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COMMENTARY

Look-alike, sound-alike drugs in India

Virendra S. Ligade

The Indian pharmaceutical market is swamped with many branded and generic drugs which look-alike and
sound-alike. These are a nightmare for healthcare professionals who deal with them. These drugs overlap in
strength, dosage, indications, and storage conditions and packaging as well. The risks due to look-alike,
sound-alike drug names result when a pharmacist or healthcare professional accidentally gives the wrong
drug or patients select the wrong drugs themselves due to similarity in the name or packaging of the drug.
The present study was aimed at listing out the recent drugs which look-alike and sound-alike in the Indian
pharmaceutical market and also highlight various regulatory guidelines which are available in selected
countries.

Accountability of patient safety should tions are only for information purpose cies must play a crucial role for the
be given prime importance in the health- and not medical guidance. The confusing import, manufacture, distribution and
care sector. Drugs are used to treat patients drug and brand names were analysed for sale of drugs. These agencies should
who suffer from diseases. While treating, the study. For the study of regulatory have control over the brand names of
prescribing and dispensing drugs to guidelines websites of various regulatory new drugs. They should be more strin-
patients, healthcare professionals need to agencies were referred. gent while issuing licenses and should
be careful to avoid medication errors. Tables 1 and 2 shows confusing exercise more control when it comes to
Such medication errors are usually due to generic drug names and brand names branding of formulations. The regulatory
incomplete prescribing information, poor with their indications. aspects of a few countries are discussed
communication skills, poor listening, or Usually pharmaceutical companies se- below.
lack of knowledge about the drugs. Some lect brand names which are easy to re- (1) WHO: The World Health Organi-
patients take multiple drugs prescribed member. This selection is based on either zation’s International non-proprietary
by different healthcare providers. In such indication, action, company name or in- names expert group works to develop
cases it becomes more difficult to verify gredients of the drugs. As can be seen international non-proprietary names for
the cause of medication error 1. Another from Tables 1 and 2, more the similarity pharmaceutical medicinal substances for
major contributing factor to medication in the names, more are the confusion er- acceptance worldwide 4. However the
error is confusing drug names that look rors. It can also be noted that drug brand drug brand names are fixed by pharma-
or sound alike. The Indian pharmaceutical names or generic names resemble each ceutical companies, which differ from
sector is the fastest growing across other, though they are mentioned for oth- country to country.
global pharmaceutical market. Many of er indications. Thus measures need to be (2) Canada: The Health Canada is the
the branded and generic drugs available taken to reduce confusion errors. Basi- federal department responsible for help-
in the market have confusing names. cally all healthcare professionals need to ing Canadians to maintain and improve
These drugs are called as look-alike, play a vital role to reduce medication their health. The Health Canada has
sound-alike drugs which are similar errors. Prescribers should be made aware issued a revised draft on review of drug
looking and similar sounding. Look- of such types of drugs which are avail- names for look-alike/sound-alike drugs
alike, sound-alike drugs create nightmare able in the market. The latest information attributes for the pharmaceutical indus-
for health care professionals when they about similar drug names and brand try. The policy objective of review of
deal with2. The medication error due to names can be provided through drug drug names for look-alike/sound-alike
these drugs is increasing because of their safety updates. Further, a prescription drugs is to provide market authorization
similarities in many of features like should be clear and readable by nurses holders more detailed direction on the
strength, dosage, indications, storage and pharmacists 3. The pharmacists can process to be followed and information
conditions and packaging too. The aim of also play an important role in reducing to be submitted to the Health Canada. The
the study was to classify these confusing medication errors. Whenever there is information is regarding the potential for
drugs names and to focus on regulatory confusion or prescription error due to a proposed name which is similar to
guidelines available in selected coun- look-like/sound-like drugs, the pharma- another product, so that it can be author-
tries. cist should immediately refer back to the ized for use in Canada with the aim of
The needed information was collected physician. When look-alike/sound-alike reducing medication errors 5.
through secondary sources. Recent issues drugs are stored in the pharmacy, there (3) United States of America: The
of Drug Today (January–March 2015, should be different colour labels for easy National Coordinating Council for Medi-
vols I and II) and Current Index of Medi- identification. Drug manufacturers can cation Errors Reporting and Prevention
cal Specialities (CIMS, October 2014– also reduce confusion of these similar was formed by the United States Phar-
January 2015) were referred for the looking drugs by giving different brand macopeial Convention to actively pro-
study. These issues enlist various medi- names to them. Packaging can also be mote the reporting, understanding, and
cal formulations available in the Indian different with minimal error for such types prevention of medication errors through
pharmaceutical market. These formula- of drugs. Above all, the regulatory agen- the coordinated efforts of its member

