Example medicines to prescribe by brand name

Using this list

Use this list in conjunction with these principles: Prescribing by generic or brand name (SPS page)

Not all medicines requiring brand-name prescribing are included in this list. For example, not all biologic or biosimilar medicines and not all devices where patient training is an issue.

Switching between products

Brand-name prescribing prevents inadvertent switching between brands or between brand and generic products.

Intentional switching, where a patient needs to change product, for example for clinical or supply reasons, can be performed safely with appropriate care and consideration.

Allergy and immunology

Adrenaline

Prescribe by brand name to ensure patients receive an auto-injector device they have been trained to use. If switching between brands, patients should receive full training in use of the new device.

Licensed doses differ between brands of adrenaline auto-injectors.

Adrenaline bioavailability may be influenced by factors including formulation and needle length.

Immunoglobulins

Preparations from different manufacturers vary widely in rate of infusion, reconstitution requirements and licensed route of administration. Products are not interchangeable.

Immunoglobins are biologic medicines. Biologic and biosimilar medicines should be prescribed by brand name.

Anaesthesia and pain

Buprenorphine SL tablets

Brands of buprenorphine 400mcg sublingual (SL) tablets differ in their licensed indications. Some are licensed for pain relief; others are licensed for use in treating opioid dependence.

Opioid patches

Buprenorphine

Buprenorphine transdermal patches are available as 72-hourly, 96-hourly and 7-day formulations. Brand name prescribing is recommended to reduce the risk of confusion and error in dispensing and administration.

Fentanyl

Fentanyl transdermal patches are available as matrix and reservoir formulations. Reservoir patches must not be cut because damage to the rate-limiting membrane can lead to a rapid release of fentanyl resulting in overdose. If the prescriber intends the patch to be cut (which is unlicensed and not recommended) then the prescription must specify a brand of matrix formulation patch.

Opioids MR

Morphine, oxycodone, tramadol

These medicines are available as 12-hourly and 24-hourly modified-release (MR) oral formulations. Brand-name prescribing is recommended to reduce the risk of confusion in dispensing and administration.

Cardiovascular

Metolazone

UK-licensed metolazone tablets (Xaqua) have up to two-fold difference in bioavailability compared to other (unlicensed, imported) metolazone preparations.

Between 2012 and 2022, patients needing metolazone in the UK used unlicensed, imported tablets. Patients switching to the UK-licensed version may require dose adjustment depending on clinical effect; patients should be monitored for dehydration and electrolyte disturbance. Imported tablets are still used for some people.

Diltiazem MR

Modified-release (MR) tablets and capsules are available as once daily and twice daily formulations. Licensed indications also differ between brands.

The BNF notes that different versions of diltiazem modified-release preparations containing more than 60mg may not have the same clinical effect.

Nifedipine MR

Licensed indications and dosage instructions differ between brands of modified-release tablets and capsules.

The BNF notes that different versions of nifedipine modified-release preparations may not have the same clinical effect.

Low molecular weight heparins

Low molecular weight heparins (bemiparin, dalteparin, enoxaparin and tinzaparin) are biologic medicines. Biologic and biosimilar medicines should be prescribed by brand name.

Endocrinology

Insulins

NICE guidance recommends insulins are prescribed by brand name.

It is important to ensure patients receive an administration device they have been trained to use.

Manufacturers advise any switch between brands or formulation of insulin should be done under strict supervision; a change in dose may be required.

Insulins are biologic medicines. Biologic and biosimilar medicines should be prescribed by brand name.

GLP-1 receptor agonists

Licensed indications differ between products. Brand-name prescribing is also recommended to ensure patients receive a device they have been trained to use.

GLP-1 receptor agonists are biologic medicines. Biologic and biosimilar medicines should be prescribed by brand name.

Gastrointestinal

Mesalazine

The BNF states there is no evidence that any one oral preparation of mesalazine is more effective than another; however, delivery characteristics of mesalazine preparations may vary.

