similar, confusable drug names that the FDA approved. The fact is that there’s no way to prevent such mix-ups entirely, which is why it’s so important to be vigilant whenever getting your prescriptions filled. Simply double-checking that you can read your physician or nurse’s writing is a great first step, and you can ask them to write down not just the name of the drug, but also its intended purpose – even something as basic as “for diabetes” on the prescription pad can help prevent the most serious mix-ups.

Knowing both the trade name and the generic name of your medication is also really smart – while Januvia, Jantoven, and Enjuvia could all be mixed up, it’s a lot harder to confuse sitagliptin, warfarin, and synthetic conjugated estrogens. If you’re uncertain whether your pharmacist has supplied you with the correct medication, ask him or her what the medication is meant to treat: if they start talking about anticoagulation and osteoporosis, then a mistake has probably been made. You can find a list of some potentially helpful tips and questions to ask here, and if you’re still uncertain you can always research the medication name online to double-check it does what it’s supposed to.

How Drugs Get Their Names (read more) http://diatribe.us/issues/50/learning-curve


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