Doctors must now prescribe drugs using their chemical name, not brand names. That’s good news for patients



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Matthew Grant, Monash University

From today (February 1), when you receive a prescription in Australia, it will list the name of the medication’s active ingredient rather than the brand name. So, for example, instead of receiving a prescription for Ventolin, your script will say “salbutamol”.

This national legislation change, called active ingredient prescribing, is long overdue for Australian health care.

Using the name of the drug — instead of the brand name, of which there are often many — will simplify how we talk about and use medications.

This could have a range of benefits, including fewer medication errors by both doctors and patients.

What is an active ingredient?

The active ingredient describes the main chemical compound in the medicine that affects your body. It’s the ingredient that helps control your asthma or headache, for example.

Drugs are tested to ensure they contain exactly the same active ingredients regardless of which brand you buy.

There’s only one active ingredient name for each type of medical compound, although they may come in different strengths. Some types of medications may contain multiple active ingredients, such as Panadeine Forte, which contains both paracetamol and codeine.




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There can be several brand names

Until now, doctors and other prescribers have used a mixture of brand and active ingredient names when prescribing medicines. An Australian study found doctors used brand names for 80.5% of prescriptions.

Different brands are available for most medications — up to 12 for some. Combined with active ingredient names, this equates to thousands of different names — too many for any patient, doctor, nurse or pharmacist to remember.

A senior man taking a tablet. There are a variety of medications on the table.
Older people are at higher risk of making medication errors, as they tend to take more medications.
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Here’s an example of the problem.

I ask John, a patient whom I’ve just met, whether he takes cholesterol medications, commonly called statins. The active ingredient names for this group of medications all end in “statin” (for example, pravastatin, simvastatin).

“Ummm, I’m not sure, is it a blue pill?” John asks.

“It could come in many colours. It might be called atorvastatin, or Lipitor,” I reply. “Perhaps rosuvastatin, or Crestor, or Zocor?”

“Ah yes, Crestor, I am taking that,” John exclaims, after deliberating for some time.

This is a common and important conversation, but could be simpler for both of us if John was familiar with the active ingredient name.

And while we did eventually come to the answer, this medication could have easily been overlooked, by both John and myself. This may have significant implications and interact with other medicines I might prescribe.




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Cause for confusion

The main problem with using brand names for medications is the potential for confusion, as we see with John.

A prescription written using a brand name doesn’t mean you can’t buy other brands. And your pharmacist may offer to substitute the brand specified for an equivalent generic drug. So, people often leave the pharmacy with a medication name or package that bears no resemblance to the prescription.

When the terms we use to describe medicines in conversation, on prescriptions and what’s written on the medication packet can all be different, patients might not understand which medications they’re taking, or why.

This often leads to doubling up (taking two brands of the same medication), or forgetting to take a certain medication because the name on the package doesn’t match what’s written on your medication list or prescription.

Confusion resulting from using brand names has been associated with serious medication errors, including overdoses. Elderly people are the most susceptible, as they’re most likely to take multiple medications.

Even when the confusion doesn’t cause harm, it can be problematic in other ways. If patients don’t understand their medicines, they may be less likely to be proactive in making decisions with their doctor or pharmacist about their health care.

Health professionals can also get confused, potentially leading to prescribing errors.

What are the benefits of active ingredient prescribing?

The main benefit of the switch is to simplify the language around medications.

Once we become accustomed to using one standardised name for each medicine, it will be easier to talk about medicines, whether with a family member, pharmacist or doctor.

The better we understand the medications we’re using, the fewer errors we make, and the more control we can take over our medication use and decisions.

A pharmacist studies a woman's prescription.
A pharmacist can let you know which brands of your medication are are available.
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This change will also serve to promote choice.

When you’re prescribed a medicine with a certain name, you’re more likely to buy that brand. In some cases there may be generic medicines that are cheaper and just as effective. Or there may be other forms of the medication that better suit your needs, such as a capsule only available in another brand.

Not too much will change

This new rule is not expected to lead to extra work for doctors, pharmacists or other health professionals who prescribe medicines, as most clinical software will make the transition automatically.