1230 CURRENT SCIENCE, VOL. 109, NO. 7, 10 OCTOBER 2015


COMMENTARY
Table 1. Look-alike and sound-alike drugs – similar generic and brand names
Generic name Brand name Indications (class of drugs)
Aminophylline Aminophylline, phyllocontin Antiasthmatic and chronic obstructive pulmonary disease preparations
Amitriptyline Amline Antidepressants
Amoxicillin Actimox, amoxil Penicillins
Ampicillin Ampilin, eskaycillin Penicillins
Azithromycin Elzithro, Loromycin Macrolides
Erythromycin Althrocin, Eltocin Acne treatment preparations, macrolides
Atenolol Tenolol, catenol Anti-anginal drugs, beta-blockers
Timolol Glucomol, nyolol Antiglaucoma preparations
Beclometasone Beclate, becoride Topical corticosteroids, antiasthmatic and chronic obstructive pulmonary
disease preparations, nasal decongestants, other nasal preparations
Betamethasone Betnelan, betnesol Eye corticosteroids, ear corticosteroids, antiasthmatic and chronic
obstructive pulmonary disease preparations, Corticosteroid hormones
Bisacodyl Bidlax-5 Laxatives, purgatives
Bisoprolol Bisbeta, bisveda Beta-blockers
Carbamazepine Carbadac, mezapin Anticonvulsants
Carbimazole Thyrozole Antithyroid agents
Clonazepam Clonopam, ozepam Anxiolytics, anticonvulsants
Lorazepam L-Zepam Anxiolytics, anticonvulsants
Clofazimine Clofaz Antileprotics
Clomipramine Clomifril Antidepressants
Carboplatin Carboplan, carbotin Cytotoxic chemotherapy
Cisplatin Cisplan, cytoplatin Cytotoxic chemotherapy
Cefotaxime Cefotim, sifotaxim Cephalosporins
Cefuroxime Cefoprim, cefurin Cephalosporins
Cimetidine Cimetiget Antacids, antireflux agents
Clonidine Clodict Antihypertensive drug
Daunorubicin Daunotec Cytotoxic chemotherapy
Doxorubicin Doxobin Cytotoxic chemotherapy
Digoxin Digox Cardiac drugs
Doxepin Doxesom Antidepressants drugs
Dopamine Dopacard Cardiac drugs
Dobutamine Dobucard Cardiac drugs
Ergotamine Vasograin Antimigraine preparations
Ethionamide Ethide Anti-TB agents, antileprotics
Folic acid Foliday Vitamins and minerals
Fusidic acid Fucidin Topical antibiotics
Gatifloxacin Gatiquin DPS Eye anti-infectives, antiseptics
Gemifloxacin Gemibid Quinolones
Gliclazide Glazed Antidiabetic agents
Glipizide Dibizide Antidiabetic agents
Ibuprofen Brufen Nonsteroidal anti-inflammatory drugs
Ketoprofen Ketopatch Nonsteroidal anti-inflammatory drugs
Rabeprazole R.P. Zole, rabezil Antacids, antireflux agents, antiulcerants
Ketoconazole Ketofast Topical antifungals
Methyldopa Alphadopa Other antihypertensive drugs
Levodopa Levopa Antiparkinsonian drugs
Mebendazole Mebazole Anthelmintics
Metronidazole Metron Preparations for vaginal conditions, topical antibiotics, antiamoebics
Nifedipine Depin, nifedine Anti-anginal drugs, calcium antagonists
Nimodipine Modipin, Nimodip Peripheral vasodilators, cerebral activators
Olanzapine Olzap, lezapin-MD Antipsychotics
Olapatadine Olodin, opat Ophthalmic decongestants, anesthetics, anti-inflammatories
Pheniramine Pheniramine, retard Antihistamines, antiallergics
Phenylephrine Drosyn Mydriatic drugs, anorectal preparations, cough and cold preparations
Quinidine Natcardine Cardiac drugs, antimalarials
Quinine sulphate Sacquine Antimalarials
Roxatidine Rotane Antacids, antireflux agents, antiulcerants
Rupatadine Rupanex, rup-AL Antihistamines, antiallergics
Spiramycin Rovamycin Forte Macrolides
Streptomycin Streptomac Aminoglycosides
Simvastatin Simvotin Dyslipidaemic agents
Somatostatin Somatosan Haemostatics
Tramadol Trama, tramazac Analgesics (opioid)
Trazodone Traze Anxiolytics, antidepressants
Vinblastine Cytoblastin Carcino-chemotherapeutic drugs
Vincristine Cytocristin, B-kristina Carcino-chemotherapeutic drugs

