# Tall Man lettering

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Practice of writing part of a drug's name in upper case letters

A vial of [dopamine](/source/Dopamine_(medication)), labeled as "DOPamine HCl"

**Tall man lettering** (**tall-man lettering** or **tallman lettering**) is the practice of writing part of a [drug](/source/Drug)'s name in [upper case](/source/Upper_case) letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors.[1][2] For example, in tall man lettering, "[prednisone](/source/Prednisone)" and "[prednisolone](/source/Prednisolone)" should be written "predniSONE" and "predniSOLONE", respectively. The Office of Generic Drugs of the US [Food and Drug Administration](/source/Food_and_Drug_Administration) (FDA) encourages [manufacturers](/source/Pharmaceutical_company) to use tall man lettering labels to visually differentiate their drugs' names,[1] and a number of hospitals, clinics, and health care systems use tall man lettering in their computerized order entry, automated dispensing machines, medication admission records, prescription labels, and drug product labels.[3]

## Effectiveness

Wrong-drug errors have been found to occur at a rate of about one per thousand orders filled or dispensed.[4] Evidence regarding the effect of Tall Man lettering on error rates is mixed.

A 2004 [eye-tracking](/source/Eye-tracking) study found that Tall Man lettering resulted in fewer errors when selecting a target drug from an array of choices.[5] Other laboratory-based studies of Tall Man lettering show a mixture of positive and [null results](/source/Null_result), which may be further complicated due to [demand characteristics](/source/Demand_characteristics) of some of the studies.[4]

A 2016 [time-series analysis](/source/Time-series_analysis) of data from 42 children's hospitals over a 9-year period found no significant difference before and after a 2007 recommendation for hospitals to adopt Tall Man lettering.[6] However, this study has been criticized due to methodological limitations, such as not recording when and how Tall Man lettering was adopted, if at all, at each of the hospitals studied.[4]

## Examples

The FDA published a list[7]: Table 1 of recommended Tall-Man Letters for look-alike drugs which includes, but is not limited to:

- [acetaZOLAMIDE](/source/Acetazolamide) vs. [acetoHEXAMIDE](/source/Acetohexamide)

- [buPROPion](/source/Bupropion) vs. [busPIRone](/source/Buspirone)

- [chlorproMAZINE](/source/Chlorpromazine) vs. [chlorproPAMIDE](/source/Chlorpropamide)

- [clomiPHENE](/source/Clomiphene) vs. [clomiPRAMINE](/source/Clomipramine)

- [cycloSERINE](/source/Cycloserine) vs. [cycloSPORINE](/source/Cyclosporine)

- [DAUNOrubicin](/source/Daunorubicin) vs. [DOXOrubicin](/source/Doxorubicin)

- [DOBUTamine](/source/Dobutamine) vs. [DOPamine](/source/Dopamine)

- [hydrALAzine](/source/Hydralazine) vs. [hydrOXYzine](/source/Hydroxyzine)

- [TOLAZamide](/source/Tolazamide) vs. [TOLBUTamide](/source/Tolbutamide)

- [vinBLAStine](/source/Vinblastine) vs. [vinCRIStine](/source/Vincristine)

The [Institute for Safe Medication Practices](/source/Institute_for_Safe_Medication_Practices) (ISMP) has a supplemental list covering pairs not recommended by the FDA, but considered necessary by the ISMP.[7]: Table 2 ISMP Canada also offers additional recommendations.[8]

## See also

- [Health informatics](/source/Health_informatics)

## References

1. ^ [***a***](#cite_ref-FDA_1-0) [***b***](#cite_ref-FDA_1-1) ["Name Differentiation Project"](https://web.archive.org/web/20080221164437/https://www.fda.gov/cder/drug/MedErrors/nameDiff.htm). *FDA.gov*. Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Archived from [the original](https://www.fda.gov/cder/drug/MedErrors/nameDiff.htm) on February 21, 2008. Retrieved January 10, 2022.

1. **[^](#cite_ref-ISMP_2-0)** ["FAQ: 5. How should Tallman lettering be applied to look-alike/sound-alike drug name pairs?"](https://web.archive.org/web/20071218023454/https://www.ismp.org/faq.asp#Question_5). *ISMP.org*. [Institute for Safe Medication Practices](/source/Institute_for_Safe_Medication_Practices). Archived from [the original](http://www.ismp.org/faq.asp#Question_5) on December 18, 2007. Retrieved January 10, 2022.