Licensed indications and doses also vary between products. If switching to a different brand of mesalazine, advise the patient to report any changes in symptoms.

Our article Using mesalazine tablets appropriately (SPS page) has more information.

Mental health

Clozapine

Clozapine must be prescribed by brand. Patients must be registered with the relevant brand-specific monitoring service. See Clinical considerations for patients prescribed clozapine (SPS page) for more information.

Lithium

Lithium has a narrow therapeutic index and preparations vary widely in bioavailability. Changing the preparation requires the same precautions as initiation of treatment.

Methylphenidate MR

Methylphenidate modified-release (MR) preparations contain both immediate-release (IR) and MR methylphenidate. The proportion of IR and MR methylphenidate differs between brands; different preparations may not have the same clinical effect.

Neurology

Antiseizure medications for seizure disorders

MHRA guidance groups antiseizure medications into three categories of risk. This helps healthcare professionals decide whether it is necessary to maintain continuity of a specific manufacturer’s product. The groups are:

Category 1

Specific measures are necessary to ensure consistent supply of a particular product (which could be either a branded product or specified manufacturer’s generic product) for medicines in this category.
Medicines: carbamazepine, phenobarbital, phenytoin, primidone

Category 2

By default, this category includes all antiseizure medications not listed in categories 1 or 3. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and  consultation with patient and/or carer. Consider clinical factors such as seizure frequency, treatment history and the potential implications for the individual of having a breakthrough seizure.
Medicines: clobazam, clonazepam, eslicarbazepine, lamotrigine, oxcarbazepine, perampanel, rufinamide, topiramate, valproate, zonisamide

Category 3:

Therapeutic equivalence between branded and generic products (and between generics) can be assumed for medicines in this category. They can be prescribed generically unless there are other specific reasons such as patient anxiety, confusion or risk of dosing errors.
Medicines: brivaracetam, ethosuxamide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin

For advice on switching, when necessary, see Switching brand and generic anti-seizure medicines for epilepsy (SPS page).

Botulinum toxin A

Botulinum toxin A is used in a variety of therapeutic areas. Licensed indications differ between brands.

Botulinum toxin A is a biologic. Biologic and biosimilar medicines should be prescribed by brand name.

Rivastigmine patches

Patches are available for daily or twice-weekly administration. Brand-name prescribing is recommended to reduce the risk of confusion in dispensing and administration.

Organ transplantation

Medicines to prevent transplant rejection are commissioned by NHS England and should routinely be prescribed by secondary care.

Ciclosporin

Patients should be stabilised on a particular brand of oral ciclosporin. Switching between formulations without close monitoring may lead to clinically important changes in blood ciclosporin concentration.

Switching should be initiated only by a transplant specialist. Monitor the person closely for changes in blood-ciclosporin concentration, serum creatinine, blood pressure, and transplant function.

Tacrolimus

Inadvertent switching between oral tacrolimus products has been associated with reports of toxicity and graft rejection. Oral tacrolimus products should be prescribed and dispensed by brand name only.

Switching between tacrolimus formulations should be initiated only by a transplant specialist.

Respiratory

Inhalers

Generic prescribing of inhalers can lead to people being given an unfamiliar device which could affect usage and adherence.

Beclometasone-containing pMDIs

Beclometasone dipropionate pressurised metered-dose inhalers are not interchangeable. Qvar and Kelhale have extra-fine particles and are more potent than Clenil Modulite and Soprobec. MHRA advice to prescribe beclometasone inhalers by brand name was issued in 2008.

Beclomethasone with formoterol pressurised metered-dose inhalers are not interchangeable. Fostair and Luforbec have extra-fine particles and are more potent than Bibecfo, Proxor and Vivarie.

Tiotropium

To ensure patients receive an inhaler they have been trained to use, tiotropium capsules, cartridges and administration devices should be prescribed by brand name.

Women’s health

Levonorgestrel IUD

Brands differ in their licensed indications, duration of use and insertion technique. MHRA advice to prescribe levonorgestrel-releasing intrauterine systems by brand name was issued in 2016.

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