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Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


his list of confused drug names, which includes look-alike and
sound-alike name pairs, consists of those name pairs that have
been published in the ISMP Medication Safety Alert! and the
ISMP Medication Safety Alert! Community/Ambulatory Care Edition.
Events involving these medications were reported to ISMP through
either the ISMP National Medication Errors Reporting Program (ISMP
MERP) or ISMP National Vaccine Errors Reporting Program (ISMP
VERP). We hope you will use this list to determine which medications

require special safeguards to reduce the risk of errors. This may


include strategies such as: using both the brand and generic names on
prescriptions and labels; including the purpose of the medication on
prescriptions; configuring computer selection screens to prevent lookalike names from appearing consecutively; and changing the appearance of look-alike product names to draw attention to their dissimilarities. Both the FDA-approved and the ISMP-recommended tall man
(mixed case) letters have been included in the list below.
Updated February 2015

Drug Name

Confused Drug Name

Abelcet
amphotericin B
Accupril
Aciphex
acetaZOLAMIDE
acetoHEXAMIDE
acetic acid for irrigation
glacial acetic acid
acetoHEXAMIDE
acetaZOLAMIDE
Aciphex
Accupril
Aciphex
Aricept
Activase
Cathflo Activase
Activase
TNKase
Actonel
Actos
Actos
Actonel
Adacel (Tdap)
Daptacel (DTaP)
Adderall
Inderal
Adderall
Adderall XR
Adderall XR
Adderall
ado-trastuzumab emtansine
trastuzumab
Advair
Advicor
Advicor
Advair
Advicor
Altocor
Afrin (oxymetazoline)
Afrin (saline)
Afrin (saline)
Afrin (oxymetazoline)
Aggrastat
argatroban
Aldara
Alora
Alkeran
Leukeran
Alkeran
Myleran
Allegra Anti-Itch Cream (diphenhydrAMINE/allantoin)
Allegra (fexofenadine)
Allegra
Viagra
Allegra Anti-Itch Cream (diphenhydrAMINE/allantoin)
Allegra (fexofenadine)
Alora
Aldara
ALPRAZolam
LORazepam
Altocor
Advicor
amantadine
amiodarone
Amaryl
Reminyl
Ambisome
amphotericin B
Amicar
Omacor

Drug Name

Confused Drug Name

Amikin
Kineret
aMILoride
amLODIPine
amiodarone
amantadine
amLODIPine
aMILoride
amphotericin B
Abelcet
amphotericin B
Ambisome
Anacin
Anacin-3
Anacin-3
Anacin
antacid
Atacand
Anticoagulant Citrate Dextrose Solution Formula A Anticoagulant Sodium Citrate Solution
Anticoagulant Sodium Citrate Solution Anticoagulant Citrate Dextrose Solution Formula A
Antivert
Axert
Anzemet
Avandamet
Apidra
Spiriva
Apresoline
Priscoline
argatroban
Aggrastat
argatroban
Orgaran
Aricept
Aciphex
Aricept
Azilect
ARIPiprazole
proton pump inhibitors
ARIPiprazole
RABEprazole
Arista AH (absorbable hemostatic agent)
Arixtra
Arixtra
Arista AH (absorbable hemostatic agent)
Asacol
Os-Cal
Atacand
antacid
atomoxetine
atorvastatin
atorvastatin
atomoxetine
Atrovent
Natru-Vent
Avandamet
Anzemet
Avandia
Prandin
Avandia
Coumadin
AVINza
INVanz
AVINza
Evista
Axert
Antivert
azaCITIDine
azaTHIOprine

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.