Doctors can elect to still include the brand name on the prescription, if they feel it’s important for the patient. But aside from some limited exceptions, the active ingredient name will need to be listed, and will be listed first.

Some active ingredient names may be a bit longer and more complex than certain brand names, so there might be a period of adjustment for consumers.

But in the long term, this change will streamline terminology around medicines and make things easier, and hopefully safer, for everyone.

Next time you receive your prescription, have a look at the name of the active ingredient. Remember it, and use that name when you talk to your family, doctor and pharmacist.




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The Conversation


Matthew Grant, Palliative Medicine Physician, Research Fellow, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

PAKISTAN: TWO CHRISTIANS ACQUITTED OF ‘BLASPHEMY’


After nearly two and half years in jail, elderly men’s 10-year sentences overturned.

ISTANBUL, April 21 (Compass Direct News) – After more than two years in a Pakistani jail, two elderly Christian men convicted of “blasphemy” against the Quran were acquitted on Thursday (April 16) when a high court in Lahore overturned their 10-year sentence.

James Masih, 67, and Buta Masih, 72, were accused of burning pages from the Quran in October 2006 and were also tried under an anti-terrorism law because their actions were deemed to have created fear and panic. In a case that drew crowds of Islamic fanatics, they were convicted on Nov. 25, 2006 of blaspheming Islam’s sacred book.

The pair has claimed from the start that the blasphemy charges were fabricated due to a dispute over a plot of land that a Muslim neighbor wanted James Masih to sell.

“It happens many times, it is always a false story due to some other enmity,” said Father Yaqub Yousaf, the men’s parish priest. “Pastors and priests, we tell them that it is better not to speak on religion with the Muslims, not to say anything that can hurt them, so normally they don’t do that.”

After rumors erupted that the two men had burned pages of the Quran on Oct. 8, 2006, some 500 Muslims attempted to kill them. Police arrested the two Christians and held off the crowds, which stayed outside the police station through the night.

The Christian men launched an appeal soon after their conviction and have since remained in prison.

“I appeared in court 27 times during the appeal,” said Khalil Tahir Sindhu, their lawyer. “Most of the time the judges postponed the case, saying, ‘We will hear the case next time.’”

Sindhu told Compass that religious bias and public pressure led to the judge’s original decision to sentence the men and could have had much to do with the delays in hearing the appeal.

“At the last hearing [Dec. 15, 2008], the judge reserved judgment, which according to law has to be given within three months,” he said. “But it was over three months, so I went to court and told him, ‘These are old men and they are sick, so please announce the judgment.’”

James Masih was hospitalized three times during his internment, receiving treatment for a chest infection.

“Jail is totally different [in Pakistan], you hardly have proper food, and no facilities,” said Fr. Yousaf. Sources said both men were traumatized by their ordeal, an effect also felt keenly by their families, who were rarely able to visit.

 

Permanent Stigma

Articles 295-B and 295-C of the Pakistan Penal Code respectively prescribe life imprisonment for desecrating the Quran and death for insulting Muhammad, the prophet of Islam.

Although the law has not been implemented to the full extent of capital punishment or life in prison since its introduction in 1986, there have been more than 20 deaths recorded in blasphemy-related violence.

Even after their acquittal and release, Sindhu said, the men will not be able to immediately return home.

“It is dangerous now, we will not send them to their home,” said Sindhu. “We will keep them away for one to two months until the situation changes. Anyone can kill them.”

Christians previously accused of blasphemy continued to experience prejudice and sometimes violence even after being cleared of the charges.

“It is difficult for the blasphemy accused to find work,” commented Wasim Muntizar from the Lahore-based Center for Legal Aid Assistance and Settlement. “Churches are afraid to help them, because fanatics won’t hesitate to kill the ‘blasphemer’ and attack the church.”

Although the families of James and Buta Masih remain excited at the prospect of the pair’s upcoming return home, Fr. Yousaf has urged them to keep their celebrations muted.

“They are excited, yes, but I told them not to express so strongly their joy about it,” he said. “I requested them to keep it secret, because it may not be safe – some of the Muslims may say the court has not taken the right decision. In the past people have been killed after being acquitted.”

Report from Compass Direct News