Prescription Drugs--Brand and Generic Names

“Say Curmudge, a few weeks ago we talked about your wife’s fall in Prague that dislocated her shoulder. How is she doing?”

“When we got back to the U.S. we learned that she had injured her rotator cuff, so it was repaired in our outpatient surgery unit. Her take-home instructions for controlling pain were to take one MS Contin tablet every 12 hours starting at 8:00 p.m. and one or two Percocet tablets as needed every four hours. Our experience with these meds was instructive, so I put our dialog into a script. You, Jaded Julie, can play the part of Mrs. Curmudgeon.”

“Okay, as long as I don’t have to fall down and break something.”

“You’re settled into your recliner, MK, so I’ll go to the drugstore and get these two prescriptions filled.”

“Don’t take too long, Mudge, the anesthetic is wearing off and my shoulder is beginning to hurt.”

So I took the two scripts, one for Percocet and the other for MS Contin, and had them filled. When I returned home and took the bottles out of the bag, one was labeled OXYCODONE/APAP and the other MORPHINE SULFATE ER. Apparently we had received generic substitutes for the prescribed meds. But which was which? I read the fine print on the page of cautions that accompanied each bottle, but Percocet was not mentioned anywhere.

“Mudge, CODONE sounds a bit like Contin, so maybe I should be taking the other stuff, the MORPHINE SULFATE, as needed.”

“Nope MK. Until I learn more, we’d better trust the pharmacist and take the pills in the bottle that says ‘every four hours as needed’ even though the bottle isn’t labeled Percocet. Meanwhile, there’s something I want to track down.”

“Track! Curmudge, you couldn’t track an elephant in four feet of snow.”

“C’mon, Julie, stick with the script. No improvisation allowed.” “I found it, MK. A book on prescription drugs that I bought for 50 cents at the used book sale. It says that oxycodone with acetaminophen is sold under the brand name Percocet and morphine is sold under the brand name MS Contin. We’ve got the right stuff.”

“Please Curmudge, can I go back to being Jaded Julie? If I stay Mrs. Curmudgeon much longer I’ll have to get color put in my hair.”

“Okay, Julie, you can be you again. I think you see the problem; generic drugs are great because they cost less, but the names are often unfamiliar. As we have experienced, even health care providers most often prescribe drugs by brand name (1). So our systems need to be designed to prevent the patient’s becoming confused as to what is in a given bottle. That could easily happen if the patient is still woozy following outpatient surgery.”

“The uncertainty that you and Mrs. C experienced would have been avoided if the bottles had been labeled ‘OXYCODONE substitute for Percocet’ and ‘MORPHINE SULFATE substitute for MS Contin.’”

“I have seen that on labels for other meds; perhaps it should be on all bottles where a generic has been substituted for the prescribed brand name drug. Of course, a puzzled patient could always call the pharmacist or the physician or find a table of brand and generic drug names on the computer (2). But senior citizens and lots of other folks may be reluctant or unable to do any of these things.”

“Curmudge, it’s a good thing your wife didn’t take the extended-release morphine sulfate every four hours; she would have accumulated a real snoot full of morphine.”

“And possibly a worse case of constipation.”

Affinity’s Kaizen Curmudgeon

(1) Steinman, M. A., et al. What’s in a name? Use of brand versus generic drug names in United States outpatient practice. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1852907
(2) http://www.rxlist.com/drugs/alpha_a.htm