www.ismp.org

Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


Drug Name

Confused Drug Name

Drug Name

Confused Drug Name

azaTHIOprine
Azilect
B & O (belladonna and opium)
BabyBIG
Bayhep-B
Bayhep-B
Bayrab
Bayrab
Bayrho-D
Bayrho-D
Beano
Benadryl
benazepril
Benicar
Betadine (with providone-iodine)
Betadine (without providone-iodine)
Bextra
Bicillin C-R
Bicillin L-A
Bicitra
Bidex
Brethine
Bio-T-Gel
Brevibloc
Brevital
Brilinta
Brintellix
buPROPion
busPIRone
Capadex [non-US product]
Capex
Carac
captopril
carBAMazepine
CARBOplatin
Cardene
Cardizem
Cardura
carvedilol
Casodex
Cathflo Activase
Cedax
ceFAZolin
cefTRIAXone
CeleBREX
CeleBREX

azaCITIDine
Aricept
Beano
HBIG (hepatitis B immune globulin)
Bayrab
Bayrho-D
Bayhep-B
Bayrho-D
Bayhep-B
Bayrab
B & O (belladonna and opium)
benazepril
Benadryl
Mevacor
Betadine (without providone-iodine)
Betadine (with providone-iodine)
Zetia
Bicillin L-A
Bicillin C-R
Polycitra
Videx
Methergine
T-Gel
Brevital
Brevibloc
Brintellix
Brilinta
busPIRone
buPROPion
Kapidex
Kapidex
Kuric
carvedilol
OXcarbazepine
CISplatin
Cardizem
Cardene
Coumadin
captopril
Kapidex
Activase
Cidex
cefTRIAXone
ceFAZolin
CeleXA
Cerebyx

CeleXA
CeleXA
CeleXA
Cerebyx
Cerebyx
cetirizine
cetirizine
chlordiazePOXIDE
chlorproMAZINE
chlorproMAZINE
chlorproPAMIDE
Cidex
CISplatin
Claritin (loratadine)
Claritin-D
Claritin-D 24
Claritin Eye (ketotifen fumarate)
Clindesse
Clindets
clobazam
clomiPHENE
clomiPRAMINE
clonazePAM
clonazePAM
clonazePAM
cloNIDine
cloNIDine
Clozaril
coagulation factor IX (recombinant)
codeine
Colace
Colazal
colchicine
Comvax
Cortrosyn
Coumadin
Coumadin
Covaryx HS
Covera HS
Cozaar
Cozaar
cyclophosphamide
cycloSERINE
cycloSPORINE
cycloSPORINE
Cymbalta

ZyPREXA
CeleBREX
Cerebyx
CeleBREX
CeleXA
sertraline
stavudine
chlorproMAZINE
chlordiazePOXIDE
chlorproPAMIDE
chlorproMAZINE
Cedax
CARBOplatin
Claritin Eye (ketotifen fumarate)
Claritin-D 24
Claritin-D
Claritin (loratadine)
Clindets
Clindesse
clonazePAM
clomiPRAMINE
clomiPHENE
clobazam
cloNIDine
LORazepam
clonazePAM
KlonoPIN
Colazal
factor IX complex, vapor heated
Lodine
Cozaar
Clozaril
Cortrosyn
Recombivax HB
colchicine
Avandia
Cardura
Covera HS
Covaryx HS
Colace
Zocor
cycloSPORINE
cycloSPORINE
cyclophosphamide
cycloSERINE
Symbyax

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.

www.ismp.org

Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


Drug Name

Confused Drug Name

Drug Name

Confused Drug Name

DACTINomycin
Daptacel (DTaP)
DAPTOmycin
Darvocet
Darvon
DAUNOrubicin
DAUNOrubicin
DAUNOrubicin
DAUNOrubicin citrate liposomal
Denavir
Depakote
Depakote ER
Depo-Medrol
Depo-Provera
Depo-subQ provera 104
desipramine
Desyrel
dexmethylphenidate
Diabenese
Diabeta
Diamox
Diflucan
Dilacor XR
Dilaudid
Dilaudid-5
dimenhyDRINATE
diphenhydrAMINE
Dioval
Diovan
Diovan
Diovan
Diprivan
Diprivan
disopyramide
Ditropan
DOBUTamine
DOPamine
Doribax
Doxil
DOXOrubicin
DOXOrubicin
DOXOrubicin
DOXOrubicin liposomal
Dulcolax (bisacodyl)
Dulcolax (docusate sodium)
DULoxetine

