Dual branding of drugs by the industry is confusing and should be stopped
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Dual branding of drugs by the industryis confusing and should be stopped
By Stein Lyftingsmo, a hospital pharmacist from Elverum, Norway, who has a special interest in packaging and medicines information Before the medicine was withdrawn from dosage of bupropion:Zyban and Wellbutrin cer,in preventing Alzheimer’s disease and in
the treatment of HIV. MSD chose to use one
Brand splitting may increase total sale. But
brand name for chronic pain, and another for
the market in Norway:Vioxx and Vioxx AC.
each brand will have reduced turnover. Low-
acute pain. So it is not difficult to imagine an-
The tablets had the same active ingredient,
turnover packages are not kept in pharmacy
and the same shape, colour and excipients.
stock, and the patient may have to wait hours
Now look at an older substance: atenolol.
The brands had different information.Vioxx
— even days in rural areas — for his or her
was for arthritis and chronic pain, and Vioxx
treatment. Brand splitting may give simpler
atenolol; the Norwegian medicine authori-
ties, another three.There is good evidence for
the use of atenolol for another five indica-
Generally, brand
tions — altogether 11 different uses for one
active substance. Imagine 11 brands, each
building is the
packaged with information for only one in-
opposite of
For patient packs the information in drug
catalogues and package inserts usually comes
from the manufacturing company. There are
medicine;
several examples of manufacturers claiming
building double
copyright on patient information. In the US
bulk, the PILs mostly comes from companies
specialising in providing information. certainly is
Different patient groups need different in-
Do we have one different brand for each in-
dication or information that covers all the
physicians and pharmacists do not realise or
minds, to the extent that some patients will
different uses? Each solution has its advan-
tages and drawbacks. It is important that a
There is another substance that is old, but
risk analysis is made, since different substances
to generic competition between companies.
interesting in this connection: thalidomide.
But to most people it is unexpected and il-
Leprosy is the only indication approved by
Is it possible to differentiate information
logical that a company should appear to com-
in generic packages? Perhaps there should be
two setss of PILs. Maybe there could be sep-
Doctors are confused. I know this because
main uses of thalidomide are off-label for tu-
arate frames or sections in the PIL for each
I see their prescriptions. Pharmacists are also
patient group. Perhaps there are other solu-
confused. And having called the company for
Thalidomide’s patent ran out long ago, but
information, I discovered that company staff
a company, Celgene, has patented a thalido-
Generally, brand building is the opposite
mide distribution system (as Pharmion has in
of generic medicine; building double brands
tients are not confused, but only because they
some European countries.) The information
certainly is. I believe that the issues around
information here are so confusing and ob-
scure that it takes us back to the old days of
patent medicines and secret formulae.
ganisations delivering information for dis-
I want regulatory restrictions to stop phar-
smoking cessation and as Wellbutrin for de-
pensing from bulk) is more generic and at
pression. Fluoxetine from Lilly is the iconic
brand name on a medicine. But if companies
brand Prozac. Lilly also marketed fluoxetine
Another example of mainly off-label use is
are to be allowed to continue to have more
as Sarafem (which has been licensed to an-
misoprostol (Cytotec). In Norway, all infor-
than one brand of the same drug, it should be
other company.). The colours here are not
identical. Prozac is green and cream. Sarafem,
leaflets is about preventing gastrointestinal ul-
should be generic, and that information in
however, is pink, which may be considered a
ceration during treatment with non-steroidal
formularies and package inserts should not
better colour for a medicine for the treatment
anti-inflammatory drugs. But almost all uses
of premenstrual tension. Allowing for differ-
of the drug are for gynaecological purposes
ent strengths, other dual brands are Yentreve
(abortion, cervical priming, labour induc-
Broad spectrum
and Cymbalta (duloxetine), and Propecia and
The Broad Spectrum feature is open to any
It is possible that if Vioxx had not been
reader. Contributions of around 1,100 words
commenting on topical issues should be sent
creases the risk of double medication.The US
chapters to its story. For example, there are
patents and clinical evidence for rofecoxib
(ISMP) has even reported a case of triple
having an effect in preventing colorectal can-
The Pharmaceutical Journal (Vol 278) 3 February 2007
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