NATIONAL INSTITUTES OF HEALTH

CLINICAL CENTER PHARMACY DEPARTMENT

Look-Alike Sound-Alike Medications

Drug Name with Tall-Man Letters Confused With

ABObotulinumtoxin A (DYSPORT) ONAbotulinumtoxin A (BOTOX)
acetaZOLAMIDE acetoHEXAMIDE
acetoHEXAMIDE acetaZOLAMIDE
ALPRAZolam LORazepam – clonazePAM
aMILoride amLODIPine
amLODIPine aMILoride
anticoagulant citrate DEXTROSE SOLUTION ACD anticoagulant SODIUM CITRATE solution
formula A
ARIPiprazole RABEprazole
azaCITIDine azaTHIOprine
azaTHIOprine azaCITIDine
buPROPion busPIRone
busPIRone buPROPion
carBAMazepine OXcarbazepine
CARBOplatin CISplatin
ceFAZolin cefoTEtan – cefOXitin – cefTAZidime – cefTRIAXone
cefoTEtan ceFAZolin – cefOXitin – cefTAZidime – cefTRIAXone
cefOXitin ceFAZolin – cefoTEtan – cefTAZidime – cefTRIAXone
cefTAZidime ceFAZolin – cefoTEtan – cefOXitin – cefTRIAXone
cefTRIAXone ceFAZolin – cefoTEtan – cefOXitin – cefTAZidime
chlordiazePOXIDE chlorproMAZINE
chlorproMAZINE chlordiazePOXIDE – chlorproPAMIDE
chlorproPAMIDE chlorproMAZINE
CISplatin CARBOplatin
cloBAZam clonazePAM
clomiPHENE clomiPRAMINE
clomiPRAMINE clomiPHENE
clonazePAM cloNIDine – cloZAPine – cloBAZam – LORazepam
cloNIDine clonazePAM – cloZAPine
cloZAPine clonazePAM – cloNIDine
cycloSERINE cycloSPORINE
cycloSPORINE cycloSERINE
DACTINomycin DAPTOmycin
DAPTOmycin DACTINomycin
DAUNOrubicin DOXOrubicin
DeferASIROX DeferOXAMINE
diazePAM dilTIAZem
dilTIAZem diazePAM
dimenhyDRINATE diphenhydrAMINE
diphenhydrAMINE dimenhyDRINATE

Page 1 of 4
Approved by P&T: May 23, 2019
 NATIONAL INSTITUTES OF HEALTH
CLINICAL CENTER PHARMACY DEPARTMENT

Drug Name with Tall-Man Letters Confused With

DOBUTamine DOPamine
DOCEtaxel PACLitaxel
DOPamine DOBUTamine
DOXOrubicin DAUNOrubicin – IDArubicin
DULoxetine FLUoxetine – PARoxetine
ePHEDrine EPINEPHrine
EPINEPHrine ePHEDrine
epiRUBicin eriBULin
eriBULin epiRUBicin
fentaNYL SUFentanil
flavoxATE fluvoxaMINE
FLUoxetine DULoxetine – PARoxetine
fluPHENAZine fluvoxaMINE
fluvoxaMINE fluPHENAZine – flavoxATE
glipiZIDE glyBURIDE
glyBURIDE glipiZIDE
guaiFENesin guanFACINE
guanFACINE guaiFENesin
HumaLOG HumuLIN
HumuLIN HumaLOG
hydrALAZINE hydrOXYzine – HYDROmorphone –
hydroCHLOROthiazide
hydroCHLOROthiazide hydrOXYzine – hydrALAZINE
HYDROcodone oxyCODONE
HYDROmorphone hydrOXYzine – hydrALAZINE – morphine –
oxyMORphone
HYDROXYprogesterone medroxyPROGESTERone
hydrOXYzine hydrALAZINE – HYDROmorphone –
hydroCHLOROthiazide
IDArubicin DOXOrubicin – idaruCIZUmab
idaruCIZUmab IDArubicin
inFLIXimab riTUXimab
ISOtretinoin tretinoin
lamiVUDine lamoTRIgine
lamoTRIgine lamiVUDine
levETIRAcetam levOCARNitine – levoFLOXacin
levOCARNitine levETIRAcetam
levoFLOXacin levETIRAcetam
LEVOleucovorin leucovorin
LORazepam ALPRAZolam – clonazePAM
medroxyPROGESTERone methylPREDNISolone – methylTESTOSTERone –
HYDROXYprogesterone
metFORMIN metroNIDAZOLE