DAPTOmycin
Adacel (Tdap)
DACTINomycin
Percocet
Diovan
DAUNOrubicin citrate liposomal
DOXOrubicin
IDArubicin
DAUNOrubicin
indinavir
Depakote ER
Depakote
Solu-MEDROL
Depo-subQ provera 104
Depo-Provera
disopyramide
SEROquel
methadone
Diamox
Zebeta
Diabenese
Diprivan
Pilocar
Dilaudid-5
Dilaudid
diphenhydrAMINE
dimenhyDRINATE
Diovan
Dioval
Zyban
Darvon
Diflucan
Ditropan
desipramine
Diprivan
DOPamine
DOBUTamine
Zovirax
Paxil
DAUNOrubicin
DOXOrubicin liposomal
IDArubicin
DOXOrubicin
Dulcolax (docusate sodium)
Dulcolax (bisacodyl)
FLUoxetine

Durasal
Durezol
Duricef
Dynacin
Dynacirc
edetate calcium disodium
edetate disodium
Effexor
Effexor XR
Effexor XR
Enablex
Enbrel
Engerix-B adult
Engerix-B pediatric/adolescent
Enjuvia
ePHEDrine
EPINEPHrine
epirubicin
eribulin
Estratest
Estratest HS
ethambutol
ethaverine [non-US name]
Ethmozine
etravirine
Evista
factor IX complex, vapor heated
Fanapt
Farxiga
Fastin (phentermine)
Fastin (dietary supplement)
Femara
Femhrt
fentaNYL
Fetzima
Fioricet
Fiorinal
flavoxATE
Flonase
Floranex
Florastor
Florinef
Florinef
Flovent
flumazenil
FLUoxetine

Durezol
Durasal
Ultracet
Dynacirc
Dynacin
edetate disodium
edetate calcium disodium
Effexor XR
Enablex
Effexor
Effexor XR
Levbid
Engerix-B pediatric/adolescent
Engerix-B adult
Januvia
EPINEPHrine
ePHEDrine
eribulin
epirubicin
Estratest HS
Estratest
Ethmozine
etravirine
ethambutol
ethaverine [non-US name]
AVINza
coagulation factor IX (recombinant)
Xanax
Fetzima
Fastin (dietary supplement)
Fastin (phentermine)
Femhrt
Femara
SUFentanil
Farxiga
Fiorinal
Fioricet
fluvoxaMINE
Flovent
Florinef
Florinef
Floranex
Florastor
Flonase
influenza virus vaccine
PARoxetine

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.

www.ismp.org

Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


Drug Name

Confused Drug Name

FLUoxetine
DULoxetine
FLUoxetine
Loxitane
fluvoxaMINE
flavoxATE
Focalgin B
Focalin
Focalin
Focalgin B
Folex
Foltx
folic acid
folinic acid (leucovorin calcium)
folinic acid (leucovorin calcium)
folic acid
Foltx
Folex
fomepizole
omeprazole
Foradil
Fortical
Foradil
Toradol
Fortical
Foradil
gentamicin
gentian violet
gentian violet
gentamicin
glacial acetic acid
acetic acid for irrigation
glipiZIDE
glyBURIDE
Glucotrol
Glycotrol
glyBURIDE
glipiZIDE
Glycotrol
Glucotrol
Granulex
Regranex
guaiFENesin
guanFACINE
guanFACINE
guaiFENesin
HBIG (hepatitis B immune globulin)
BabyBIG
Healon
Hyalgan
heparin
Hespan
Hespan
heparin
HMG-CoA reductase inhibitors ("statins")
nystatin
HumaLOG
HumuLIN
HumaLOG
NovoLOG
HumaLOG Mix 75/25
HumuLIN 70/30
Humapen Memoir (for use with HumaLOG)
Humira Pen
Humira Pen
Humapen Memoir (for use with HumaLOG)
HumuLIN
NovoLIN
HumuLIN
HumaLOG
HumuLIN 70/30
HumaLOG Mix 75/25
HumuLIN R U-100
HumuLIN R U-500
HumuLIN R U-500
HumuLIN R U-100
Hyalgan
Healon
hydrALAZINE
hydrOXYzine
Hydrea
Lyrica
HYDROcodone
oxyCODONE
Hydrogesic
hydrOXYzine
HYDROmorphone
morphine
hydrOXYzine
Hydrogesic
hydrOXYzine
hydrALAZINE

