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Safety problems posed by investigational drug name abbreviations and acronyms

From the December 3, 1997 issue

PROBLEM: Abbreviations and acronyms are commonly used to describe chemotherapy regimens and specific investigational drugs, but this practice often leads to confusion. Because of similar names of drugs used in various regimens, acronyms are often nearly identical and, therefore, easily confused. In addition, some abbreviations used for investigational drugs are similar to those used for established drugs, which also causes confusion. Recently, an oncologist approached a clinical pharmacist to inquire about the investigational drug mitoguazone (Zyrkamine®) as part of a protocol referred to as MIME. The MIME regimen, consisting of mitoguazone 500 mg/m2 on days 1 and 14 plus ifosfamide on days 1 to 5, methotrexate on day 3, and etoposide on days 1 to 3, has been administered in Hodgkin's disease and non-Hodgkin's lymphoma. Mitoguazone is available for emergency compassionate investigational use only. To verify the dose, the referring oncologist was contacted, but he stated that he had recommended the MINE protocol (mesna, ifosfamide, mitoxantrone (Novantrone®) and etoposide, which is also used in Non-Hodgkin's lymphoma. Sound-alike regimens within a disease state are especially risky. For example, common regimens for non-Hodgkin's lymphoma include CHOP, COPP, COP, and COP-BLAM.

Two problematic investigational drug name abbreviations were also reported this past week. "PZA" is being used as an abbreviation for pyrazoloacridine (available in 500 mg vials), a drug employed in several NIH-sponsored cancer protocols. However, this abbreviation is also frequently used for the antituberculous agent pyrazinamide (available in 500 mg tablets). We also heard about "CPX," an investigational drug now being tested in cystic fibrosis. This sounds much like "CTX," an abbreviation often used for the chemotherapy agent Cytoxan®(cyclophosphamide).

SAFE PRACTICE RECOMMENDATION: It is critical that chemotherapy treatment recommendations be communicated in writing (print). Verbal orders are not safe and should not be allowed. Considering the critical nature of cancer chemotherapy, it's surprising that anyone would take risks with misunderstanding abbreviations and acronyms. Even though some of the names of chemotherapy agents are long and cumbersome, for patient safety, the full names should be written out in orders. The problem is that clinical studies with new agents frequently begin before a generic name or brand name has been assigned. Thus, abbreviations, and sometimes code numbers, are used for reference. These abbreviations often become accepted in the research community and are then used in journal publications or by speakers at professional meetings. By the time a brand or generic name is assigned, the abbreviation or code number may be so well known that it sticks. For example, many people still refer to Prograf® (tacrolimus) as FK 506. Calling an investigational drug by the same or similar abbreviation as an already established drug is especially dangerous. We are recommending that NIH and other investigators stop using the abbreviation PZA for pyrazoloacridine. SciClone Pharmaceuticals told us last week that a brand name will be available for CPX by the time it enters Phase III, but since the drug is now in Phase I, we've requested that they speed up the naming process.

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