Changing Australian medicine names with Jerry Yik

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I’m Dhineli Perera, your host for this episode, and it's a pleasure to be speaking to Jerry Yik today about changing Australian medicine names. Jerry Yik is a policy analyst at the Society of Hospital Pharmacists of Australia. He also currently works as a hospital and community pharmacist in Melbourne. In the June edition of Australian Prescriber Jerry explains how the Therapeutic Goods Administration is changing the names of approximately 200 medicines. Jerry, welcome to the program.

Thank you very much Dhineli.

The main aim of these changes is to harmonise Australian medicine names with international names. Can you tell us a bit more about these changes and how they ultimately improve medication safety?

The whole idea of this was to harmonise what's known as the Australian Approved Names or the AAN with the international names known as the International Non-proprietary Name, to reduce the confusion and inconsistency with medicines naming. And the whole idea of this was to ultimately improve medication safety and the quality use of medicines. We know that in a country like Australia there are a lot of health practitioners who travel internationally, a lot of patients who travel internationally and also there’s a high level of practitioners from overseas that come to Australia. So there can be situations that arise where what you know as a certain medicine name may be different to what you've known it as your entire life of practising and what you've learnt at university and suddenly, when you’re put into a different sitting altogether, there might potentiate some confusion, can lead to prescribing errors and ultimately medication errors as well.

All right, OK, so sort of bringing it in line with everyone else?

Yeah, pretty much.

OK and so most of the medicines will have a four-year transitional arrangement is my understanding. How is it decided which medicines will require a seven-year transition and why?

So some medicines require a seven-year transition requirements and these seven-year transition requirements mean that they needed to undergo dual labelling so on the medicine label and also on the dispensing label it should show both names. So just for example for frusemide, what it’ll change to is furosemide, so what should appear now on medicine labels is furosemide and then afterwards in brackets frusemide, and all medicine labels for furosemide should show both those names for the next seven years until 2023, and then from 2023 only furosemide should be used and frusemide will never be used ever again. Now how it was decided that these medicines would require dual labelling, because the TGA’s determined that they just carry more significant risk and more clinical significance that required dual labelling, and I think the reason for this is that their new name is just that little bit more different that could potentiate some confusion and may be misconstrued as another medication altogether. So for example another medicine that requires dual labelling is dothiepin. Dothiepin will now be known as dosulepin. For another example, lignocaine is now lidocaine, or glycopyrrolate and glycopyrronium. So there’s just enough variation in those letters that it may be misconstrued as a new medicine and we know, you know, when you’re studying chemistry and biology a few letters can actually mean something else altogether, so that's why they've used dual labelling for these ones. But they haven't for say amoxicillin and cefalexin that have just literally one or two letters changed. The chances of having amoxicillin and cefalexin misconstrued as something else is very very low.

Right, so the medicines that will have the four-year transition won't have the dual labelling. Is that correct?

That's right.

Yeah, OK, so can you tell us a bit more about why adrenaline and noradrenaline will be treated so differently to all other medicines?

Yeah, so adrenaline and noradrenaline, just to be clear, they are not the International Non-proprietary Names. The INN for these medicines is epinephrine and norepinephrine. Now adrenaline and noradrenaline have received special treatment because the naming is so inherent and so fixed in our systems and in our healthcare environment, and due to their therapeutic use in anaphylaxis and life-threatening situations, the risk in changing these names completely is too great in terms of safe prescribing, dispensing and administration, especially where time is very very critical. So from now on adrenaline and noradrenaline will always be known dually as adrenaline (epinephrine) and noradrenaline (norepinephrine). So it's the Australian Approved Name first and then the INN in parentheses afterwards.

Right, OK, that sounds fair enough. Some medicine names will not change despite having common alternatives used overseas. Can you tell us a bit more about those?

