Consumer Experiences of Mispurchase Associated with Drug Names

Irina Glazkova, Anastasia Sinitsyna*, Tatiana Litvinova, Georgii Sarukhanian,

Olga Savinova, Dmitriy Babaskin

I.M. Sechenov First Moscow State Medical University (Sechenov University),

8-2 Trubetskaya Str., Moscow, 119991, Russia.

*Corresponding Author E-mail: i.a.sinitsyna@mail.ru, sinitsyna_a_a@staff.sechenov.ru

ABSTRACT:

Several studies suggest that confusable brand names are the most common reason for the mispurchase of medicinal products, accounting for a quarter (25%) of all errors made in the administration of medicinal products. The study aims to investigate the frequency of mistakes associated with the naming of medicinal products. The research shows that consumers tend to confuse medicinal products with the same and different dosage forms. In 65.3% of cases, mistakes are made when choosing between two brand names with the same administration method. The detected mistakes are classified by criticality according to the severity of their consequences. The analysis shows that 79.07% of mispurchases due to confusable brand names are marked by a high criticality of consequences, as consumers confuse medicinal products belonging to different pharmacological groups. Patients do not receive the necessary treatment and end up taking drugs that are not indicated for them, which is especially dangerous for chronic patients. In 5.81% of cases, consumers mix up the brand names of medicinal products and dietary supplements or medical devices or confuse dietary supplements. In 15.12% of cases, consumers confuse analogous medicinal products with the same active substance.

KEYWORDS: Consumerism, Medicinal products, Branding, Brand names, Market research.

INTRODUCTION: 

The safety of drugs is a fundamental problem in contemporary healthcare, especially given the increasing complexity of pharmaceutical treatments^1,2. The rising accessibility of prescription and over-the-counter drugs creates a new problem for healthcare providers, pharmacists, and consumers^3,4. One of the most acute problems is medication errors that occur at different stages of medication administration, from prescription and dispensing to self-administration by patients^5-7. A significant factor in these errors is drug naming. The names of drugs are sometimes phonetically or visually similar, leading to misidentification⁸.

The risks of such confusion are particularly high in environments where decisions need to be made quickly, such as pharmacies, hospitals, and emergency departments⁹. Even in less urgent circumstances, consumers themselves are prone to making mistakes, especially in self-medication scenarios or when relying on memory to select a familiar-sounding drug^10-12.

In the pharmaceutical industry, an informed approach to medicinal product (MP) naming is of particular importance because of its direct impact on consumer health^13,14. Unfortunate sound combinations and associations with MP brand names can be confusing to non-specialists^15,16. According to several studies, the error rate associated with confusing MP brand names is the highest in the process of MP acquisition (25%)^17,18. Studies on the acquisition of MPs from pharmacies also show that mispurchases associated with confusable brand names that result in the patient receiving a drug different from the prescribed one occur up to 3.9 million times a year in the USA¹⁹. Misuse of MPs, including at home, can lead to serious health consequences, which is especially dangerous for older people and those who live alone^20,21.

It is a topical objective to initiate the development of preventive recommendations on health-saving MP naming based on real cases. The task facing pharmaceutical companies is to develop new MP brand names that will not be confusable with the existing ones. This approach to MP naming should become an indispensable part of the strategy of pharmaceutical companies ensuring the safety of product consumers and preserving the brand’s positive reputation.

The study focuses on the frequency and nature of mistakes associated with drug names with an emphasis on the most commonly confused pairs of drugs. Using consumer experience analysis, we develop recommendations on how to improve medication naming practices, thereby helping to improve patient safety and reduce the likelihood of adverse outcomes.

METHODS:

Study design:

The study was conducted in 2023 in different regions of Russia. An online survey of respondents was chosen as the primary research method.

Sample:

The study sample consisted of 1,000 adult participants selected using randomized sampling techniques to ensure the representation of different demographic groups including age, gender, and health status. Participants were recruited from different regions and included people with recent experience of purchasing prescription or over-the-counter medicines. Inclusion criteria required respondents to have personally experienced or witnessed confusion or errors when purchasing medications due to similarities in drug names.

As a result of the survey, we identified 86 pairs of MPs the names of which were the most frequently confused by consumers.

Studied Medications:

The survey identified a total of 86 pairs of medications commonly confused by consumers due to similar-sounding or visually similar names. The pairs of drugs were analyzed based on their international nonproprietary name (INN), active substance, and pharmacological action according to the Anatomical Therapeutic Chemical (ATC) Classification System. The drugs mistaken for each other were categorized according to their therapeutic use, method of administration, and prescription status.

