MIME and MINE:
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.