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What's in a brand name?
J K Aronson, clinical reader in clinical pharmacology aa University Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE
Correspondence to: Dr Aronson.
When doctors prescribe drugs by their brand names they can confidently expect that their patients will be given particular compounds by the pharmacist. For example, if they prescribe Brufen they can be confident that the pharmacist will dispense a formulation that contains ibuprofen.
When patients buy drugs over the counter, however, matters may be more complicated. For example, if they buy tablets with the name Anadin on the box they may be buying a formulation that contains aspirin and caffeine; aspirin, caffeine, and quinine; aspirin, caffeine, and paracetamol; paracetamol alone; or even ibuprofen alone. Of course, these different formulations may have slightly different names, such as Anadin Extra for aspirin plus caffeine plus paracetamol and Anadin Paracetamol for paracetamol alone; but it takes a high degree of awareness to realise, for example, that one of these contains aspirin while the other does not. In another example Aspro Paraclear contains paracetamol and not aspirin whereas Aspro Clear contains aspirin and not paracetamol.
There are several similar examples of brand name drugs that are available over the counter under the same or closely similar names but that contain different drugs or combinations of drugs. The table lists these -both formulations for oral use and formulations for topical use --culled from an issue of Chemist and Druggist.1 This list is by no means comprehensive. For example, I have omitted formulations for which differences are limited to what might be regarded as inactive excipients, such as sodium citrate in effervescent formulations. I have also omitted examples in which a difference between formulations arises because the formulations are intended for different uses and would be unlikely to be confused--for example, ointments versus tablets.
Over the counter formulations of medicines with the same brand name containing different ingredients
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Brand name Formulation Contents
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Oral formulations
Actifed Compound linctus Triprolidine, pseudoephedrine,
dextromethorphan HBr
Actifed Expectorant Triprolidine, pseudoephedrine, guaiphenesin
Actifed Syrup and tablets Triprolidine, pseudoephedrine
Aller-eze Tablets Clemastine hydrogen fumarate
Aller-eze Plus Tablets Clemastine, phenylpropanolamine
Altacite Suspension and tablets Hydrotalcite
Altacite Plus@ Suspension and tablets Dimethicone, hydrotalcite
Aludrox* Liquid Aluminium hydroxide
Aludrox* Tablets Aluminium hydroxide, magnesium carbonate,
magnesium hydroxide
Anadin Capsules Aspirin, caffeine
Anadin* Tablets (soluble) Aspirin, caffeine citrate
Anadin@ Tablets Aspirin, caffeine, quinine sulphate
Anadin Extra@ Tablets (soluble) Aspirin, caffeine, paracetamol
Anadin Ibuprofen Tablets Ibuprofen
Anadin Paracetamol@ Tablets Paracetamol
Andrews* Tablets Calcium carbonate, magnesium carbonate
Andrews* "Liver salts" Sodium bicarbonate, citric acid, magnesium
sulphate dehydrate
Andrews Answer* Sachets Paracetamol, caffeine, sodium bicarbonate,
citric acid
Asilone* Liquid, suspension Dimethicone, aluminium hydroxide,
magnesium oxide
Asilone* Tablets Dimethicone, aluminium hydroxide, sucrose
Aspro@ Tablets Aspirin
Aspro Clear@ Tablets Aspirin
Aspro Paraclear* Tablets Paracetamol
Beechams* Pills Aloin
Beechams Tablets Aspirin
Beechams@ Powders Aspirin, caffeine
Beechams* Powder capsules Paracetamol, caffeine, phenylephrine HCl
Beechams@ Tablets Aspirin, caffeine
Beechams* "Hot lemon" Paracetamol, ascorbic acid, phenylephrine
HCl
Beecham Coughcaps Capsules Dextromethorphan HBr
Benylin Liquid (chesty cough) Diphenhydramine HCl, menthol
Benylin Liquid (dry cough) Diphenhydramine HCl, dextromethorphan
HBr, menthol
Benylin Liquid (mentholated) Diphenhydramine HCl, dextromethorphan
HBr, pseudoephedrine HCl, menthol
