Sunday, August 25, 2013

Foreign medication brand names

Let’s start with a patient case.  An elderly patient has recently arrived from Italy and you are performing the medication reconciliation from their home medication list.  Their medication list includes Flomax which may frequently be continued without hesitation.  In this example, however, Flomax is NOT the brand name for tamsulosin in Italy but rather the identical name for a different medication. 

There is serious potential for error as brand names will often have different active ingredients in different countries.  Oftentimes, the brand names may differ by only a letter but have completely different generics.  Here are a couple of tips to ensure an appropriate medication reconciliation is performed for patients who might be receiving medication internationally:
  • Communicate with patients using generic names/active ingredients of medication
  • Verify that the generic name matches the brand name in the Index Nominum

The Index Nominum is an international drug directory which contains more than 5,300 substances, 12,800 synonyms, and 41,800 brand names from more than 45 countries.  It is included if your institution subscribes to Micromedex.  Follow the following steps to confirm that the generic and brand names match in a particular country.
  1. To go and click “Micromedex 2.0” on the right side
  2. Type in “Flomax” in the search box and hit “Search”
  3. Multiple results of active ingredients will be listed here
  4. Click on one of the results (you may want to start with tamsulosin which is the choice you would expect to be the answer)
  5. Click on the generic drug name under “Other information” → “Index Nominum”
  6. Here it is - the list of all of the brand names for this generic in all countries in the database
  7. If you see “Flomax®” with a manufacturer followed by “IT” for Italy in our example above, then Flomax is tamsulosin in Italy (but you’re not going to find it on this list because it’s not there)
  8. Go back to the results page after you type in Flomax and try a different generic on the right until you find “Flomax®” with a manufacturer followed by “IT” in the Index Nominum
  • Use the “Index Nominum Abbreviations Key” to see the code used for your desired country in this list
  • You can also use this method to find if a drug is available in another country by starting by typing in the generic name and reaching the Index Nominum from there
  • Solution: Flomax is the brand for morniflumate in Italy, an NSAID not available in the United States

A survey last year (abstract here) found that 85% of medical residents in one academic medical center used Google as their primary choice to solve a problem like this.  Try to use Index Nominum through Micromedex for a more direct approach from a reliable database.

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