Look Alike & Sound Alike Drugs
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- Kristopher Sullivan
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1 Look Alike & Sound Alike Drugs To prevent medication errors involving drugs that may look alike or sound alike, consider the following practices: Medication Ordering Distinguishing Medications By: Medication Administration/Storage: PRINT clearly Purchase DIFFERENT BRAND DOUBLE CHECK against order and MAR before DO NOT ABBREVIATE drug name Store in SEPARATE areas Write both GENERIC and BRAND names DISTINGUISH names HIGH ALERT meds require independent double Write INDICATION for use TALL MAN lettering checks Circle/highlight/underline differences (with warning on shelf, different color bins) POTENTIALLY ERROR-PRONE Acetazolamide (DiaMOX ) Chlorothiazide (DiuRIL ) AmiloRIDE (Midamor ) AmlodiPINE (Norvasc ) Amphotericin B (Fungizone ) Amphotericin B Liposomal (AmBisome, Amphotec ) BuPROPion Sustained Release (Wellbutrin SR, Zyban ) BuPROPion Extended Release (Wellbutrin XL ) BupreNORphine (Subutex ) BupreNORphine/naloxone (Suboxone ) BusPIRone (Buspar ) Medications have the same indication Similarity in generic names, dosage strengths, and dosing may Confusion may occur between conventional and liposomal formulations; products are NOT INTERCHANGEABLE Similarity in generic names may Both BuPROPions come in 150mg tablets but can be dosed either twice daily (SR) or once daily (XL). These medications have different Liposomal formulation requires ID approval Wellbutrin XL is on formulary, Wellbutrin SR is non-formulary Formulary status (buprenorphine; buprenorphine/naloxone are both formulary with restrictions) 1
2 CARBOplatin (Paraplatin ) CISplatin (Platinol ) CarBAMazepine (Tegretol ) OXcarbazepine (Trileptal ) CarVEDilol (Coreg ) CapTOPril (Capoten ) CHLORpromazine (Thorazine ) ProchlorPERazine (Compazine ) ProMETHazine (Phenergan ) EScitalopram (Lexapro ) CITalopram (CELexa ) CloNIDine (Catapres ) CloZAPine (Clozaril, Fazaclo ODT ) ClonazePAM (KlonoPIN ) Divalproex (Depakote, Depakote Sprinkle ) Divalproex Extended Release (Depakote ER ) Valproic Acid/Sodium Valproate (Depakene ) DOPamine (Intropin ) DOBUTamine (Dobutrex ) DOCEtaxel (TaxoTERE ) PACLItaxel (TaxOL ) Similarity in generic names may Doses appropriate for CARBOplatin usually exceed the maximum safe dose of CISplatin Similarity in generic names, indication and dosage strengths may Similar generic names may Similarity in generic names and may Similarity in generic names may Confusion may occur between the regular release and extended release formulations, which may result in under/over-dosing Similarity in names and strengths may lead to errors Tall Man lettering in pumps, with warning on shelf, different color bins Encourage written with both generic and brand names Preprinted order form for initial clozapine Formulary status (CloZAPine ODT is restricted) Pop-up in Siemens Rx system Bar code verification in all MAK units, with warning on, with warning on 2
3 DOXOrubicin (conventional) (Adriamycin ) DOXOrubicin (liposomal) (Doxil, Lipodox 50 ) FluPHENazine (ProLIXIN ) FluPHENazine Decanoate (LONG acting ProLIXIN ) FluOXETine (ProZAC ) GlipiZIDE (Glucotrol ) GlyBURide (Micronase, Diabeta,Glynase ) Haloperidol Decanoate (LONG acting -- Haldol ) Haloperidol Lactate (SHORT acting -- Haldol ) Haemophilus B vaccine(pedvax HIB, ActHIB, Hiberix ) Hepatitis B vaccine (Recombivax HB, Engerix-B ) HydrALAZINE (Apresoline ) HydrOXYzine (Vistaril ) Similarity in names, strengths, and may GlipiZIDE = shorter acting; max dose 40 mg/day