Drug Name

Confused Drug Name

IDArubicin
DAUNOrubicin
IDArubicin
DOXOrubicin
Inderal
Adderall
indinavir
Denavir
inFLIXimab
riTUXimab
influenza virus vaccine
flumazenil
influenza virus vaccine
perflutren lipid microspheres
influenza virus vaccine
tuberculin purified protein derivative (PPD)
Inspra
Spiriva
Intuniv
Invega
INVanz
AVINza
Invega
Intuniv
iodine
Lodine
Isordil
Plendil
ISOtretinoin
tretinoin
Jantoven
Janumet
Jantoven
Januvia
Janumet
Jantoven
Janumet
Januvia
Janumet
Sinemet
Januvia
Enjuvia
Januvia
Jantoven
Januvia
Janumet
K-Phos Neutral
Neutra-Phos-K
Kaopectate (bismuth subsalcylate)
Kaopectate (docusate calcium)
Kaopectate (docusate calcium)
Kaopectate (bismuth subsalcylate)
Kadian
Kapidex
Kaletra
Keppra
Kapidex
Capadex [non-US product]
Kapidex
Capex
Kapidex
Casodex
Kapidex
Kadian
Keflex
Keppra
Keppra
Kaletra
Keppra
Keflex
Ketalar
ketorolac
ketorolac
Ketalar
ketorolac
methadone
Kineret
Amikin
KlonoPIN
cloNIDine
Kuric
Carac
Kwell
Qwell
LaMICtal
LamISIL
LamISIL
LaMICtal
lamiVUDine
lamoTRIgine
lamoTRIgine
lamiVUDine

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.

www.ismp.org

Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


Drug Name

Confused Drug Name

Drug Name

Confused Drug Name

lamoTRIgine
lamoTRIgine
Lanoxin
Lanoxin
lanthanum carbonate
Lantus
Lantus
Lariam
Lasix
Latuda
Lente
Letairis
Letaris [non-US product]
leucovorin calcium
leucovorin calcium
Leukeran
Leukeran
Leukeran
Levaquin
Levbid
levETIRAcetam
Levemir
levETIRAcetam
levETIRAcetam
levOCARNitine
levofloxacin
levoleucovorin
levothyroxine
levothyroxine
levothyroxine
Lexapro
Lexiva
liothyronine
Lipitor
Lipitor
lithium
lithium carbonate
Lodine
Lodine
Loniten
Lopressor
LORazepam
LORazepam
LORazepam
Lotronex
Lovaza

levETIRAcetam
levothyroxine
levothyroxine
naloxone
lithium carbonate
Latuda
Lente
Levaquin
Luvox
Lantus
Lantus
Letaris [non-US product]
Letairis
Leukeran
levoleucovorin
Alkeran
Myleran
leucovorin calcium
Lariam
Enbrel
lamoTRIgine
Lovenox
levOCARNitine
levofloxacin
levETIRAcetam
levETIRAcetam
leucovorin calcium
lamoTRIgine
Lanoxin
liothyronine
Loxitane
Pexeva
levothyroxine
Loniten
ZyrTEC
Ultram
lanthanum carbonate
codeine
iodine
Lipitor
Lyrica
ALPRAZolam
clonazePAM
Lovaza
Protonix
LORazepam

