In hospitals, the use of approved names for prescribing and labelling is an essential requirement for precision and safety in giving medicines. Substitution is an unavoidable consequence of using approved names which brings benefits, but creates problems that demand more widespread recognition and urgent attention. In particular, dangerous variations in response following brand changes can occur in patients stabilized on certain products. The Licensing Authority and the Pharmaceutical Industry have a responsibility to eliminate brand bio-availability differences. But there is an immediate need; firstly, to identify the small number of products where brand changes in patients stabilized on them can result in potentially dangerous variations in response; and secondly, to safeguard patients being treated with these products, by avoiding substitution and preventing inadvertent brand changes by including brand or manufacturer's names on labels and in all communications between hospital doctors and general practitioners. The complete elimination of substitution is not feasible and the indiscriminate use of brand names in hospitals causes confusion and increases risks of error in giving medicines.
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