CURRENT SCIENCE, VOL. 109, NO. 7, 10 OCTOBER 2015 1231


COMMENTARY
Table 2. Look-alike and sound-alike drugs – generic drug pairs

Generic name Brand name Indications (class of drugs)

Amoxicillin + cloxacillin Alclox Penicillins


Cloxacillin + ampicillin Ampoxin Penicillins
Fluconazole + tinidazole Fluzon-T Antifungals
Levodopa + carbidopa Pardopa Antiparkinsonian drugs
Tramadol + paracetamol Tramol-DT Analgesics

associations and agencies, and to focus (7) The United Kingdom: The Medi- ing report errors and potentially hazard-
on ways to enhance patient safety6. In cines and Healthcare Products Regula- ous conditions related to confusing drug
USA, the pharmaceutical manufacturers tory Agency regulates medicines and or brand names. To find out similar
get pre-approval for proposed names medical devices in the UK. The agency names of drugs, an on-line searching
from various organizations like US plays leading role in protecting and system should be implemented by the
Pharmacopeia (USP) and US Food and improving public health. Through drug government. Further manufacturers and
Drug Administration (USFDA) 3. safety updates the agency gives informa- regulatory agencies should play a signi-
(4) Australia: The proposed regulatory tion about particular care to be taken ficant role in framing regulatory guide-
changes according to the Therapeutic when prescribing or dispensing look- lines related to active ingredients, safety
Goods and Administration (TGA) Aus- alike/sound-alike medicines. Recent profile, efficacy and dosage regimen for
tralia, state that companies or sponsors of examples of medication errors are listed these drugs.
new medicines will be required to submit in drug safety updates 10.
evidence of risk assessment of the pro- (8) Japan: To find out similar names of
posed labelling and packaging. Further, drugs, an on-line searching system (Jap- 1. Kawano, A., Qi (Kathy) Li. and Ho, C.,
Pharmacy Connection, 2014, 28–33.
TGA is looking for methods to electroni- anese Similar Names Searching System)
2. Rataboli, P. V. and Garg, A., J. Post-
cally screen proposed brand names was implemented in Japan in 2008. In
grad. Med., 2005, 51(1), 13–16.
against already existing brand names to addition, the Japan Council for Quality 3. Keny, M. S. and Rataboli, P. V., Indian
identify potential look-alike and sound- Healthcare has developed a system in J. Clin. Practice, 2013, 23(9), 508–513.
alike names. Regarding branding of me- order to avoid medication errors 11. 4. Look-alike, sound-alike medication names;
dicines, the same brand name cannot be (9) India: The Pharmacovigilance available from: http://www.who.int/
applied to products that have different Programme of India was launched to patientsafety/solutions/patientsafety/PS-
active ingredients or their combinations, improve patient safety and welfare in the Solution1.pdf (accessed on 7 February
unless the active ingredients are closely Indian population by monitoring drug 2015)
related and safety profile, efficacy and safety and thereby reducing risk associ- 5. Preventable medication errors – look-alike/
sound-alike drug names; available from:
dosage regimen are similar 7. ated with the use of medicines 12. This
http://www.ismp-canada.org/download/
(5) Malaysia: The Pharmaceutical programme mainly emphasizes on
PharmacyConnection/PC2014-02-Spring_
Services Division, Ministry of Health, adverse drug events. However in order to LookalikeSoundalike.pdf (accessed on 22
