The Pharmaceutical Journal
Vol 279 No 7470 p326
22 September 2007

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Letters to the Editor

Prescribing

Use of brand names in prescribing

From Mr B. G. Burnett, MRPharmS, and Mr U. M. Chouhan, MRPharmS

The National Patient Safety Agency’s “Rapid response report 2” has been issued to alert all health care staff of the need to be aware of the differences in the formulations of intravenous amphotericin since they all have differing dosing schedules (PJ, 8 September 2007, p249). Confusion between these can lead to fatalities as the alert indicates.

One of the ways of reducing the risk of prescribing and administration errors is to prescribe by brand names. With respect to amphotericin, the non-lipid formulation is Fungizone, the lipid formulations are Abelcet, AmBisome and Amphocil. Prescribing by means of the generic name of amphotericin is not appropriate since the choice is then between four different products.

There are other products that we also believe should be prescribed by brand names, eg, cytarabine injection, available as generic and encapsulated in liposomes (DepoCyte). This was the subject of the first “Rapid response report” in June 2007 from the NPSA.

Liposomal formulations of other drugs such as doxorubicin should also be prescribed as brand names, particularly since there are also two versions of this product: Caelyx and Myocet.

Other products which would benefit from being prescribed by the brand name include certain antiepileptic medicines, and the Movicol range which is available as Idrolax, Movicol, Movicol Half, Movicol Paediatric Plain, Moviprep and Klean-Prep. The latter products are listed in the current electronic edition of the BNF under macrogols.

Confusion in prescribing, dispensing, preparation and administration can be reduced by appropriate use of brand names and the standard mantra that all prescribing should be by generic names should be rethought to avoid the risk of seriously harming the patients.

However, this is not a panacea. There is an increasing tendency to use a brand name for a range of both strength and formulation, eg, “LA”, “M/R”, “SR” and illustrated by the Movicol range above.

Therefore consideration should be given to modification of the brand name to prevent confusion, particularly where a single strength is available in a range of formulations. This is something the regulators should consider in future licence applications.

Bruce Burnett
Principal Pharmacist (Cancer Services)
Uttamlal M. Chouhan
Principal Pharmacist (Clinical Services)
Glan Clwyd Hospital, Rhyl

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