Benylin Liquid (non-drowsy) Guaiphenesin, menthol
Benylin Liquid (non-drowsy, dry Dextromethorphan HBr
cough)
Benylin Liquid (paediatric) Diphenhydramine HCl, menthol
Benylin Liquid (with codeine) Diphenhydramine HCl, codeine, sodium
citrate, menthol
Benylin Day and Tablets Paracetamol, phenylpropanolamine HCl (day
Night tablets);
Paracetamol, diphenhydramine HCl (night
tablets)
Bisodol* Powders Heavy magnesium carbonate, light
magnesium carbonate, sodium bicarbonate
Bisodol* Tablets Calcium carbonate, light magnesium
carbonate, sodium bicarbonate
Bisodol Extra* Tablets Calcium carbonate, light magnesium
carbonate, sodium bicarbonate,
simethicone
Bradosol* Lozenges Benzalkonium chloride
Bradosol Plus Lozenges Domiphen bromide, lignocaine HCl
Bronalin Liquid (decongestant) Pseudoephedrine HCl
Bronalin Liquid (dry cough) Dextromethorphan HBr, pseudoephedrine
HCl, alcohol
Bronalin Liquid (expectorant) Diphenhydramine HCl, sodium citrate,
ammonium chloride
Bronalin Liquid (expectorant) Diphenhydramine HCl, sodium citrate
paediatric)
Coldrex* Powders Paracetamol, phenylephrine HCl, ascorbic acid
Coldrex* Tablets Paracetamol, phenylephrine HCl, caffeine,
terpin hydrate, ascorbic acid
Collis Browne's Mixture Morphine anhydrous, peppermint oil
Collis Browne's Tablets Light kaolin, morphine HCl, heavy calcium
carbonate
De Witt's@ Analgesic pills Paracetamol, caffeine
De Witt's* Antacid powders Magnesium trisilicate, light magnesium
carbonate, calcium carbonate,
sodium bicarbonate, light kaolin,
peppermint oil
De Witt's* Antacid tablets Calcium carbonate, magnesium carbonate,
magnesium trisilicate, peppermint oil,
lactose
De Witt's* Kidney and bladder pills Extract of buchu, extract of uva ursi
De Witt's* Lozenges Tyrothricin, benzocaine, cetylpyridinium
chloride
Dimotane Elixir Brompheniramine maleate
Dimotane Plus Elixir, paediatric elixir Brompheniramine maleate, pseudoephedrine
HCl
Dimotane Tablets Brompheniramine maleate
Dimotane LA Tablets Brompheniramine maleate
Dimotane Plus LA Tablets Brompheniramine maleate, pseudoephedrine
HCl
Dimotane Expectorant Brompheniramine maleate, guaiphenesin,
phenylephrine HCl, phenylpropanolamine
HCl
Dimotane Co Liquid (adult and Brompheniramine maleate, pseudoephedrine
paediatric) HCl, codeine phosphate
Diocalm Tablets Morphine HCl, attapulgite
Diocalm Junior Sachets Morphine HCl, attapulgite
Diocalm Ultra Capsules Loperamide
Disprin@ Tablets Aspirin
Disprin CV Tablets Aspirin
Disprin Direct* Tablets Aspirin, glycine
Disprin Extra* Tablets Aspirin, paracetamol
Expulin Cough linctus Pholcodine, pseudoephedrine HCl,
chlorpheniramine maleate
Expulin Linctus (dry cough) Pholcodine
Expulin Paediatric linctus Pholcodine, chlorpheniramine maleate
Famel* Expectorant Guaiphenesin
Famel Linctus Pholcodine
Famel "Original" Creosote, codeine phosphate
Fedril Expectorant Diphenhydramine HCl, ammonium chloride,
menthol
Fedril Expectorant (paediatric) Diphenhydramine HCl, menthol
Fedril Liquid (tickly cough) Cetyl pyridinium chloride, ipecacuanha, lemon
oil, honey, ammonium chloride, glycerin,
citric acid
Fennings@ Powders (children's) Paracetamol
Fennings* Gripe mixture Sodium bicarbonate, peppermint oil, dill oil,
caraway oil
Fennings* Lemon mix Sodium salicylate
Fennings* "Little healers" Ipecacuanha
Flurex Liquid ("bedtime") Paracetamol, diphenhydramine HCl,
pseudoephedrine
Flurex Liquid ("hot lemon") Codeine phosphate, ephedrine HCl,
diphenhydramine HCl
Flurex Capsules Paracetamol, phenylephrine HCl
Flurex* Tablets Paracetamol, phenylephrine HCl, caffeine
Franolyn Expect Liquid (chesty cough) Ephedrine, guaiphenesin, theophylline
Franolyn SED Liquid (dry cough) Dextromethorphan HBr
Galfer Capsules, syrup Ferrous fumarate
Galfer FA Capsules Ferrous fumarate, folic acid
Galpseud Linctus, tablets Pseudoephedrine HCl
Galpseud Plus Linctus Pseudoephedrine HCl, chlorpheniramine
maleate
Gaviscon Liquid Sodium alginate, sodium bicarbonate, calcium
carbonate
Gaviscon/ Tablets Alginic acid, sodium bicarbonate, aluminium
Gaviscon 250 hydroxide, magnesium trisilicate
Gaviscon Sachets (infant) Sodium alginate, magnesium alginate,
