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What's in a brand name?

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6937.1140 (Published 30 April 1994) Cite this as: BMJ 1994;308:1140
  1. J K Aronson, clinical reader in clinical pharmacologya
  1. a University Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE
  1. Correspondence to: Dr Aronson.
  • Accepted 12 November 1993

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

View this table:

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.

References

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