Medications Overseas: Potential Hazards – Avoiding Drug Rx Problems

NOTICE: This article is for general information only, and is not intended as medical advice. Always consult a physician or a pharmacist before using any medication.

Many of the medications that North Americans use are produced by German or Swiss companies. But that doesn’t mean there is a worldwide standard for the names of those medications. Sometimes even a drug that has the same name may have different ingredients and applications in the US versus Europe. And even if you know a drug’s full chemical name (“fluoxetine hydrochloride” = Prozac), you may not be able to obtain it the same way as in your home country.

Eine Apotheke (a pharmacy) in a Berlin shopping mall. PHOTO © Hyde Flippo

The drug known as Vivelle in both the United States and Austria is not the same thing in those two countries. In the US, Vivelle is prescribed for estrogen deficiency or menopausal disorders (active ingredient: estradiol). Vivelle in Austria is an oral contraceptive and acne medicine (active ingredients: ethinylestradiol, norgestimate). The two different medicines with the same name not only have different purposes, but they can also have very different side effects.

A recent article in the Wall Street Journal pointed out the dangers for American travelers overseas who get medical prescriptions filled in a foreign country. The Journal cited the true story of an American who got a prescription for his Dilacor hypertension medication filled in Serbia. The Serbian Dilacor, despite its identical name, is not the same drug at all. It is intended for congestive heart failure and has a different ingredient than the US version. The man survived the mix-up, but his case illustrates the hazard of identical drug names with very different ingredients. Apparently, there is no international body responsible for helping people avoid the dangers of different drugs with the same brand name.

Different Names, Same Drug

A similar problem arises from the fact that a drug’s US name may be completely different in Germany or elsewhere. Pfizer’s antidepressant medication, known as Zoloft (sertraline hydrochloride) in the US, is called Gladem in Austria and Germany. Pfizer’s Lipitor (atorvastatin calcium) is sold under the name Sortis in Germany. Eli Lilly’s Prozac (fluoxetine hydrochloride) is known as Fluctin in Germany, but is called Fluctine in Austria and Switzerland. In other countries Prozac is known variously by the following brand names: Adofen, Andep, Auroken, Deproxin, Fludac, Flufran, Flunil, Fluoxac, Fluoxeren, Fluoxil, Prizma, Proctin, Sanzur, Zactin, and more. Talk about confusing! And that is just one drug.

The Swiss version on the left is only available with a prescription. The US Omeprazole package is sold over the counter in the US. See details below. PHOTO: Hyde Flippo

Unavailable Drugs

Another, only slightly less serious concern is the fact that some drugs may not be available at all, under any name. A drug approved by the FDA in the US may not be approved in Germany (or vice versa). I had this experience myself. After suffering a serious skin rash one summer in Berlin, I walked into a German Apotheke to try to get something to alleviate the problem. I showed the German pharmacist the rash on my leg, and asked him if he had something that might help. He sold me a tube of ointment that worked so well, I later tried to find it in the US. When I had my doctor check on it (using the empty tube’s labeling), he told me that the German ointment contained aspirin, an ingredient that is sold over the counter in the US, but is forbidden in ointments by the FDA! (Aspercreme contains trolamine salicylate, but no aspirin!) The only way I can get that medication is to buy it in Germany. One can only wonder why it is okay to have aspirin in a German ointment, but not in an American salve.

Bringing Drugs vs Shipping Drugs
This points out the importance of knowing if a particular drug is available overseas or not. If not, you need to bring an adequate supply with you (with a written prescription from your physician, for customs). Be aware that German law prohibits the mailing or shipment of drugs, including prescription medicines, to private persons in Germany from the US or other foreign countries. However, if you are carrying prescribed medicine with you while traveling to Germany, that is permitted. It is advisable to keep the drugs in the original prescription bottle or container with your name on it.

An alternative is to ask your local Apotheker(in) (pharmacist) to convert your US prescription to the German equivalent. He or she may require a visit to a local physician who can prescribe the medicine you need. A bonus: You’ll now have a local doctor! Another bonus is that the German equivalent is often much cheaper than the same drug purchased in the US.

Die Apotheke

Anyone going to Germany or any of the other German-speaking countries also needs to know some of the important differences between medical practices there and in their home country. For instance, in Germany there is much more emphasis on “natural” medicine. Herbal medications are considered drugs and are rated for safety and efficacy. While it is easy to purchase a bottle of aspirin (a German invention) off the shelf in the US, even in a supermarket, in Germany you can only buy it in an Apotheke.

OTC versus Prescription Drugs
Another possible drug conflict can surprise expats in Europe: A drug that is sold over the counter (OTC) in your home country, but is only available via prescription in Austria, Germany or Switzerland. One example is the common heartburn acid reducer omeprazole (generic Prilosec®). In the US you can buy delayed-release omeprazole tablets in most grocery stores, just like aspirin or Tylenol. But in Switzerland omeprazole is Rezeptpflichtig, sold only with a doctor’s prescription. While the US OTC version is usually sold in foil blister tabs with 14 20-mg tablets, the Swiss version (Omeprazol-Mepha®) is sold in a bottle with 28 capsules (Kapseln). (See photo above.) The cost per pill/capsule is higher in Switzerland than in the US. The Swiss capsules are made by Mepha Pharma AG in Basel, Switzerland, while the US tablets come from Israel.

The prescription status of drugs can change over time. While Prilosec in the US was once a prescribed medication, the generic omeprazole is now an OTC medication. That could also happen in Switzerland or elsewhere in the near future. Always check with your local Apotheker or Apothekerin to be sure. Also see the web links below for more information from various sources.

Learn more about the topic of doctors, medications, and pharmacies on our Health Care in Germany page.

Back | Living in Germany

Related Pages
AT THE GERMAN

• The Apotheke Way – Alie’s blog post about her personal experience with the German pharmacy.
• Health Care in Germany – What expats need to know.
• GW Expat Blog: Rx for Drugs in Germany – Lessons from the field
• Living in Germany – More expat topics

ON THE WEB

• MedicineNet.com – Medications A-Z list – Over 2500 common drugs listed by chemical and brand names
• MedicineNet.com – Health and medical information produced by doctors and pharmacists
• FDA – The U.S. Food and Drug Administration
• FDA – Drug Safety and Availability – The FDA’s Center for Drug Evaluation and Research (CEDER)
• The Complex Process of Naming Drugs – from the Annals of Internal Medicine (first-page preview)

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