Lovenox
Loxitane
Loxitane
Loxitane
Lunesta
Lupron Depot-3 Month
Lupron Depot-Ped
Luvox
Lyrica
Lyrica
Maalox
Maalox Total Stomach Relief
Matulane
Materna
Maxzide
Menactra
Menomune
Mephyton
Metadate
Metadate CD
Metadate ER
Metadate ER
metFORMIN
methadone
methadone
methadone
methadone
methadone
methadone
methadone
Methergine
methimazole
methylene blue
methylphenidate
metolazone
metolazone
metoprolol succinate
metoprolol tartrate
metroNIDAZOLE
Mevacor
Micronase
Microzide
Microzide
midodrine
Midrin
mifepristone

Levemir
Lexapro
FLUoxetine
Soriatane
Neulasta
Lupron Depot-Ped
Lupron Depot-3 Month
Lasix
Hydrea
Lopressor
Maalox Total Stomach Relief
Maalox
Materna
Matulane
Microzide
Menomune
Menactra
methadone
methadone
Metadate ER
Metadate CD
methadone
metroNIDAZOLE
dexmethylphenidate
ketorolac
Mephyton
Metadate
Metadate ER
methylphenidate
metolazone
Brethine
metolazone
VisionBlue
methadone
methadone
methimazole
metoprolol tartrate
metoprolol succinate
metFORMIN
Benicar
Microzide
Maxzide
Micronase
Midrin
midodrine
misoprostol

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.

www.ismp.org

Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


Drug Name

Confused Drug Name

Miralax
Mirapex
Mirapex
Miralax
misoprostol
mifepristone
mitoMYcin
mitoXANtrone
mitoXANtrone
mitoMYcin
morphine
HYDROmorphone
morphine - non-concentrated oral liquid
morphine - oral liquid concentrate
morphine - oral liquid concentrate morphine - non-concentrated oral liquid
Motrin
Neurontin
MS Contin
OxyCONTIN
Mucinex
Mucinex Allergy
Mucinex
Mucomyst
Mucinex Allergy
Mucinex
Mucinex D
Mucinex DM
Mucinex DM
Mucinex D
Mucomyst
Mucinex
Myleran
Alkeran
Myleran
Leukeran
nalbuphine
naloxone
naloxone
Lanoxin
naloxone
nalbuphine
Narcan
Norcuron
Natru-Vent
Atrovent
Navane
Norvasc
Neo-Synephrine (oxymetazoline)
Neo-Synephrine (phenylephrine)
Neo-Synephrine (phenylephrine)
Neo-Synephrine (oxymetazoline)
Neulasta
Lunesta
Neulasta
Neumega
Neulasta
Nuedexta
Neumega
Neupogen
Neumega
Neulasta
Neupogen
Neumega
Neurontin
Motrin
Neurontin
Noroxin
Neutra-Phos-K
K-Phos Neutral
NexAVAR
NexIUM
NexIUM
NexAVAR
niCARdipine
NIFEdipine
NIFEdipine
niCARdipine
NIFEdipine
niMODipine
niMODipine
NIFEdipine
Norcuron
Narcan
Normodyne
Norpramin
Noroxin
Neurontin
Norpramin
Normodyne
Norvasc
Navane