Data analysis:

The mistakes were categorized according to their potential impact on the patient's health: low, average, and high criticality. Frequency rates for each drug pair and error type and the prevalence of errors in the study sample were determined using statistical methods.

RESULTS:

In the course of the study, we identified 86 MP pairs most often confused by consumers.

Figure 1. Distribution of mistakes related to brand names by different methods of administration

In 65.3% of cases, the mixed-up drugs under different brand names have the same method of administration (Figure 1): 60.2% – internal, 4.1% – topical, and 1% – external. In 34.7% of cases, the mixed-up drugs have different forms of administration: internal topical (26.5%), internal injection (4.01%), external/topical internal (2.0%), external topical, and internal-external (1%). Table 1 shows the pairs of MPs mixed up most often.

Table 1. Top 20 MP brand names by mistake rate

Pair	Brand name	Status	Composition (active substance in the MP according to the INN)	ATC code	Mistake rate, %
1	Enap	MP	Enalapril	C09A	19.50%
	Enam	MP	Enalapril	C09A
2	Cetirizine	MP	Levocetirizine	R06A	17.23%
	Cinnarizine	MP	Cinnarizine	N07C
3	Valocordin	MP	Phenobarbital + Ethyl bromisovalerianate	N05C	13.84%
	Valocormid	MP	Atropa tincture + valerian tincture + lily of the valley tincture + sodium bromide + menthol racemic	N05C
4	Trekrezan	MP	Oxyethylammonium methylphenoxyacetate	A13A	11.45%
	Trexan	MP	Methotrexate	L01B
5	Imudon	MP	Bacterial lysates mixture	L03A	10.06%
	Imodium	MP	Loperamide	A07D
6	Paracetamol	MP	Paracetamol	M01A	5.66%
	Prostamol Uno	MP	Saw palmetto fruit extract	G04C
7	Loperamide	MP	Loperamide	A07D	5.16%
	Indapamide	MP	Indapamide	C03
8	Furosemide	MP	Furosemide	C03	4.78%
	Furacilin	MP	Nitrofural	D08A
9	Visomitin	MP	Plastoquinonyl-decyl-triphenylphosphonium bromide	S01X	3.90%
	Isoptin	MP	Verapamil	C08D
10	Furacilin	MP	Nitrofural	D08A	2.52%
	Furazolidone	MP	Furazolidone	J01
11	VitA-POS	MD	Ophthalmic lubricant with vitamin A	–	2.52%
	Vitaprost	MP	Prostate extract	G04B
12	Diazolin	MP	Mebhydrolin	R06A	2.52%
	Dibazol	MP	Bendazol	C04A
13	Triamtel	MP	Triamterene	C03	2.26%
	Co-trimoxazole	MP	Trimethoprim + sulfamethoxazole	J01
14	Melatonin	MP	Melatonin	N05C	2.26%
	Meloxicam	MP	Meloxicam	M01A
15	Ginkgoum	MP	Ginkgo biloba leaf extract	N06D	2.26%
	Imodium	MP	Loperamide	A07D
16	Ginkgoum	MP	Ginkgo biloba leaf extract	N06D	2.26%
	Ginkgo biloba	DS	Ginkgo biloba leaf extract	–
17	Enalapril	MP	Enalapril	C09A	2.14%
	Anaprilin	MP	Propranolol	C07A
18	TheraFlu	MP	Paracetamol + phenylephrine hydrochloride + pheniramine maleate	N02B	2.14%
	Theraflex	MP	Glucosamine hydrochloride + sodium chondroitin sulfate	M01B
19	Furagin	MP	Furazidine	J01	2.14%
	Furadonin	MP	Nitrofurantoin	J01
20	Espumisan	MP	Simeticone	A03A	2.01%
	Aescusan	MP	Horse chestnut seed extract dry + thiamine	C05

Table 1 lists both MPs and dietary supplements (DSs). Not only do consumers make mistakes when purchasing different MPs, but they also confuse MPs and DSs. The consequences of mistakes associated with MP brand names can be divided into three categories:

1) Low criticality – the two MPs belong to the same pharmacological group (15.12%). No matter which of the two drugs is used, the patient will receive the necessary treatment.

In half of the cases (46.15%) the drugs under the confusable brand names had the same active substance, being analogs. In case of such an error, the patient will receive the necessary treatment in full.

2) Average criticality – a DS is purchased instead of an MP (5.81%). In this case, the patient will not receive the necessary treatment, but the substances taken will not have any adverse side effects.

3) High criticality – instead of the necessary MP, the patient purchases an MP belonging to a different pharmacological group (79.07%). In this case, not only does the buyer not receive the treatment they need, but they also get an MP with indications for use that they do not have.