Malaysia has issued guidance on han- ensure patient safety, preventive meas- February 2015).
dling of look-alike/sound-alike medica- ures need to be taken to tackle medica- 6. NCCMERP, Available from: http://www.
tions. The guidelines consist of strategies tion errors due to confusing drug names nccmerp.org/ (accessed on 15 February
to avoid errors with look-alike and sound- in India 13. Introduction of appropriate 2015).
alike medications. The strategies are re- system to search similar brand or confus- 7. TGA Medicine and Packaging Review,
lated to procurement, storage, prescribing, ing drug names is the need of the hour. available from: https://www.tga.gov.au/
dispensing, administration, monitoring, The Indian pharmaceutical industry is book/look-alike-and-sound-alike-
medicine-brand-names-and-look-alike-
information, patient education and evalu- growing at a fast pace and is considered
packaging-and-branding; (accessed on 20
ation of such drugs 8. to be the third largest in the world in
February 2015).
(6) Singapore: The Ministry of Health, terms of volume. It is also among the top 8. Guide on handling look-alike, sound-
Singapore has issued a guidance note on in the manufacture of generic medicines. alike medications, available from: http://
medication safety. Practice guidelines New brands of drugs may continue to www.pharmacy.gov.my/v2/sites/default/
and tools mention about medication come to the pharmaceutical market on a files/document-upload/guide-handling-
safety pointing towards medication errors. regular basis. The need of the hour is to lasa.pdf (accessed on 24 January 2015).
These guidelines and tools may help create awareness regarding the look- 9. Medication safety, practice guidelines
healthcare professionals to ensure that alike/sound-alike drugs, and develop and tools, available from: https://www.
the medication use process is safe. The methods such that there is no confusion moh.gov.sg/content/dam/moh_web/HPP/
all_healthcare_professionals/Medication-
guidelines also mention about storage, regarding new brand names and non-
%20Safety.pdf (accessed on 18 February
repackaging, caution to be maintained proprietary names. Awareness among
2015).
while dealing with look-alike and sound- healthcare professionals, nurses, pharma- 10. Drug safety update, available from: https://
alike medicines. It also give post infor- cists and patients can done through vari- www.gov.uk/drug-safety-update/recent-
mation to staff on medications with simi- ous channels, e.g. mobile technology. drug-name-confusion (accessed on 22
lar names 9. Patients must also be encouraged regard- February 2015).

1232 CURRENT SCIENCE, VOL. 109, NO. 7, 10 OCTOBER 2015


COMMENTARY
11. The evaluation of the Japanese similar 12. Pharmacovigilance programme of India, com/ArticleDetails.aspx?aid=83445&sid=
names searching system for the future de- available from: http://www.ipc.gov.in/ 1 (accessed on 25 January 2015).
velopment of the system in the US, avail- PvPI/pv_about.html (accessed on 26
able from: http://www.kchponline.com/ March 2015). Virendra S. Ligade is in the Department
archive/posters/2010%20-%20Japanese%- 13. Jagashetty, B. R., Government should of Pharmacy Management, Manipal Col-
20Similar%20Names%20Poster%20-%20- stall approval of ‘sound-alike’ drugs to lege of Pharmaceutical Sciences, Mani-
Nakano.pdf (accessed on 18 February prevent dispensing errors and adverse reac- pal University, Manipal 576 104, India.
2015). tions, available from: http://pharmabiz. e-mail: virendra123sl@gmail.com

