Look Out for Oral Contraceptives With Similar Names or Packaging

A recent "near miss" will highlight your role in preventing product selection errors with oral contraceptives (OCs).

In the case, a patient almost received a pack of Tarina Fe 1/20 EQ (ethinyl estradiol/norethindrone/iron) instead of Cyred EQ (ethinyl estradiol/desogestrel).

This may seem surprising at first, since the med names don't look or sound anything alike. But both are made by the same manufacturer...and come in pink-and-white-colored packaging.

Revisit strategies for ensuring your patient gets the right oral contraceptive. Dispensing the wrong one may lead to side effects, such as bleeding, mood changes, or nausea...or even pregnancy.

Read incoming Rxs closely. For example, it can be easy to mistake Junel 1/20 for Junel 1.5/30...Seasonique for LoSeasonique...or Tri-Sprintec for Tri-Lo-Sprintec.

Take care when substituting with generic oral contraceptives...many generics have "brand-like" names that can cause confusion.

For instance, in many states, Levora may be substituted with an equivalent...such as Altavera, Marlissa, or Portia-28.

To help identify products with the same hormone content, see our chart, Comparison of Oral Contraceptives...and check with your pharmacist if you're unsure which one to dispense.

Use bar-code scanning to confirm you have the intended med...especially since many OCs have similar-colored packaging. For instance, Kaitlib Fe and Blisovi Fe 1/20 both come in yellow-and-green stock boxes.

Pay extra attention when pulling or restocking similar-looking OCs...and use shelf tags or stickers to alert staff to potential mix-ups.

But don't place stickers over key info on products. Covering up "Fe" in Microgestin Fe 1/20 could lead to someone mistaking the med for Microgestin 1/20...which doesn't contain iron.

Dig into our updated tech tutorial, Dispensing Oral Contraceptives, for tips on days' supply, labeling, and more.

Key References

  • ISMP Med Safety Alert! Community/Ambul Care 2020;19(4):1-4
  • J Obstet Gynaecol Can 2008;30(11):1050-62
Pharmacy Technician's Letter. October 2020, No. 361010

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