Thiruvananthapuram: Nephrologist Jayant Mathews in Thrissur got a shocker when his patient, prescribed with an immunosuppressant, returned a week later to tell him that a drug store substituted it, thinking that the doctor had probably got its name wrong. Dr Jayant Mathews had prescribed epoetin alfa injection to treat his anaemia (generally given to dialysis patients) but the “pharmacist” at the private medical store “prescribed” the similar-sounding eptoin, which is the drug of choice for epilepsy. Luckily the doctor could identify the wrong medicine and avert a catastrophe. The culprit here has been the “so-called” pharmacist, who mistook the sound-alike branded drugs to be the same. Lookalike sound-alike (LASA) drugs (branded as well as generic) have become potentially life-threatening agents. Proliferating manufacturers are able to churn out drugs with no centralized digital control mechanism to prevent LASA drugs and save millions of patients, especially in rural areas.
Recently, the Goa Directorate of Food and Drugs Administration put out an SOS on Medzol. The directorate received an email on January 21 from the Office of Drugs Controller General (India), highlighting the availability of two different pharmacological categories of drugs being marketed under one brand name –Medzol- to avoid the prescription of the drugs so that dispensing errors at the retail end are avoided in larger patient safety. Medzol injection is used for conscious sedation (an awake but relaxed state of calmness during a medical test or procedure), anesthesia and sedative at an ICU. Again, Medzol is also a branded drug-Pantoprazole-used to treat certain stomach and esophagus problems (such as acid reflux). “These two medicines (shown in pic) would have been dispensed many times over because their packets look alike and an unsuspecting salesman at the drug store would have passed them on, even advising the patient that their doctor must be in the wrong and the tablet would do instead of an injection”, said D r K G Revi Kumar, a consultant pharmacist.
Medzol
Says dentist G.R. Manikandan: “Confusions not reported but there are issues of unavailability and often poor quality brands people prefer because of low pricing. Good brands are high in price most of the times”. This hits the poor the worst. LASA generic drugs are also part of the problem. Take, for instance, Chlopramazine to treat schizophrenia and chlorpropamaide, used to control high blood sugar in people with type 2 diabetes. Imagine one being substituted for the other; the outcome can be disastrous for patients already having co-morbid conditions. Says Dr Revi Kumar: “We do not get reports of fatalities caused by the LASA phenomenon because of the prevailing inefficiency in the medical sector. This calls for better surveillance in patient care and tighter pharma controls to check LASA drugs. Dr Jothydev, a specialist in diabetes and geriatric medicine, says LASA confusion is rampant. The confusion occurs at three points – patients, pharmacists, doctors. Forty percent onset of new illnesses in old age owes drug-to-drug interaction and drug interaction with patient’s system. The patient may not tell the cardiologist what has been prescribed by the bone specialist. There is no effective system to give a consolidated advice in case of OPs.
Bexol
“It happens with same prescription but more commonly when multiple doctors are treating same patient for different ailments. Writing generic prescriptions are not the solution since patients will receive substandard medications at cheaper rates. Family physician or nurse practitioner concept should come to India. Though patient education is more important than prescriptions, neither the doctors nor the patients have the time. All medications need to be verified twice and patients should be educated on it,” he says. Drug manufacturing and labeling often bore on the insane. Says Dr Jayant: “The drug will have half the name of the molecule and half the name of the company. So the namesakes are bound to occur”.
Dr Kumar says the proliferation of medicine manufacturers has to be checked. “If you have to start a company, you need to get it approved by the Registrar of Companies. But medicines manufactured under licence in any place can be sold across the country. There is centralized registry. Archaic keeping aids in corruption. Free imports are allowed while other countries issue a composite questionnaire before local imports are allowed to get a proper pharmaco-economic evaluation,” he adds. Hospitals should have educators to advise patients on drugs. It’s a team work of clinical pharmacist, nurse practitioner and doctor. Even the dietician is crucial and cannot be working independent of doctors. Perhaps the only way the system can be jolted out of its fatal stupor is to encourage damages suits. But for this, medical literacy is a must.