Page 2 of 4
Approved by P&T: May 23, 2019
 NATIONAL INSTITUTES OF HEALTH
CLINICAL CENTER PHARMACY DEPARTMENT

Drug Name with Tall-Man Letters Confused With

methazolAMIDE methIMAzole – metOLazone
methIMAzole metOLazone – methazolAMIDE
metOLazone methIMAzole – methazolAMIDE
methylPREDNISolone medroxyPROGESTERone – methylTESTOSTERone
methylTESTOSTERone medroxyPROGESTERone – methylPREDNISolone
metoprolol succinate (Toprol XL) Metoprolol tartrate
metroNIDAZOLE metFORMIN
metyraPONE (METOPIRONE) metyroSINE (DEMSER)
metyroSINE (DEMSER) metyraPONE (METOPIRONE)
miFEPRIStone miSOPROStol
miSOPROStol miFEPRIStone
mitoMYcin mitoXANTRONE
mitoXANTRONE mitoMYcin
niCARdipine NIFEdipine – niMODipine
NIFEdipine niCARdipine – niMODipine
niMODipine NIFEdipine – niCARdipine
NovoLIN NovoLOG
NovoLOG NovoLIN
OLANZapine QUEtiapine
OXcarbazepine carBAMazepine
oxyCODONE HYDROcodone – oxyMORphone
oxyMORphone HYDROmorphone – oxyCODONE
PACLitaxel DOCEtaxel
PARoxetine FLUoxetine – DULoxetine
PAZOPanib PONATinib
PEMEtrexed PRALAtrexate
penicillAMINE penicillin
penicillin SODIUM penicillin POTASSIUM
PENTobarbital PHENobarbital
PHENobarbital PENTobarbital
PONATinib PAZOPanib
Potassium CHLORIDE Potassium CITRATE
PRALAtrexate PEMEtrexed
prednisoLONE predniSONE
predniSONE prednisoLONE
QUEtiapine OLANZapine
quiNIDine quiNINE
quiNINE quiNIDine
RABEprazole ARIPiprazole
raNITIdine riMANTAdine
rifAMPin rifAXIMin
rifAXIMin rifAMPin
riMANTAdine raNITIdine

Page 3 of 4
Approved by P&T: May 23, 2019
 NATIONAL INSTITUTES OF HEALTH
CLINICAL CENTER PHARMACY DEPARTMENT

Drug Name with Tall-Man Letters Confused With

risperiDONE rOPINIRole
riTUXimab inFLIXimab
romiDEPsin romiPLOStim
romiPLOStim romiDEPsin
rOPINIRole risperiDONE
sAXagliptin SITagliptin
SITagliptin sAXagliptin – SUMAtriptan
SORAfenib SUNItinib
SUFentanil fentaNYL
sulfADIAZINE sulfiSOXAZOLE – sulfaSALAzine
sulfaSALAzine sulfADIAZINE
sulfiSOXAZOLE sulfADIAZINE
SUMAtriptan SITagliptin – ZOLMitriptan
SUNitinib SORAfenib
Tetanus & Diphtheria Toxoid (TENIVAC) Diphtheria/Tetanus/acellular Pertussis (DTaP-
INFANRIX)
Tetanus/Diphtheria/aPertussis (TdaP-ADACEL)
tiaGABine tiZANidine
tiZANidine tiaGABine
TOLAZamide TOLBUTamide
TOLBUTamide TOLAZamide
traMADol traZODone
traZODone traMADol
valACYclovir valGANciclovir
valGANciclovir valACYclovir
vinBLAStine vinCRIStine
vinCRIStine vinBLAStine
ZOLMitriptan SUMAtriptan

Page 4 of 4
Approved by P&T: May 23, 2019