aluminium hydroxide
Lem-Plus* Capsules Paracetamol, caffeine, phenylephrine HCl
Lem-Plus* Powders Paracetamol, ascorbic acid
Lemsip* Capsules Paracetamol, anhydrous caffeine,
phenylephrine
Lemsip Liquid ("night time") Paracetamol, dextromethorphan HBr,
chlorpheniramine maleate,
phenylpropanolamine HCl
Mac* Lozenges Amylmetacresol, menthol, sucrose, glucose
Mac Extra* Lozenges Hexylresorcinol
Meltus* Liquid (baby) Acetic acid
Meltus Liquid (dry cough) Dextromethorphan HBr, pseudoephedrine
HCl, alcohol
Meltus* Liquid (adult/junior Guaiphenesin, cetylpyridinium chloride,
expectorant) honey
Meltus* Liquid ("honey and Guaiphenesin, honey, glycerin
lemon")
Mu-Cron Syrup Phenylpropanolamine HCl, ipecacuanha
Mu-Cron Tablets Phenylpropanolamine HCl, paracetamol
Normacol* Sachets Sterculia
Normacol Plus* Granules, sachets Sterculia, frangula
Nutrizym 10/22* Capsules Pancreatin
Nutrizym GR* Capsules Pancreatin, lipase, protease, amylase
Rennie* Tablets Calcium carbonate, magnesium carbonate
Rennie Gold* Tablets Calcium carbonate
Robitussin Liquid (cough soother) Dextromethorphan
Robitussin Expectorant Guaiphenesin
Robitussin Plus Expectorant Guaiphenesin, pseudoephedrine HCl
Sudafed Expectorant Pseudoephedrine HCl
Sudafed Expectorant Guaiphenesin, pseudoephedrine HCl
Sudafed Linctus Dextromethorphan HBr, pseudoephedrine
HCl
Sudafed Tablets Pseudoephedrine HCl
Sudafed Plus Syrup, tablets Triprolidine HCl, pseudoephedrine HCl
Sudafed-Co Tablets Paracetamol, pseudoephedrine HCl
Tixylix Cough and Linctus Pseudoephedrine HCl, chlorpheniramine
Cold maleate, pholcodine
Tixylix Daytime Linctus Pholcodine
Tixylix Night-time Linctus Promethazine HCl, pholcodine
Ulcaid* Gel Lignocaine HCl, ethyl alcohol,
cetylpyridinium chloride
Ulcaid Tablets Tyrothricin, benzocaine, cetylpyridinium
chloride
Venos* Liquid (dry cough) Glucose, treacle, aniseed oil, capsicum,
camphor
Venos* Liquid (expectorant) Guaiphenesin, glucose, treacle, aniseed oil,
capsicum, camphor
Venos* Liquid ("honey/lemon") Lemon juice, honey, glucose
Topical formulations
Biactol* Face wash ("regular Sodium lauryl ether sulphate,
skin") phenoxypropanol
Biactol Face wash ("sensitive Phenoxypropanol
skin")
Brolene Eyedrops Propamidine isethionate, benzalkonium
chloride, phenylethanol
Brolene Ointment Dibromopropamidine isethionate
Cupal Cold sore lotion Povidone iodine
Cupal* Cold sore ointment Diperodon HCl
Cupal Corn solvent Salicylic acid
Cupal Insect bite cream Antazoline HCl
Cupal* Nail bite cream Bitrex, turpentine oil, menthol, eucalyptus oil,
allantoin, camphor, zinc oxide
Cupal Verruca treatment Salicylic acid
Cupal Wart solvent Glacial acetic acid
Dettol* Mouth wash Cetylpyridinium chloride
Dettol* Cream Chloroxylenol, triclosan, edetic acid
Dettol* Liquid Chloroxylenol
Dettol Fresh antiseptic Benzalkonium chloride
disinfectant
Dettol* Soap Trichlorocarbanilide
Diprobase* Cream Chlorocresol
Diprobase* Ointment Liquid paraffin, white soft paraffin
Eludril* Mouthwash Chlorhexidine digluconate, chlorbutol
hemihydrate
Eludril Spray Chlorhexidine digluconate, amethocaine HCl
Fiery Jack* Cream Glycol salicylate, diethylamine salicylate,
capsicum oleoresin, methyl nicotinate
Fiery Jack* Ointment Capsicum oleoresin
Gelcotar Gel Coal tar, pine tar
Gelcotar* Shampoo Coal tar, cade oil
Germolene* Cream Chlorhexidine gluconate, phenol
Germolene* Ointment Anhydrous lanolin, yellow and white soft
paraffins, light liquid paraffin, starch, zinc
oxide, methyl salicylate, octaphonium
chloride, phenol
Germolene* Spray Triclosan, dichlorophen
Germolene* Wipes Benzalkonium chloride, chlorhexidine
gluconate
Germoloids* Cream, ointment Zinc oxide, lignocaine HCl
Germoloids* Suppositories Lignocaine HCl, zinc oxide
Germoloids* Wipes Chlorhexidine gluconate, benzalkonium
chloride, menthol
Hydromol* Emollient bath additive Liquid paraffin, isopropyl myristate
Hydromol* Cream Arachnis oil, isopropyl myristate, liquid
paraffin, sodium pyrrolidone carboxylate,
sodium lactate
Lacto calamine Cream Calamine, zinc oxide, zinc carbonate,
hamamelis water
Lacto calamine* Lotion Calamine, hamamelis water, phenol, zinc
