Psychotropic Drugs : What's in a Name ?

Sir, Shamasundar (1992) listed different psychotropic drugs with closely similar brand names, and suggested that confusion may arise in dispensing these preparations. A case is reported below where such a situation indeed did arise. Mr. A, a 25 year old student suffering from Major Depression with melancholia (DSM-IV), had been started on fluoxetine (Prodep) 20 mg/ day by his previous psychiatrist. At follow-up a month later, he showed satisfactory improvement , and the psychiatrist renewed the prescription with a different brand of the same drug (Flumeg). Within a week, A's clinical state rapidly deteriorated. There was a recurrence of depres-sive thought, and pronounced fatigue, lethargy, drowsiness and psychomotor slowing. He was brought to this author for a second opinion. On the surface, it appeared that A had replapsed into depression. The reason for the marked severity of symptoms was unclear-until A took out a strip of his current medication and showed it. The drug was penfluridol, not fluoxetine. When A had his second prescriiption filled out, the pharmacist had dispensed 'Flumap' instead of 'Flumeg'. The two names are closely similar ; even the difference in the.last 2 letters can be obscured if the physician has the style of writing 'g' in reverse, as many indeed do ; also, both drugs are available in 20 mg strengths. The likelihood of a mix-up, such as occurred with Mr A, is therefore great. One wonders how often such a mix up happens. Shamasundar (1992) did not mention the Flumeg/Flumap similarity but reported other closely similar names : Seradol (haloperidol), Seridac (mianserin) and Serodep (trazodone); Mezatil (chlorpromazine) and Mazetol (carbamazepine); Anxipar (buspirone) and Anxipax (alprazolam); Elewal (doxepin) and Eliwel (amitriptyline) etc. Other similarities not reported by Shamasundar include Epilent (carbamazepine) and Epilex (sodium valproate); Traz (lorazepam), Trazine (trifluperazine) and trazonil (trazodone); Melleril (thioridazine) and Mezaril (carbamazepine) etc. And, Lozapin is not loxapine but clozapine ! The problem with similar brand names is that if a clinician unfamiliar with a brand sees it on a prescription he may misconstrue the pa-tient's treatment history ; if the pharmacist is unfamiliar with the brand he may dispense the wrong drug. The best way to resolve the issue is for clinicians to routinely specify the pharmacological name of the drug in parenthesis after the brand name on the prescription. It may also be useful if, on the reverse of the prescription, alternate brand names are written should the …