Every year, thousands of people in the U.S. and Australia are harmed because two drug names look or sound too similar. It’s not a typo. It’s not bad handwriting. It’s a silent, systemic problem called look-alike and sound-alike (LASA) drug names. You might not realize it, but your doctor’s prescription, the pharmacy label, or even the automated dispenser in your hospital could be showing you a name that’s dangerously close to another. And if you don’t know how to spot the difference, you could end up with the wrong medicine.
What Makes Drug Names Look or Sound Alike?
Not all drug names are created equal. Some are long, some are weird, but a surprising number share the same first few letters, the same ending, or even the same rhythm when spoken aloud. For example:- HydroXYzine and HydroALazine
- DoXEpamine and DoBUTamine
- CISplatin and CARBOplatin
- ValACYclovir and ValGANciclovir
Tall Man Lettering: The Visual Lifesaver
The most common fix? Tall man lettering (TML). It’s not fancy. It’s simple: capitalize the parts of the drug name that are different.- HydroXYzine
- HydroALazine
Why TML Alone Isn’t Enough
Tall man lettering helps - but it’s not a magic bullet. A 2022 study in the Journal of Patient Safety found that combining TML with color coding raised error reduction to 47%. Add a short note like “For high blood pressure” or “For anxiety” next to the drug name, and effectiveness jumps to 59%. Why? Because your brain doesn’t just read letters - it looks for meaning. If you see “Hydroxyzine” with a note saying “Allergy,” and “Hydralazine” with “High BP,” your brain uses context to catch the error. That’s why Johns Hopkins Hospital cut LASA errors by 67% by adding purpose-of-treatment labels to every high-risk drug. Even better? Barcode scanning. When a nurse scans the medication before giving it to a patient, the system checks if it matches the prescription. This catches 89% of errors. But it’s expensive - hospitals spend an average of $153,000 to install the system. Not every clinic can afford it.
What You Can Do: A 3-Step Check
You don’t need to be a pharmacist to protect yourself. Here’s a simple, proven method used in hospitals across Australia and the U.S.:- Read the full label - every word. Don’t just skim. Look for the capitalized letters in TML.
- Confirm with someone else - ask the pharmacist or nurse: “Is this the one for [condition]?”
- Read it again - before you take it. Say it out loud. “Hydroxy-zine. Not hydralazine.”
Handwritten Prescriptions Are Still a Big Risk
Despite all the tech, handwritten prescriptions are still a major problem. A 2023 Reddit thread from Australian pharmacists showed that 41% of LASA errors came from unclear handwriting. Even if the doctor meant “Hydroxyzine,” a sloppy “y” can look like an “a.” If you’re handed a paper script, don’t assume it’s correct. Ask the pharmacist: “Can you confirm this is HydroXYzine?” If they hesitate, walk away. Better safe than sorry.
Technology Isn’t Perfect - But It’s Getting Better
New tools are emerging. Google Health’s AI model, Med-PaLM 2, can predict which drug names are likely to be confused with 89% accuracy. The FDA now requires all new drug names to be tested using two algorithms - BI-SIM (for spelling) and ALINE (for sound) - before approval. Between 2018 and 2023, this stopped 17 potentially dangerous names from ever reaching shelves. But tech can’t replace human vigilance. A 2021 study in JAMA Internal Medicine found that clinicians override 49% of computer alerts because they’re too noisy. If your system flashes “Possible LASA error” every time you type “Doxepin,” you’ll start ignoring it. The fix? Only trigger alerts for the most dangerous pairs - like the 35 FDA-recommended ones.What’s Changing in 2026?
The FDA just added 12 new drug pairs to its official TML list in late 2023, bringing the total to 35. By December 2024, all U.S. hospitals and pharmacies must use TML for these. Australia is following closely - the Therapeutic Goods Administration (TGA) now requires TML on all electronic prescriptions for high-risk drugs. The ISMP’s 2023 Action Plan pushes for full TML adoption across all healthcare settings by 2026. That includes automated dispensers, mobile apps, and even online pharmacy portals. And here’s the kicker: the new National Council for Prescription Drug Programs (NCPDP) standard, released in January 2023, lets systems share LASA risk data in real time. That means your pharmacy’s system might warn you if the drug your doctor ordered matches a known dangerous pair - even if it’s not yet labeled with TML.Final Thought: Don’t Trust the Label - Trust Your Eyes
Medication safety isn’t about one perfect system. It’s about layers. TML helps. Barcodes help. AI helps. But the most powerful tool is still you - the person holding the bottle, reading the label, asking the question. If a drug name looks too familiar, pause. If it sounds like another one you’ve heard before, check again. If you’re unsure, ask. Your life isn’t worth the risk of assuming.What are look-alike and sound-alike (LASA) drug names?
Look-alike and sound-alike (LASA) drug names are medications that have similar spellings or pronunciations, making them easy to confuse. Examples include hydroXYzine and hydroALazine, or doXEPamine and doBUTamine. These similarities can lead to dangerous medication errors if not properly identified and labeled.
What is tall man lettering and how does it help?
Tall man lettering (TML) is a technique where key differing letters in similar drug names are capitalized to make them stand out visually. For example, hydroXYzine and hydroALazine. This helps reduce confusion by forcing the eye to notice the difference. Studies show TML reduces visual errors by about 32% when used correctly.
Is tall man lettering used everywhere?
No. While TML is required on electronic prescriptions and pharmacy labels in the U.S. and Australia for FDA-recommended pairs, inconsistencies remain. Handwritten prescriptions, older systems, and poor printing quality often omit TML. Nurses and pharmacists frequently report mismatched labeling between digital systems and physical labels.
Can barcode scanning prevent LASA errors?
Yes. Barcode scanning at four key points - stocking, dispensing, refilling automated cabinets, and before administration - prevents up to 89% of LASA errors. However, it requires significant investment, averaging $153,000 per hospital, and isn’t available in all clinics or pharmacies.
What should I do if I think my prescription might be wrong?
Stop. Don’t take it. Read the full label, check the capitalized letters in the drug name, and ask the pharmacist: “Is this the right medicine for my condition?” If it’s a handwritten script, request a printed version. Always confirm the purpose - for example, “This is for anxiety, not high blood pressure.”
Are there new technologies to detect LASA errors?
Yes. AI tools like Google Health’s Med-PaLM 2 can predict confusing drug pairs with 89% accuracy. The FDA now uses BI-SIM and ALINE algorithms to screen all new drug names before approval. Some hospitals are testing smartphone apps with computer vision to scan pill bottles and flag look-alike packaging.
How can I help reduce LASA errors as a patient?
Always read the full label, ask for the purpose of the medication, and use the three-step check: read the label, confirm with a provider, and read it again before taking it. Don’t assume the name is correct just because it looks familiar. Your attention is the last line of defense.