USP Quality Review

No. 68, Issued September 1999

Introduction

Three is a crowd... and four is downright confusing.

The USP Practitioners' Reporting NetworkSM (USP PRN®) is receiving numerous reports concerning potential and actual errors involving the products Cerebyx®, Celebrex®, and Celexa®. The similarity of the look, sound, and spelling of these names is confusing for physicians, pharmacists, nurses, and other health care professionals. Reports include confusion between combinations of two of the drugs or, in some cases, confusion among all three. Since this problem was initially reported in October 1998, nearly 10% of all incoming reports to USP PRN have involved the similar names of these products. To make matters more complex, USP received a report expressing concern that a dietary supplement, Cerebra™, could potentially be confused with the prescription products Cerebyx, Celebrex, and/or Celexa.