OSF Saint Francis Medical Center, Peoria, Illinois

...an educational memo from your Pharmacy and Therapeutics Committee

October, 2001

Insulin glargine is a new long-acting human insulin analog approved for type 1 and type 2 diabetes. This insulin product is distinctly different from all other available insulins, included the long-acting ultralente insulin. Administered once daily at bedtime, insulin glargine does not produce a peak concentration, but rather mimics a continuous infusion of rapid-acting regular insulin, with the effects lasting the full 24 hour period. Insulin glargine must not be mixed in the same syringe with any other solution or insulin. With the introduction of this and other new insulin products, verifying the insulin names on the bottles is very important in order to avoid a potentially serious medication error.

Given the way thousands of available drug products are prescribed, either by a hand-written prescription or through a verbal telephone order, it is easy to understand how an error can be made in choosing the correct medication. Many of these drugs have names that either look or sound alike. It is important that written orders are as clear as possible and verbal orders are repeated back to the prescriber. Providing the intended use for the drug can also eliminate confusion. Listed below are just a few of the many drugs that either sound or look alike when prescribed.

Serzone……. Seroquel Xanax………. Serax Zestril………. Desyrel

Celebrex…… Cerebrex Vexol……….. VoSol Vicodin………Hycodan

Lantus ……… Lente Volmax……...Flomax Stadol……….Sotalol

Accupril…….Accolate Slow K………Slow FE Os-Cal………Asacol

Xanax………Zantac Iodine……….Lodine Intropin………Isoptin

Xanax………Tenex Clinoril………Clozaril Captopril…….Capitol

The OSF Pharmacy carries two caffeine-containing products; caffeine citrate and caffeine and sodium benzoate. When ordering, each drug must be written out entirely to avoid confusion between these products and caffeine, which is not on the Formulary. Caffeine citrate is used for apnea in premature infants and is usually given IV or orally as a 20 mg/kg loading dose and then 10 mg/kg daily. Caffeine and sodium benzoate is used for post dural puncture headaches and is usually administered intravenously over 60 minutes with 500mg of the drug diluted in a 500 or 1000 ml solution