I think the reason why the medicine names for those haven't changed despite common uses overseas is because we are already currently using the INN and therefore there's no reason to change that. I think when people say they're commonly used overseas it's probably because in the American context, where a lot of research does come out, so for example is paracetamol, which is what we know in Australia, that already is the INN, whereas in America they know that as acetaminophen. For what we know as salbutamol here, which is used in your asthma relievers, that's known as albuterol in America. But because Australia already uses INN we're not changing that, and the onus is on the other countries that don't use INN to change their practices if they do think that there is an inherent risk.

Obviously health professionals have to lead the way with communicating changes to patients. What resources have been developed to help us do that?

Therapeutic Goods Administration has come up with some resources both for consumers, pharmacists and doctors that provides some leaflets and handouts, so you can put in your pharmacy or the GP practice that let consumers know that there may have been a change to your medicine name and that you need to speak to your doctor and/or your pharmacist to be across them. Similarly with the Australian Government Department of Health they've also come up with a leaflet that explains these changes as well, what was just some examples of what was the previously active name and what the updated active name now is.

Okay, great, and I think there is a link in your article online to some of those resources.

Yeah there is.

So speaking of resources I imagine this will be a huge project to update medicine information resources. Do you know when and how these changes will appear in references like Australian Medicines Handbook?

So it is quite a massive change that all these resources have had to undertake and that's sort of why they've been given a four-year transition period. I know with the Australian Medicines Handbook currently the monograph is still directed to the current Australian Approved Name and it hasn't transitioned over to what the new name will be. However if you look on the index for the new name, it will say see old name and then you look at the old name again and then you’re directed to the page. So for example if you search furosemide, FUR…, in AMH it'll tell you to go look at frusemide instead. Same for something quite different, so trimeprazine is going to change to alimemazine which is quite a massive change in spelling, so if you look at the new spelling, oh sorry, the new name which is alimemazine, it will tell you to look at trimeprazine.

All right, OK, so the index has got both of them at the moment but the monographs are yet to change.

That's right and the other resources that will really change, things like your Therapeutic Guidelines, MIMS, any clinical guidelines that are used in local hospitals. Another thing that needs to change would be, as hospitals make the move towards using electronic medical records and they track health records, the data sets that they’re loaded up with need to reflect the new names as well.

So it is a big project then? Yeah, I think people will probably have to get used to looking at both names in some resources until it's completely changed over.

That's right.

Yeah, OK. And so you also mentioned in your article that these changes were completed in the UK and New Zealand already, which is nice to have someone else as a guinea pig for big changes like this. Do you know if there are any incidents that occurred in those countries and, if so, how we will mitigate the risk of those incidents occurring here?

Yeah. I tried to do a literature search as to if there were any medication errors or many adverse events that were attributed to when they decided to harmonise their medicine names, and unfortunately I wasn't able to find much data on this. But I wouldn't say that's because it doesn't occur. I think it might be because medicine adverse events are multifactorial and, if they did occur, they may not have been entirely attributed to a confusion in name change. It might be, you know, some other factor. I did come across an interesting anecdote in America where, I’m not sure it was America but it was another country where they knew paracetamol as acetaminophen and someone who had overdosed on paracetamol had ordered acetaminophen off the internet and then while they were in quite a bad state and trying to communicate that to the nurses and the doctors in the emergency department, they were saying one drug name but they just weren't understanding what it was and so the paracetamol overdose wasn't detected for quite some time later.

That's unfortunately all the time we've got for this episode. Thanks for joining us today Jerry.

Thanks Dhineli.

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Jerry Yik’s full article is available online at nps.org.au/australian-prescriber and, like our whole journal, it's free. Subscribe to get the latest Australian Prescriber delivered straight to your email inbox and follow us on Twitter @AustPrescriber to get the latest updates. The views of the hosts and guests on the podcast are their own and may not represent Australian Prescriber or NPS MedicineWise. I'm Dhineli Perera and thanks for joining us on the Australian Prescriber Podcast.