Drug Name

Confused Drug Name

NovoLIN
HumuLIN
NovoLIN
NovoLOG
NovoLIN 70/30
NovoLOG Mix 70/30
NovoLOG
HumaLOG
NovoLOG
NovoLIN
NovoLOG Flexpen
NovoLOG Mix 70/30 Flexpen
NovoLOG Mix 70/30 Flexpen
NovoLOG Flexpen
NovoLOG Mix 70/30
NovoLIN 70/30
Nuedexta
Neulasta
nystatin
HMG-CoA reductase inhibitors ("statins")
Occlusal-HP
Ocuflox
Ocuflox
Occlusal-HP
OLANZapine
QUEtiapine
Omacor
Amicar
omeprazole
fomepizole
opium tincture
paregoric (camphorated tincture of opium)
Oracea
Orencia
Orencia
Oracea
Orgaran
argatroban
Ortho Tri-Cyclen
Ortho Tri-Cyclen LO
Ortho Tri-Cyclen LO
Ortho Tri-Cyclen
Os-Cal
Asacol
oxaprozin
OXcarbazepine
OXcarbazepine
oxaprozin
OXcarbazepine
carBAMazepine
oxyCODONE
HYDROcodone
oxyCODONE
OxyCONTIN
OxyCONTIN
MS Contin
OxyCONTIN
oxyCODONE
PACLitaxel
PACLitaxel protein-bound particles
PACLitaxel protein-bound particles
PACLitaxel
Pamelor
Panlor DC
Pamelor
Tambocor
Panlor DC
Pamelor
paregoric (camphorated tincture of opium)
opium tincture
PARoxetine
FLUoxetine
PARoxetine
piroxicam
Patanol
Platinol
Pavulon
Peptavlon
Paxil
Doxil
Paxil
Taxol
Paxil
Plavix
PAZOPanib
PONATinib
PEMEtrexed
PRALAtrexate
penicillin
penicillAMINE
penicillAMINE
penicillin

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.

www.ismp.org

Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


Drug Name

Confused Drug Name

Drug Name

Confused Drug Name

Peptavlon
Percocet
Percocet
perflutren lipid microspheres
Pexeva
PENTobarbital
PHENobarbital
Pilocar
piroxicam
Platinol
Plavix
Plavix
Plavix
Plendil
pneumococcal 7-valent vaccine
pneumococcal polyvalent vaccine
Polycitra
PONATinib
potassium acetate
PRALAtrexate
Pradax [Non-US Product]
Pradaxa
Prandin
Precare
Precose
prednisoLONE
predniSONE
Prenexa
PriLOSEC
PriLOSEC
Priscoline
Pristiq
probenecid
Procan SR
Procanbid
Procanbid
Procardia XL
Procet
Prograf
propylthiouracil
Proscar
Protain XL
protamine
proton pump inhibitors
Protonix
Protonix

Pavulon
Darvocet
Procet
influenza virus vaccine
Lexiva
PHENobarbital
PENTobarbital
Dilacor XR
PARoxetine
Patanol
Paxil
Pradax [Non-US Product]
Pradaxa
Isordil
pneumococcal polyvalent vaccine
pneumococcal 7-valent vaccine
Bicitra
PAZOPanib
sodium acetate
PEMEtrexed
Plavix
Plavix
Avandia
Precose
Precare
predniSONE
prednisoLONE
Ranexa
Pristiq
PROzac
Apresoline
PriLOSEC
Procanbid
Procanbid
probenecid
Procan SR
Protain XL
Percocet
PROzac
Purinethol
Provera
Procardia XL
Protonix
ARIPiprazole
Lotronex
protamine

Provera
Provera
PROzac
PROzac
PROzac
Purinethol
Pyridium
pyridoxine
QUEtiapine
quiNIDine
quiNINE
Qwell
RABEprazole
Ranexa
Rapaflo
Rapamune
Razadyne
Recombivax HB
Regranex
Reminyl
Reminyl
Renagel
Renvela
Reprexain
Restoril
Retrovir
Rifadin
Rifamate
rifampin
rifampin
Rifater
rifaximin
RisperDAL
risperiDONE
Ritalin
Ritalin LA
Ritalin SR
ritodrine
ritonavir
riTUXimab
Robinul
rOPINIRole
Roxanol
Roxanol
Roxicet
Roxicodone Intensol