oxide
Lana-sting Cream Benzyl alcohol, lignocaine
Lana-sting Spray Benzocaine, benzethonium chloride
Mycil* Footspray Tolnaftate
Mycil* Ointment Tolnaftate, benzalkonium chloride
Mycil* Powder Chlorhexidine HCl, tolnaftate
Mycota* Cream, powder Zinc undecanoate, undecanoic acid
Mycota* Spray Undecanoic acid, dichlorophen
Oilatum* Cream Arachis oil, povidone iodine
Oilatum* Emollient Liquid paraffin, acetylated wool alcohols
Oilatum* Gel Light liquid paraffin
Phytocil Cream Phenoxypropanol, chlorophenoxyethanol,
salicylic acid, menthol
Phytocil Powder Phenoxypropanol, chlorophenoxyethanol,
zinc undecanoate
Quinoderm Cream, gel Potassium hydroxyquinoline sulphate,
benzoyl peroxide
Quinoderm* Face wash Chlorhexidine gluconate, cetrimide, sodium
N-lauroyl sacosinate, lauric diethanolamide
Ralgex* Cream Methyl nicotinate, capsicin
Ralgex* Spray Glycol monosalicylate, ethyl salicylate, methyl
salicylate, methyl nicotinate
Ralgex* Stick Glycol salicylate, ethyl salicylate, methyl
salicylate, capsicin, menthol
Ralgex* Low odour spray Glycol monosalicylate, methyl nicotinate
Ralgex* Freeze spray Isopentane, methoxymethane, glycol
monosalicylate
Savlon* Liquid Chlorhexidine gluconate, cetrimide
Savlon* Nappy rash cream Dimethicone, cetrimide
Savlon* Antiseptic cream Cetrimide, chlorhexidine gluconate
Spectraban 4 Lotion Isoamyl dimethylaminobenzoate
Spectraban 10 Lotion Oxybenzone, 2-ethylhexyl-p-
methoxycinnamate
Spectraban 15 Lotion Isoamyl dimethylaminobenzoate
Spectraban Ultra Lotion Padimate (isoamyl dimethylaminobenzoate),
butyl methoxy dibenzoyl methane,
oxybenzone, titanium dioxide
Steripod Liquid (wound cleanser) Sodium chloride
Steripod Liquid (wound/burns Chlorhexidine gluconate, cetrimide
cleanser)
Steripod Liquid (antimicrobial) Chlorhexidine gluconate
Ster-Zac Powder Hexachlorophane
Ster-Zac Liquid (skin cleanser) Hexachlorophane
Ster-Zac* Liquid (bath concentrate) Triclosan
Ster-Zac Shaving foam Triclosan
Throaties* Linctus Glycerol, honey, citric acid
Throaties* Linctus (child) Acetic acid, ipecac liquid extract
Valderma* Cream Potassium hydroxyquinoline sulphate,
chlorocresol
Valderma* Soap Trichlorocarbanilide
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* Formulations on General Sales List.
@ Formulations for which some pack sizes or formulations are on General Sales List.
HCl = hydrochloride, HBr = hydrobromide. |
Confusion may have important consequences
I know of no similar differences in prescription only medicines (although different formulations of the same brand name product may contain different doses or have different release characteristics). Even if there were such differences it would be up to the prescribing doctor to make clear on his or her prescription which formulation was required. The patient cannot be expected to be so discriminatory, and confusion among formulations is possible. This might be important, for example, in cases of allergy to certain components of some formulations (especially with medicines used on the skin) or for patients with asthma induced by salicylate, who might not be aware that a particular formulation contains a salicylate.
Confusion may also arise in cases of self poisoning. An example of this recently came to the attention of the drug and therapeutics committee of Oxfordshire Health Authority. A young woman took an overdose of Anadin. Thinking that all formulations of Anadin contain aspirin, the admitting doctor measured the plasma concentration of salicylate and found none. The patient was subsequently found to have taken Anadin Paracetamol, which contains paracetamol and not aspirin.
Differences among formulations with the same or similar names are likely to be most important for formulations that are subject to control under the Medicines (General Sales List) Order 1977 and can be bought without a pharmacist being present. These are indicated in the table. Doctors should be aware of these differences among over the counter formulations with the same or similar names.
(Accepted 12 November 1993)
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