LASA Drugs: understanding drugs that look alike and sound alike

LASA drugs, an acronym for “look-alike, sound-alike” drugs, refers to drugs that either look similar or have names that sound similar. These similarities can cause confusion and errors in prescribing, dispensing, or administering medications, which can result in patient harm or even life-threatening situations.

Causes of Error

Uniform packaging and labeling

• Many medicines are produced in similar shapes, sizes, colors and packaging, increasing the potential for visual confusion.
• Vials, blister packs, and tablet bottles often have a similar design, making it difficult for healthcare providers to distinguish between them.

Phonetic similarity

• Some drug names have similar phonetic qualities, particularly when written by hand or spoken in a noisy environment.
• Communication errors between healthcare providers can lead to misunderstandings about the intended medication, especially in emergency or high-pressure situations.

Abbreviations and illegible handwriting

• The use of ambiguous abbreviations or illegible handwriting in prescriptions can lead to misinterpretation of the drug name.
• For example, a handwritten prescription for “MS” might be mistaken for “morphine sulfate” instead of “magnesium sulfate.”

High workload and stress

• Health care professionals working under stressful circumstances or time constraints may be more likely to make mistakes with LASA medications.
• Time pressure may lead to incomplete cross-checking or incorrect information regarding medication orders.

Consequences of Error

Adverse Drug Reactions (ADRs)

Receiving the wrong medication due to a LASA error can lead to unintended drug effects, including toxic reactions or deterioration of the patient’s condition.

Treatment Failure

When patients are given the wrong medication, their medical conditions can go untreated, leading to disease progression or other complications.

Increased Healthcare Costs

Addressing and managing the adverse effects of LASA errors can increase hospitalization time, additional treatments, and overall health care expenditure.

Strategies to Prevent Error

Use of Tall Man lettering

• Tall man lettering is a strategy in which specific letters in a drug name are capitalized to help distinguish between LASA drugs (for example,”predniSONE” vs. “predniSOLONE”).
• This technique is effective in reducing the chances of selecting the wrong drug by drawing attention to differences in drug names.

Implementation of barcode scanning

• During the medication dispensing and administration process, barcode scanning technology ensures that the correct medication is provided to the patient.
• This acts as an additional layer of verification, reducing the risk of human error.

Standardized Labeling and Packaging

• Standardized packaging practices, such as color-coding and clear labeling, help differentiate LASA drugs more easily.
• Some organizations use unique packaging designs for high-risk drugs to prevent drug adulteration.

Education and Training

• Regular training and awareness programmes for healthcare professionals can help them be cautious about LASA drugs.
• Staff should be educated about the most common LASA drug combinations and the steps to take in case of a suspected medication error.

Use of electronic prescription systems

• Electronic prescribing (e-prescribing) reduces the risk of errors associated with handwritten prescriptions and ensures clarity in medication orders.
• Computerized physician order entry (CPOE) systems often include alerts for LASA drugs, prompting verification when a high-risk drug is prescribed.

Creating a High-Risk Drug List

• Hospitals and pharmacies often maintain lists of high-risk LASA medications and review them regularly to implement the latest safety measures.
• This list helps prioritize the use of safety practices for medications that are most likely to cause errors.

Role of Regulatory Agencies

Approval of drug names: Ensuring that new drug names are unique and not confused with existing drugs.

Labeling standards: Enforcing standardized labeling requirements for packaging to reduce the risk of confusion.

Encouraging reporting systems: Promote reporting of medication errors to learn from mistakes and develop further strategies to enhance medication safety.

Examples of LASA Drugs

• Hydroxyzine and hydralazine: These medications sound similar but have completely different purposes. Hydroxyzine is an antihistamine used for allergy relief, while hydralazine is used to treat high blood pressure.
• Prednisone and prednisolone: ​​Both of these drugs are corticosteroids, but their indications and formulations are different. The similarity in their names can cause confusion.
• Clonazepam and Clonidine: Clonazepam is used as an anti-anxiety medication, while clonidine is primarily used to treat high blood pressure.