Proscar
PROzac
Prograf
PriLOSEC
Provera
propylthiouracil
pyridoxine
Pyridium
OLANZapine
quiNINE
quiNIDine
Kwell
ARIPiprazole
Prenexa
Rapamune
Rapaflo
Rozerem
Comvax
Granulex
Robinul
Amaryl
Renvela
Renagel
ZyPREXA
RisperDAL
ritonavir
Rifater
rifampin
Rifamate
rifaximin
Rifadin
rifampin
Restoril
rOPINIRole
ritodrine
Ritalin SR
Ritalin LA
Ritalin
Retrovir
inFLIXimab
Reminyl
risperiDONE
Roxicodone Intensol
Roxicet
Roxanol
Roxanol

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.

www.ismp.org

Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


Drug Name

Rozerem
Salagen
SandIMMUNE
SandoSTATIN
saquinavir
saquinavir (free base)
saquinavir mesylate
Sarafem
selegiline
Serophene
SEROquel
SEROquel
SEROquel
SEROquel
SEROquel XR
sertraline
sertraline
Serzone
silodosin
Sinemet
SINEquan
SINEquan
SINEquan
SINEquan
Singulair
sirolimus
sitaGLIPtin
sodium acetate
Solu-CORTEF
Solu-MEDROL
Solu-MEDROL
Sonata
Soriatane
Soriatane
Soriatane
sotalol
Spiriva
Spiriva
stavudine
Sudafed
Sudafed
Sudafed 12 Hour
Sudafed 12 Hour Pressure + Pain
Sudafed PE
SUFentanil
sulfADIAZINE

Confused Drug Name

Razadyne
selegiline
SandoSTATIN
SandIMMUNE
SINEquan
saquinavir mesylate
saquinavir (free base)
Serophene
Salagen
Sarafem
Desyrel
SEROquel XR
Serzone
SINEquan
SEROquel
cetirizine
Soriatane
SEROquel
sirolimus
Janumet
saquinavir
SEROquel
Singulair
Zonegran
SINEquan
silodosin
SUMAtriptan
potassium acetate
Solu-MEDROL
Depo-Medrol
Solu-CORTEF
Soriatane
Loxitane
sertraline
Sonata
Sudafed
Apidra
Inspra
cetirizine
sotalol
Sudafed PE
Sudafed 12 Hour Pressure + Pain
Sudafed 12 Hour
Sudafed
fentaNYL
sulfaSALAzine

Drug Name

Confused Drug Name

sulfADIAZINE
sulfaSALAzine
sulfiSOXAZOLE
SUMAtriptan
SUMAtriptan
Symbyax
T-Gel
Tambocor
Taxol
Taxol
Taxotere
TEGretol
TEGretol
TEGretol
TEGretol XR
Tenex
Tequin
Tequin
Testoderm
Testoderm
Testoderm with Adhesive
Testoderm with Adhesive
Testoderm TTS
Testoderm TTS
tetanus diptheria toxoid (Td)
Thalomid
Thiamine
tiaGABine
Tiazac
Ticlid
tiZANidine
TNKase
TNKase
Tobradex
Tobrex
TOLAZamide
TOLBUTamide
Topamax
Toprol-XL
Toradol
t-PA
Tracleer
traMADol
trastuzumab
traZODone
TRENtal

sulfiSOXAZOLE
sulfADIAZINE
sulfADIAZINE
sitaGLIPtin
ZOLMitriptan
Cymbalta
Bio-T-Gel
Pamelor
Taxotere
Paxil
Taxol
TEGretol XR
Tequin
TRENtal
TEGretol
Xanax
TEGretol
Ticlid
Testoderm with Adhesive
Testoderm TTS
Testoderm
Testoderm TTS
Testoderm
Testoderm with Adhesive
tuberculin purified protein derivative (PPD)
Thiamine
Thalomid
tiZANidine
Ziac
Tequin
tiaGABine
Activase
t-PA
Tobrex
Tobradex
TOLBUTamide
TOLAZamide
Toprol-XL
Topamax
Foradil
TNKase
Tricor
traZODone
ado-trastuzumab emtansine
traMADol
TEGretol

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.