GlyBURide = longer acting; max dose 20 mg/day Confusion may occur between the long acting and immediate release injectable formulation which may result in under/over-dosing Similarities in names and reference to Haemophilus B vaccine as HIB and Hepatitis B Vaccine as Hep B may Similarity in generic names and strengths may, with warning on, with warning on, with warning on Pop-up in Siemens Rx system, with warning on 3 IdaruCIZUMAB (Praxbind ) IDArubicin (Idamycin ) InFLIXimab (Remicade ) RiTUXimab (Rituxan ) Similarity in generic names may Formulary status (IDArubicin is non-formulary) InFLIXimab restricted to Rheumatology & GI use
4 Insulin Glargine (Lantus ) long-acting basal Insulin Lispro (HumaLOG ) rapid-acting Insulin Aspart (NovoLOG ) rapid-acting Insulin Regular (HumuLIN R, NovoLIN R ) Insulin 70/30 products (NovoLIN 70/30, NovoLOG Mix 70/30 ) KadCYLA (ado-trastuzumab emtansine) KyPROLIS (carfilzomib) LamiVUDine (Epivir ) LamoTRIgine (LaMICtal ) Terbinafine (LamISIL ) Labetalol (Trandate ) LevoFLOXacin (Levaquin ) Levothyroxine (Synthroid ) LevETIRAcetam (Keppra ) MetFORMIN (Glucophage ) MetroNIDAZOLE (Flagyl ) NiCARdipine (Cardene ) NiMODipine (Nymalize ) NIFEdipine (Procardia ) NORepinephrine (Levophed ) PHENYLephrine (Neosynephrine ) EPINEPHrine (Adrenalin ) EPHEDrine (Akovaz ) PredniSONE PrednisoLONE PHENobarbital (Luminal ) PENTobarbital (Nembutal ) RifAMPin (Rifadin ) RifAXImin (Xifaxin ) Similarity in names, strengths and concentration ratios may Similarity in brand names may Similarity in generic and brand names and strengths may Consequences of errors may include Stevens- Johnson syndrome (lamotrigine) Similarity in generic names have Similarity in names and strengths may lead to errors Similarity in generic names may Similar generic names and may Similar generic names and may Similarity in generic names and may Similarity in generic names may Formulary status (Insulin glargine and aspart are restricted, insulin lispro is non-formulary) On High Alert Medication List, requiring two independent double checks NiCARdipine is restricted to use by Anesthesia, Neurology, and Neurosurgery Encourage written and verbal communication with both generic and brand names PENTobarbital is restricted to use in the ICU/OR 4
5 RisperiDONE (RisperDAL ) ROPINIRole (Requip ) SulfaSALAzine (Azulfidine, Sulfazine ) SulfaDIAzine Tacrolimus (Prograf, Astagraf XL ) Tamsulosin (Flomax ) Tdap (Boostrix, Adacel ) DTaP (Infanrix ) Trastuzumab (Herceptin ) Ado-trastuzumab emtansine (KadCYLA ) Topiramate (TopaMAX ) Metoprolol Succinate Extended Release (TopROL XL ) TraZODone (Desyrel ) TraMADol (Ultram ) ValGANcyclovir (Valcyte ) ValACYclovir (Valtrex ) VinBLAStine (Velban ) VinCRIStine (Vincasar, Oncovin ) Abbreviations for Extended Release formulations of oral medications: CD, DR, ER, SR, XL, XR, XT Similarity in names may Similarity in names may Similarity in names, strengths and concentration ratios may. Tdap = adults; DTaP = children 6 weeks to <7 yr old Similarity in generic names may, with warning on Encourage writing with medication Encourage writing with medication Product information posters showing which one is for which age group Similarity in brand names may. Consequences of errors may include rapid decrease in heart rate. Similarity in generic names may Similarity in names may. Abbreviations do not all translate to interchangeable dosing frequencies. Some medications must be given once a day, others are given twice a day. Need to double check dosing frequency whenever the drug is ordered. 5
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