1. **[^](#cite_ref-3)** Examples: ["University of Utah Health Care Pharmacy Alert #191"](http://uuhsc.utah.edu/pharmacy/alerts/191.html) dated 2006/12/04, browsed 2007/12/20; [Fraser Health 'Doctors in the Know' newsletter](http://www.fraserhealth.ca/NR/rdonlyres/ewn3tcyxapmdwy2tuswtkze6o4gueut4oe2gwl752igxymg4agig4eofkj2vazzf6bg44rn5c7lkdj/DocKnowSept06.pdf) dated September, 2006, browsed 2007/12/20; [Johns Hopkins Hospital "Pharmacy and Therapeutics Newsletter"](https://web.archive.org/web/20070315205409/http://www.hopkinsmedicine.org/anesthesiology/Headlines/news_0725_Hosp_Pharm_July2005.pdf) dated July 2005, archived 2007/3/15.

1. ^ [***a***](#cite_ref-Lambert_4-0) [***b***](#cite_ref-Lambert_4-1) [***c***](#cite_ref-Lambert_4-2) Lambert, Bruce L; Schroeder, Scott R; Galanter, William L (2016). ["Does Tall Man lettering prevent drug name confusion errors? Incomplete and conflicting evidence suggest need for definitive study"](https://doi.org/10.1136%2Fbmjqs-2015-004929). Editorial. *[BMJ Quality & Safety](/source/BMJ_Quality_%26_Safety)*. **25** (4): 213–217. [doi](/source/Doi_(identifier)):[10.1136/bmjqs-2015-004929](https://doi.org/10.1136%2Fbmjqs-2015-004929). [PMID](/source/PMID_(identifier)) [26700541](https://pubmed.ncbi.nlm.nih.gov/26700541).

1. **[^](#cite_ref-5)** Filik, R; Purdy, K; Gale, A; Gerrett, D (December 2004). "Drug name confusion: Evaluating the effectiveness of capital ("Tall Man") letters using eye movement data". *[Social Science & Medicine](/source/Social_Science_%26_Medicine)*. **59** (12): 2597–601. [doi](/source/Doi_(identifier)):[10.1016/j.socscimed.2004.04.008](https://doi.org/10.1016%2Fj.socscimed.2004.04.008). [PMID](/source/PMID_(identifier)) [15474212](https://pubmed.ncbi.nlm.nih.gov/15474212).

1. **[^](#cite_ref-6)** Zhong, Wenjun; Feinstein, James A; Patel, Neil S; Dai, Dingwei; Feudtner, Chris (2016). ["Tall Man lettering and potential prescription errors: A time series analysis of 42 children's hospitals in the USA over 9 years"](https://doi.org/10.1136%2Fbmjqs-2015-004562). *[BMJ Quality & Safety](/source/BMJ_Quality_%26_Safety)*. **25** (4): 233–240. [doi](/source/Doi_(identifier)):[10.1136/bmjqs-2015-004562](https://doi.org/10.1136%2Fbmjqs-2015-004562). [PMID](/source/PMID_(identifier)) [26534995](https://pubmed.ncbi.nlm.nih.gov/26534995).

1. ^ [***a***](#cite_ref-ismp_7-0) [***b***](#cite_ref-ismp_7-1) ["Look-Alike Drug Names with Recommended Tall Man Letters"](https://www.ismp.org/recommendations/tall-man-letters-list). *ISMP.org*. Institute for Safe Medication Practices. November 20, 2016. Retrieved 2022-01-10. [PDF attachment (registration needed, 2011 version)](https://www.adldata.org/wp-content/uploads/2015/06/tallmanletters.pdf)

1. **[^](#cite_ref-8)** ["TALLman Lettering for Look-Alike/Sound-Alike Drug Names in Canada"](https://www.ismp-canada.org/download/TALLman/TALLman_lettering.pdf) (PDF). *ismp-canada.org*. Retrieved 25 October 2022.

## External links

- [ISMP updates its list of drug name pairs with TALL man letters](http://www.ismp.org/Newsletters/acutecare/articles/20101118.asp), November 18, 2010

- ["Drug Labelling and the Application of TALLman Lettering Project Report"](https://www.ismp-canada.org/download/TALLman/TALLmanLettering-ProjectReport.pdf) (PDF). *Institute for Safe Medication Practices Canada*. March 2016. – for an overview, and for a list of TALLman respelling systems

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Adapted from the Wikipedia article [Tall Man lettering](https://en.wikipedia.org/wiki/Tall_Man_lettering) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Tall_Man_lettering?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.