www.ismp.org

Institute for Safe Medication Practices

ISMPs List of Confused Drug Names


Drug Name

Confused Drug Name

tretinoin
ISOtretinoin
Tricor
Tracleer
tromethamine
Trophamine
Trophamine
tromethamine
tuberculin purified protein derivative (PPD)
influenza virus vaccine
tuberculin purified protein derivative (PPD)
tetanus diptheria toxoid (Td)
Tylenol
Tylenol PM
Tylenol PM
Tylenol
Ultracet
Duricef
Ultram
lithium
valACYclovir
valGANciclovir
Valcyte
Valtrex
valGANciclovir
valACYclovir
Valtrex
Valcyte
Varivax
VZIG (varicella-zoster immune globulin)
Vesanoid
Vesicare
Vesicare
Vesanoid
Vexol
Vosol
Viagra
Allegra
Videx
Bidex
vinBLAStine
vinCRIStine
vinCRIStine
vinBLAStine
Viokase
Viokase 8
Viokase 8
Viokase
Vioxx
Zyvox
Viracept
Viramune
Viramune
Viracept
Viramune (nevairapine)
Viramune (herbal product)
Viramune (herbal product)
Viramune (nevairapine)
VisionBlue
methylene blue
Vosol
Vexol
VZIG (varicella-zoster immune globulin)
Varivax
Wellbutrin SR
Wellbutrin XL
Wellbutrin XL
Wellbutrin SR
Xanax
Fanapt
Xanax
Tenex
Xanax
Zantac
Xeloda
Xenical
Xenical
Xeloda
Yasmin
Yaz
Yaz
Yasmin
Zantac
Xanax

Drug Name

Confused Drug Name

Zantac
ZyrTEC
Zavesca (escitalopram) [non-US product]
Zavesca (miglustat)
Zavesca (miglustat)
Zavesca (escitalopram) [non-US product]
Zebeta
Diabeta
Zebeta
Zetia
Zegerid
Zestril
Zelapar (Zydis formulation)
ZyPREXA Zydis
Zerit
ZyrTEC
Zestril
Zegerid
Zestril
Zetia
Zestril
ZyPREXA
Zetia
Bextra
Zetia
Zebeta
Zetia
Zestril
Ziac
Tiazac
Zocor
Cozaar
Zocor
ZyrTEC
ZOLMitriptan
SUMAtriptan
zolpidem
Zyloprim
Zonegran
SINEquan
Zostrix
Zovirax
Zovirax
Doribax
Zovirax
Zyvox
Zovirax
Zostrix
Zyban
Diovan
Zyloprim
zolpidem
ZyPREXA
CeleXA
ZyPREXA
Reprexain
ZyPREXA
Zestril
ZyPREXA
ZyrTEC
ZyPREXA Zydis
Zelapar (Zydis formulation)
ZyrTEC
Lipitor
ZyrTEC
Zantac
ZyrTEC
Zerit
ZyrTEC
Zocor
ZyrTEC
ZyPREXA
ZyrTEC
ZyrTEC-D
ZyrTEC (cetirizine)
ZyrTEC Itchy Eye Drops (ketotifen fumarate)
ZyrTEC-D
ZyrTEC
ZyrTEC Itchy Eye Drops (ketotifen fumarate)
ZyrTEC (cetirizine)
Zyvox
Vioxx
Zyvox
Zovirax

* Brand names always start with an uppercase letter. Some brand names incorporate tall man letters in initial characters and may not be readily recognized as brand names. Brand name products
appear in black; generic/other products appear in red.
ISMP 2015. Permission is granted to reproduce material with proper attribution for internal use within healthcare
organizations. Other reproduction is prohibited without written permission from the Institute for Safe Medication
Practices (ISMP). Report actual and potential medication or vaccine errors to the ISMP National Medication Errors
Reporting Program (ISMP MERP) or ISMP National Vaccine Errors Reporting Program (ISMP VERP) via the Web at
www.ismp.org/merp or by calling 1-800-FAIL-SAF(E).

www.ismp.org