Drugs with low criticality of consequences of purchase error include 13 pairs (Table 2), among them six are analogs by their active substance (46.15%). The presented pairs of brand names contain the same combinations of letters (from three to seven letters).

Table 3 with an average criticality of consequences presents MPs and DSs. It can be concluded that adding the label “Biologically active additive” to the packaging does not help to avoid errors, and consumers are mainly guided by the brand name. Replacing an MP with a DS is less critical than taking an MP instead of a DS, as in the second case the customer receives an unnecessary therapeutic effect. However, the risk increases for chronic patients and patients in the acute phase of the disease, as they may not receive the necessary treatment.

The results of our survey also show that there is a possibility of mispurchasing a medical device (MD) instead of an MP. The MD we are referring to (VitA-POS – an ophthalmic lubricant with vitamin A) is sold in primary packaging matching that of an MP (a tube). In addition, this MD contains an active ingredient, which may cause additional difficulties in consumer perception.

Table 2. Top MPs with low criticality of consequences

Pair	Brand name	Status	Composition (active substance in the MP according to the INN)	ATC code	Mistake rate, %
1	Enap	MP	Enalapril	C09A	43.79%
	Enam	MP	Enalapril	C09A
2	Valocordin	MP	Phenobarbital + Ethyl bromisovalerianate	N05C	31.07%
	Valocormid	MP	Atropa tincture + valerian tincture + lily of the valley tincture + sodium bromide + menthol racemic	N05C
3	Furagin	MP	Furazidine	J01	4.80%
	Furadonin	MP	Nitrofurantoin	J01
4	Rhinonorm	MP	Xylometazoline	R01AA	2.24%
	Rhinostop	MP	Xylometazoline	R01AA
5	Iod	MP	Iodine	D08A	4.24%
	Iodinol	MP	Iodine	D08A
6	Motilak	MP	Domperidone	A03FA	2.82%
	Motilium	MP	Domperidone	A03FA
7	Suprastin	MP	Chloropyramine	R06A	1.98%
	Suprastinex	MP	Levocetirizine	R06A
8	Amoxicillin	MP	Amoxicillin	J01	1.69%
	Azithromycin	MP	Azithromycin	J01
9	Clarithromycin	MP	Clarithromycin	J01	1.69%
	Clindamycin	MP	Clindamycin	J01
10	Nurofen	MP	Ibuprofen	M01A	1.41%
	Ibuprofen	MP	Ibuprofen	M01A
11	Tempalgin	MP	Sodium metamizole + triacetonamine-4-toluenesulfonate	N02	1.13%
	Pentalgin	MP	Drotaverine hydrochloride + caffeine anhydrous + naproxen + Paracetamol + pheniramine maleate	N02
12	Aspirin	MP	Acetylsalicylic acid	N02B	0.57%
	Analgin	MP	Sodium metamizole	N02B
13	Cetrine	MP	Cetirizine	R06A	0.57%
	Cetirizine	MP	Cetirizine	R06A

Table 3. Top MPs with average criticality of consequences

Pair	Brand name	Status in the State Register of Medicinal Products	Composition (active substance in the MP according to the INN)	ATC code	Mistake rate, %
1	VitA-POS	MD	Ophthalmic lubricant with vitamin A	–	33.90%
	Vitaprost	MP	Prostate extract	G04B
2	Ginkgoum	MP	Ginkgo biloba leaf extract	N06D	30.51%
	Ginkgo biloba	DS	Ginkgo biloba leaf extract	–
3	Keratin	DS	Keratin	–	11.86%
	Creatine	DS	Creatine	–
4	Fitoval	DS	Medicinal yeast	–	11.86%
	Phytolax	DS	Senna leaves, senna extract dry, apricots, plantain leaves, dill fruit	–
5	Concor	MP	Bisoprolol	C07A	10.17%
	Calmag	DS	Magnesium and calcium citrates	–
6	Lysobact	MP	Lysozyme hydrochloride + pyridoxine hydrochloride	R02AA	1.69%
	Livosil	DS	Artichoke leaves extract	–

