As If The Name Wasn’t Cumbersome Enough–Confusion between Brintellix and Brilinta

I recently got notified about the potential for confusion between two medications.  Brintellix, a relatively new antidepressant with a novel mechanism of action, and Brilinta, a medication used by cardiology to help prevent blood clots that could result in  a heart attack.  Obviously, the names are quite similar, but the conditions they treat could not be more different.  To date, no patients have been harmed by the confusion in names, but there have been prescribing and dispensing errors.  Doctors who prescribe either of these medications are encouraged to write the generic name (vortioxetine for Brintellix . . . ticagrelor for Brilinta) in addition to the brand name, and to include the reason for the prescription (ie . . . “for depression”).  Addition of the above should help decrease the risk of an accidental substitution of the wrong medication by the pharmacy.

Patients should also make sure that they check the pills in the bottle when they pick up their prescription.  All dosages of Brintellix have this odd and (quite frankly) inconvenient tear-drop shape that is quite distintive . . . and makes splitting the pill evenly impossible.  For patients who are having a hard time with side effects, I end up having them take the smaller half for a while then graduate up to the larger half before going back up to the whole pill.  Brilinta is a plain old regular round pill that looks like many other plain old regular round pills on the market.  Since both are “brand only” medicines at present, there will be no other pill substitutions.

Brintellix is a very interesting medication.  In many ways, it is like other SSRIs.  By blocking a nerve cell’s recycling mechanism, it increases the availability of serotonin between the cells.  In addition, it directly acts on other serotonin receptors that then (theoretically) modulates other neurotransmitters.  In that way it is a novel agent.  This may be behind its reputation for having a higher rate of symptom remission than other antidepressants.  I have utilized this in my patients receiving Transcranial Magnetic Stimulation (TMS).  Those patients have failed at least four antidepressant trials, but often have not been on Brintellix yet.  I am hopeful that TMS in conjunction with Brintellix will enhance response rates and provide more patients with a remission of their symptoms.  More on that in another blog entry.

I will be careful how I write . . . you be mindful of what you get.  No matter how careful your health care providers are, the risk of accidental substitution is always there.  If you ever have a question about your medication, be sure to contact the pharmacist or the prescribing doctor before taking it.

–Dan Hartman, MD



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