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FDA, drug maker warn of look-alike problems

Pharmacy Regulation Resource, February 9, 2005

Indianapolis-based drug maker Eli Lilly and Co. and the FDA notified healthcare professionals February 8 about reports of medication dispensing or prescribing errors between two medications with similar names.

The reports included instances where the Lilly drug Zyprexa-used for short-term maintenance treatment of schizophrenia or bipolar disorders-and the Pfizer antihistamine Zyrtec were incorrectly dispensed, leading to a potential relapse in schizophrenic or bipolar patients, the FDA said.

In a letter to healthcare professionals, Lilly Vice President Paul Eisenberg said hospitals should follow Institute for Safe Medication Practices recommendations and store the drugs in different locations. Hospitals should also print both the generic and brand names of the drugs on all prescriptions.

Healthcare providers should also discuss medications, their indications, and their uses when advising patients, Eisenberg said.

Lilly will take the following steps to improve safety, according to the letter:

  • Change the label on the 10 mg bottles from ZYPREXA to ZyPREXA for easier identification
  • Launch an awareness direct-mail campaign to pharmacists
  • Sponsor medication error-prevention education
  • Publish journal ads focusing on this dispensing error potential, emphasizing good prescribing and good dispensing practices

To read more from the FDA, including the letter to healthcare professionals, visit www.fda.gov/medwatch/SAFETY/2005/safety05.htm#ZyPREXA.

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