Tall Man Lettering
Tall Man lettering is an FDA-recommended safety practice that uses uppercase letters within drug names to highlight differences between look-alike/sound-alike (LASA) medication names, helping prevent dispensing errors.
Exam Tip
Tall Man lettering uses UPPERCASE to highlight differences between look-alike drug names (e.g., predniSONE vs. prednisoLONE). Know common LASA pairs for the ExCPT.
What Is Tall Man Lettering?
Tall Man lettering is a naming convention endorsed by the FDA and ISMP (Institute for Safe Medication Practices) that uses a mix of uppercase and lowercase letters in drug names to draw attention to the portions that differ between commonly confused medication pairs. This visual cue helps pharmacy personnel differentiate between look-alike/sound-alike (LASA) drugs.
Common Tall Man Lettering Examples
| Drug Pair | Tall Man Format | Risk If Confused |
|---|---|---|
| hydroxyzine / hydralazine | hydrOXYzine / workedALAZINE | Sedation vs. hypotension |
| predniSONE / prednisoLONE | predniSONE / prednisoLONE | Different potencies |
| chlorproMAZINE / chlorproPAMIDE | chlorproMAZINE / chlorproPAMIDE | Antipsychotic vs. diabetes drug |
| vinBLAStine / vinCRIStine | vinBLAStine / vinCRIStine | Different chemo agents |
| buPROPion / busPIRone | buPROPion / busPIRone | Antidepressant vs. anxiolytic |
| clomiPHENE / clomiPRAMINE | clomiPHENE / clomiPRAMINE | Fertility drug vs. antidepressant |
| DOBUTamine / DOPamine | DOBUTamine / DOPamine | Different vasopressors |
| glipiZIDE / glyBURIDE | glipiZIDE / glyBURIDE | Different diabetes drugs |
| ceREBYX / celeBREX | ceREBYX / celeBREX | Seizure drug vs. NSAID (brand) |
Where Tall Man Lettering Is Used
| Location | Implementation |
|---|---|
| Pharmacy computer systems | Drug names display with Tall Man formatting |
| Medication labels | Shelf labels and prescription labels |
| Drug storage bins | ADC (automated dispensing cabinet) labels |
| Reference materials | Formularies, drug references, protocols |
| Order entry systems | CPOE and prescribing systems |
ISMP List of Confused Drug Names
The ISMP maintains the definitive list of look-alike/sound-alike drug name pairs, updated regularly. Key categories include:
- Same drug class but different agents
- Different drug classes with similar names
- Brand names that look or sound alike
- Brand-generic confusion
Prevention Strategies Beyond Tall Man Lettering
| Strategy | Description |
|---|---|
| Barcode scanning | Verify NDC at point of dispensing |
| Separate storage | Store LASA drugs in different locations |
| Alert stickers | Visual warning on shelf or bin |
| Independent double-check | Second person verifies high-alert medications |
Exam Alert
Tall Man lettering is tested in both the Dispensing Process and Drugs/Drug Therapy domains. Know common LASA drug pairs and the purpose of Tall Man lettering. Remember: uppercase letters highlight the DIFFERENCES between confused names.
Study This Term In
Related Terms
NDC Number (National Drug Code)
The NDC (National Drug Code) is a unique 10-digit, 3-segment numeric identifier assigned to each medication product in the United States, identifying the labeler, product, and package size.
Sig Codes (Prescription Abbreviations)
Sig codes are standardized abbreviations derived primarily from Latin used on prescriptions to communicate directions for medication use, including frequency, route, timing, and special instructions.
FDA Drug Recall Classifications
FDA drug recall classifications are a three-tier system (Class I, II, and III) that categorizes product recalls based on the severity of the health hazard posed by the defective or potentially harmful product.
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