Should new drugs wear a ‘Proceed with Caution’ label?

SRxA’s Word on Health was alarmed to read a new study showing that almost a quarter of prescription drugs approved in Canada over 16 years were later slapped with serious safety warnings or yanked from the market for safety reasons. As Canada’s drug safety agency operates much like the U.S. Food and Drug Administration (FDA), the study may reflect the state of drug safety in the United States as well.

When assessing a new drug, regulators at Health Canada and the FDA are entrusted with making critical and difficult scientific judgments that can affect the health of hundreds of thousands of patients in a matter of months after product launch.

And the cost of error may be high given that the number of people exposed to unsafe drugs may be in the millions.

University of Toronto health policy researcher Dr. Joel Lexchin looked at the 434 drug approvals that moved through Health Canada’s drug-safety arm from the start of 1995 to the end of 2010.

About a quarter of the drugs approved in that period received a fast-track deliberation known as a “priority review” which lasts 180 days instead of the typical 300 days.

Lexchin found that drugs approved this way were 50% more likely to end up with safety warnings, compared with drugs approved according to the customary deliberation period.

And while you might assume that the most-risky drugs would be those those fast-tracked for approval for life-threatening diseases such as cancer and HIV, Lexchin discovered they were no more likely to have safety concerns than drugs fast-tracked for less serious illnesses.

That was a surprise, because regulators could be expected to accept some heightened risks when approving new medications to treat serious illness.

In an accompanying editorial, Thomas J. Moore of the Institute for Safe Medication Practices suggests that new drugs should carry special labeling for their first three years on the market, so that doctors are reminded to prescribe with caution.

Getting faster access to newer, less-thoroughly tested drugs is at best a mixed blessing,” said Moore. “For the first three years after approval, new drugs should carry a special warning akin to the black triangle used in Britain. It should be prominent and mean to every physician, ‘New Drug: Caution Indicated.’

That caution may be worth remembering by both physicians and patients when considering switching to new drugs.

What’s In A Name?

Many words sound alike but mean different things when put into writing. Think “accept” – a verb meaning to receive or agree and “except” – a preposition meaning other than. While such confusion may cause grammar teachers to lose sleep and their student’s grades to suffer, the consequences are generally minimal. When it comes to drugs, however, it’s a different matter. The existence of confusing drug names is one of the most common causes of medication error and is of concern worldwide.  Many drug names look or sound like other drug names. Contributing to this confusion are illegible handwriting and similar packaging or labeling.

Recently, the Institute for Safe Medication Practices (ISMP) warned pharmacists and other healthcare providers about mix-ups of a prescription eyedrop solution and a wart-removal drug with similar-sounding names after receiving reports describing situations in which nurses and pharmacists confused Durezol, a prescription corticosteroid eyedrop solution used to treat inflammation and pain following ocular surgery, and Durasal, a prescription wart remover. Both products are packaged in small applicator bottles.

In a case that led to a lawsuit against Walgreens earlier this year, a pharmacist allegedly misread a doctor’s prescription for Durezol eyedrops and instead dispensed Durasal wart remover. The patient put the wart remover into his eye, suffered “grievous personal injury,” and filed a $1 million lawsuit against Walgreens.

SRxA’s Word on Health has learned that this is not an isolated mix-up.  The ISMP has published a list of hundreds of drugs with sound alike names that have come to light because mix-ups have occurred. So, before you inadvertently put wart remover in your eyes…or worse, we strongly recommend that you read the labels and patient information leaflets before taking any new medication.