Need for targeted education programme for preparedness and


formulating adaptive strategies in the Indian Himalayan region

Nishikant Gupta, Asha Rajvanshi, S. Sathyakumar, J. A. Johnson, K. Sivakumar, G. S. Rawat and


Vinod B. Mathur

The Indian Himalaya continues to face increasing anthropogenic stressors despite numerous conservation
actions. Further, climate change has the potential to negatively affect this biodiversity rich region. To coun-
teract the changing climatic variables, targeted education programmes could act as a strategy and assist in
protecting the floral/faunal species requiring urgent intervention, and benefit communities and ecosystems
at large.

With the accelerating anthropogenic local stakeholders about species and their vation education among the local
stressors on ecosystems and changing habitats could be helpful in formulating communities, especially in remote parts
climatic variations, including extreme appropriate area-specific management of India such as the Himalaya. Most of
events, the importance of developing in- strategies and in mitigating negative the community-based initiatives lack
novative and more pragmatic approaches human–wildlife interactions 1. clarity of objective, time frame and ex-
to deal with these threats is widely ac- There is also recognition of targeted pected outcomes. Community targeted
knowledged1. The need to responsibly in- educational programmes and their impor- initiatives through workshops of short
form the society about current status of tance 12,13 among a number of reputed or- duration from one to a few days of field
the environmental challenges2–4 through a ganizations in India such as the Ganges training invariably leave limited impact
range of resources such as print and elec- River Dolphin Conservation; the Interna- on local communities. As most pro-
tronic media 4, broadly grouped under tional Snow Leopard Trust; WWF-India; grammes are project based with limited
targeted education programmes 5,6, is also the Wildlife Institute of India; Centre for funding and duration, there is scarcity of
felt by the governments and policy makers. Environment Education; C.P.R. Envi- long-term monitoring of implemented
Targeted education programmes 5 have ronmental Education Centre and the initiatives posing serious sustainability
the potential to act as a tool for aware- Nature Conservation Foundation, who issues.
ness and adaptive capacity building, en- have successfully conducted community There are numerous strategies which
hance the process of shaping human awareness programmes. could be utilized to overcome the chal-
behaviour for a positive response 7,8 and Despite these potential benefits to the lenges associated with targeted educa-
empower people to behave more respon- society, educating citizens outside the tional programmes. To begin with, such
sibly6. Awareness on climate sensitivity scientific community in ways that can programmes should be addressed in the
of an endangered species could help con- assist them in becoming well-informed national curriculum at the school level,
struct a positive association with that citizens 14 is perhaps a big challenge. where more focused information should
species 9 and ultimately benefit the spe- There is a limited understanding of a be provided to students regarding ecosys-
cies and the overall protection and con- measurable impact of education among tem and its services. The current envi-
servation of ecosystems 10. For instance, citizens on species conservation15 due to ronmental science course across India
local communities resolving to abstain the lack of environmentally conscious needs to be revised and up-scaled to
from hunting tragopan (Tragopan blythii) behaviour 16, despite having a good un- nurture interest among graduates. This is
in Khonoma Tragopan Sanctuary, Naga- derstanding of a particular species. Addi- especially vital due to the increasing
land, and the protection of riverine bio- tionally, the implementation of effective anthropogenic threats faced by key bio-
diversity by the villagers of Kanalsi, educational programmes is sometimes diversity hotspots of India, including the
Haryana 11 have helped in the conserva- negatively influenced by group size and Indian Himalayan region.
tion of these species. These community- demography of target audience 17,18. There is a growing pressure in the
based approaches set a good example of It is not surprising that there is often Indian Himalayan region due to increas-
what is achievable with persuasive seri- an inadequacy in the design of pro- ing population and rapid urbanization,
ousness. More importantly, knowledge of grammes oriented for spreading conser- unsustainable exploitation of natural

CURRENT SCIENCE, VOL. 109, NO. 7, 10 OCTOBER 2015 1233

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