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 Table of Contents    
LETTERS TO EDITOR  
Year : 2016  |  Volume : 58  |  Issue : 3  |  Page : 347-348
Clomipramine, clomiphene, and generic drug-dispensing errors


1 Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
2 Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

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Date of Web Publication12-Oct-2016
 

How to cite this article:
Bavle A, Andrade C. Clomipramine, clomiphene, and generic drug-dispensing errors. Indian J Psychiatry 2016;58:347-8

How to cite this URL:
Bavle A, Andrade C. Clomipramine, clomiphene, and generic drug-dispensing errors. Indian J Psychiatry [serial online] 2016 [cited 2020 Sep 22];58:347-8. Available from: http://www.indianjpsychiatry.org/text.asp?2016/58/3/347/192020


Sir,

Brand names may show similarities between neuropsychiatric drugs and drugs belonging to other medical specializations. For example, in 2015, the USA Food and Drug Administration issued a warning about prescribing and dispensing errors resulting from brand name confusion between the antidepressant drug Brintellix (vortioxetine) and the antiplatelet drug Brilinta (ticagrelor).[1] Brand names show similarities even within the neuropsychiatric domain. This is understandable when the pharmacological content is the same, but can result in potentially serious dispensing errors when the pharmacological content is different.[2],[3]

Physicians in India are exhorted to prescribe drugs by their generic name rather than by a brand name; or, more specifically, by their chemical name rather than by a brand name (the distinction is subtle but important; most Indian brands are actually generic because the original brands are out of patent). Here, we report how even generic prescriptions can result in dispensing errors.

A 35-year-old male with obsessive-compulsive disorder was prescribed clomipramine 100 mg/day in divided doses. There was no improvement; so, at a 1-month follow-up, the dose was increased to 150 mg/day. Two months later, there was still no improvement. An examination of the pill strips in his possession showed that he was actually taking six tablets of clomiphene citrate (25 mg, each) daily, and not clomipramine, as advised. He was referred to an endocrinologist; fortunately, there were no adverse consequences associated with 3 months of daily clomiphene use.

Our report illustrates how dispensing errors can arise from generic prescriptions; thus, the problem is not with similar-sounding brands, alone. Similar concerns have been reported by other authors, and computer-assisted alerts are suggested to flag possible errors.[4] Such alerts are not possible in India, given the current health-care standards. Therefore, there are several take-home messages for medical practice in India. Clinicians should write legibly. Patients should be asked to confirm that they have been dispensed with the same drug as that advised; if necessary, they should return to check with the prescriber. Finally, patients should be asked to always bring their medication strips along at follow-up so that compliance to the right drug, dose, and schedule can be checked. This is especially important when patients fail to show the expected response, and more so when unexpected adverse effects develop.

As a parting note, clomiphene is fortunately safe during long-term use. Whereas it is used for inducing ovulation in infertile women, it can also be used in men for the treatment of hypogonadism and infertility in doses such as 25–50 mg on alternate days for months to years.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Food and Drug Administration. FDA Drug Safety Podcast: FDA Warns about Prescribing and Dispensing Errors Resulting from Brand Name Confusion with Antidepressant Brintellix (Vortioxetine) and Antiplatelet Brilinta (Ticagrelor). Available from: http://www.fda.gov/Drugs/DrugSafety/DrugSafetyPodcasts/ucm456897.htm. [Last accessed on 2015 Jan 28].  Back to cited text no. 1
    
2.
Andrade C. Psychotropic drugs: What's in a name? Indian J Psychiatry 1996;38:192.  Back to cited text no. 2
    
3.
Shamasundar C. Prescriber'S nightmare. Indian J Psychiatry 1992;34:397-8.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Galanter WL, Bryson ML, Falck S, Rosenfield R, Laragh M, Shrestha N, et al. Indication alerts intercept drug name confusion errors during computerized entry of medication orders. PLoS One 2014;9:e101977.  Back to cited text no. 4
    
5.
Katz DJ, Nabulsi O, Tal R, Mulhall JP. Outcomes of clomiphene citrate treatment in young hypogonadal men. BJU Int 2012;110:573-8.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Amar Bavle
Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.192020

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