Tall Man Lettering: Preventing Drug Name Confusion

What Is Tall Man Lettering?

Tall man lettering is a safety strategy that uses uppercase letters to highlight the differences between look-alike drug names. By emphasizing the distinct portions of confusable drug names, tall man lettering helps pharmacy technicians, pharmacists, and nurses differentiate between medications that might otherwise be mixed up. This is a commonly tested topic on the PTCB certification exam.

How Tall Man Lettering Works

Tall man lettering capitalizes the portions of drug names that differ from their look-alike counterparts. For example:

• hydrOXYzine vs. hydrALAZINE
• predniSONE vs. prednisoLONE
• chlorproMAZINE vs. chlorproPAMIDE
• vinBLASTine vs. vinCRIStine
• DOBUTamine vs. DOPamine
• glipiZIDE vs. glyBURIDE
• buPROPion vs. busPIRone

The capitalized letters draw the reader's eye to the distinguishing characters, making it easier to identify the correct medication quickly.

FDA and ISMP Recommendations

The FDA and the Institute for Safe Medication Practices (ISMP) have published lists of look-alike drug name pairs that should use tall man lettering. The FDA's Office of Generic Drugs has applied tall man lettering to several drug names, and the ISMP maintains a comprehensive list that is widely adopted in healthcare settings.

Key organizations that endorse tall man lettering include:

• FDA
• ISMP
• The Joint Commission
• CMS (Centers for Medicare and Medicaid Services)

Implementation in Pharmacy Settings

Tall man lettering is used in several ways within pharmacy practice:

• Pharmacy management systems: Many software systems display drug names with tall man lettering during order entry and verification
• Shelf labels: Medication storage areas use tall man lettering on bin labels
• Automated dispensing cabinets: Hospital ADCs display tall man lettering on screens
• Printed references: Formulary lists and drug reference materials may use tall man lettering
• Staff education: Training materials highlight commonly confused drug pairs

Additional Strategies for Preventing Name Confusion

Tall man lettering is most effective when combined with other safety strategies:

• Physical separation: Storing look-alike medications in different locations
• Barcode scanning: Verifying medications by scanning barcodes during dispensing
• Leading zeros and no trailing zeros: Writing 0.5 mg (not .5 mg) and 5 mg (not 5.0 mg)
• Both brand and generic names: Including both names on labels and orders for clarity
• Independent double-checks: Having a second person verify high-alert medications

PTCB Exam Tips

For the PTCB exam, memorize the most commonly confused drug name pairs and understand that tall man lettering is endorsed by the FDA and ISMP. You may be asked to identify which drug names are commonly confused or which safety strategy addresses look-alike drug names.

Test your medication safety knowledge with our PTCB practice questions and flashcards at PTCBprep.