Table 4. Top 20 MPs with high criticality of consequences

Pair	Brand name	Status	Composition (active substance in the MP according to the INN)	ATC code	Mistake rate, %
1	Cetirizine	MP	Levocetirizine	R06A	14.35%
	Cinnarizine	MP	Cinnarizine	N07C
2	Trekrezan	MP	Oxyethylammonium methylphenoxyacetate	A13A	9.53%
	Trexan	MP	Methotrexate	L01B
3	Imudon	MP	Bacterial lysates mixture	L03A	8.38%
	Imodium	MP	Loperamide	A07D
4	Paracetamol	MP	Paracetamol	M01A	4.71%
	Prostamol Uno	MP	Saw palmetto fruit extract	G04C
5	Loperamide	MP	Loperamide	A07D	4.29%
	Indapamide	MP	Indapamide	C03
6	Furosemide	MP	Furosemide	C03	3.98%
	Furacilin	MP	Nitrofural	D08A
7	Visomitin	MP	Plastoquinonyl-decyl-triphenylphosphonium bromide	S01X	3.25%
	Isoptin	MP	Verapamil	C08D
8	Furacilin	MP	Nitrofural	D08A	2.09%
	Furazolidone	MP	Furazolidone	J01
9	Diazolin	MP	Mebhydrolin	R06A	2.09%
	Dibazol	MP	Bendazol	C04A
10	Triamtel	MP	Triamterene	C03	1.88%
	Co-trimoxazole	MP	Trimethoprim + sulfamethoxazole	J01
11	Melatonin	MP	Melatonin	N05C	1.88%
	Meloxicam	MP	Meloxicam	M01A
12	Ginkgoum	MP	Ginkgo biloba leaf extract	N06D	1.88%
	Imodium	MP	Loperamide	A07D
13	Enalapril	MP	Enalapril	C09A	1.78%
	Anaprilin	MP	Propranolol	C07A
14	TheraFlu	MP	Paracetamol + phenylephrine hydrochloride + pheniramine maleate	N02B	1.78%
	Theraflex	MP	Glucosamine hydrochloride + sodium chondroitin sulfate	M01B
15	Espumisan	MP	Simeticone	A03A	1.68%
	Aescusan	MP	Horse chestnut seed extract dry + thiamine	C05
16	Tyzine Classic	MP	Xylometazoline	R01AA	1.68%
	Visine Classic	MP	Tetryzoline	S01G
17	Phezam	MP	Piracetam + Cinnarizine	N06B	1.57%
	Phenazepam	MP	Bromdihydrochlorphenylbenzodiazepine	N05B
18	Femara	MP	Letrozole	L02	1.47%
	Femoston	MP	Dydrogesterone + Estradiol	G03
19	Furosemide	MP	Furosemide	C03	1.36%
	Furazolidone	MP	Furazolidone	J01
20	Dibazol	MP	Bendazol	C04A	1.36%
	Itrazol	MP	Itraconazole	J02A

The pairs of MPs presented in Table 4 have highly critical consequences when confused. Because they belong to different pharmacological groups, mixing up their brand names is unsafe for patients.

The results in Table 4 thus clearly demonstrate the need to control the creation of brand names for MPs²², as consumers can easily mistake MPs of different groups. The factors contributing to such mistakes include consonant MP names, well-known brands, and actively promoted slogans.

DISCUSSION:

The analysis indicates that 79.07% of mistakes associated with MP brand names have highly critical consequences: patients not only do not receive the necessary treatment but also take MPs with indications for use that are irrelevant to their situation²³. These findings are especially important to consider for patients with chronic diseases, in whom delaying or prescribing inappropriate therapy can lead to disease exacerbation or even life-threatening complications. This aligns with the conclusions drawn by K. Doheny²⁴ and M.F. Rasool et al.²⁵, who also report that mistakes in drug administration made because of confusable brand names often lead to serious health risks, especially in patients with complex medical histories or those taking multiple medications at the same time²⁶.

In 5.81% of the cases, consumers mix up an MP with a DS or MD or confuse two different DSs. This is consistent with other studies, such as one by D. Almaghaslah²⁷, which emphasize the frequency of confusion between pharmaceuticals and non-pharmaceutical products. Almaghaslah²⁷ found that consumers often rely on brand recognition or product familiarity, which increases the risk of confusing therapeutic drugs with supplements, especially when packaging or names are similar^28,29.

CONCLUSION:

Proceeding from the study, we believe it necessary to create a bank of brand names based on cognate words that distinguish MPs from each other by a few letters (that do not complicate the patient's experience of choosing any MP). It is possible to use cognate words in the trade names of MPs with the same pharmacological group and pharmacological action.

Patients are particularly at risk when using MPs from their home medicine cabinet because they are not properly monitored and counseled by pharmacists. Patients tend to base their choice of MP on familiar sounds, single words, similar syllables, or memories of slogans from advertisements.

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Received on 26.09.2024      Revised on 17.01.2025

Accepted on 14.04.2025 Published on 02.08.2025

Available online from August 08, 2025

Research J. Pharmacy and Technology. 2025;18(8):3901-3906.

DOI: 10.52711/0974-360X.2025.00560

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