diff --git a/tests/WP_SQLite_Translator_Tests.php b/tests/WP_SQLite_Translator_Tests.php
index 353b5b12..82ed6ecf 100644
--- a/tests/WP_SQLite_Translator_Tests.php
+++ b/tests/WP_SQLite_Translator_Tests.php
@@ -283,8 +283,8 @@ public function testShowCreateTable1() {
 	`option_name` varchar(255) DEFAULT '',
 	`option_value` text NOT NULL DEFAULT '',
 	PRIMARY KEY (`ID`),
-	KEY `_tmp_table__composite` (`option_name`, `option_value`),
-	UNIQUE KEY `_tmp_table__option_name` (`option_name`)
+	KEY `composite` (`option_name`, `option_value`),
+	UNIQUE KEY `option_name` (`option_name`)
 );",
 			$results[0]->{'Create Table'}
 		);
@@ -312,8 +312,8 @@ public function testShowCreateTableQuoted() {
 	`option_name` varchar(255) DEFAULT '',
 	`option_value` text NOT NULL DEFAULT '',
 	PRIMARY KEY (`ID`),
-	KEY `_tmp_table__composite` (`option_name`, `option_value`),
-	UNIQUE KEY `_tmp_table__option_name` (`option_name`)
+	KEY `composite` (`option_name`, `option_value`),
+	UNIQUE KEY `option_name` (`option_name`)
 );",
 			$results[0]->{'Create Table'}
 		);
@@ -365,12 +365,32 @@ public function testShowCreateTableWithAlterAndCreateIndex() {
 	`option_name` smallint NOT NULL DEFAULT 14,
 	`option_value` text NOT NULL DEFAULT \'\',
 	PRIMARY KEY (`ID`),
-	KEY `_tmp_table__option_name` (`option_name`)
+	KEY `option_name` (`option_name`)
 );',
 			$results[0]->{'Create Table'}
 		);
 	}
 
+	public function testCreateTablseWithIdenticalIndexNames() {
+		$this->assertQuery(
+			"CREATE TABLE _tmp_table_a (
+					ID BIGINT PRIMARY KEY AUTO_INCREMENT NOT NULL,
+					option_name VARCHAR(255) default '',
+					option_value TEXT NOT NULL,
+					KEY `option_name` (`option_name`)
+				);"
+		);
+
+		$this->assertQuery(
+			"CREATE TABLE _tmp_table_b (
+					ID BIGINT PRIMARY KEY AUTO_INCREMENT NOT NULL,
+					option_name VARCHAR(255) default '',
+					option_value TEXT NOT NULL,
+					KEY `option_name` (`option_name`)
+				);"
+		);
+	}
+
 	public function testShowCreateTableWithPrimaryKeyColumnsReverseOrdered() {
 		$this->assertQuery(
 			'CREATE TABLE `_tmp_table` (
diff --git a/wp-includes/sqlite/class-wp-sqlite-translator.php b/wp-includes/sqlite/class-wp-sqlite-translator.php
index 573c4691..12decc6e 100644
--- a/wp-includes/sqlite/class-wp-sqlite-translator.php
+++ b/wp-includes/sqlite/class-wp-sqlite-translator.php
@@ -898,8 +898,7 @@ private function execute_create_table() {
 			if ( 'UNIQUE INDEX' === $index_type ) {
 				$unique = 'UNIQUE ';
 			}
-			$index_name = "{$table->name}__{$constraint->name}";
-
+			$index_name = $this->generate_index_name( $table->name, $constraint->name );
 			$this->execute_sqlite_query(
 				"CREATE $unique INDEX \"$index_name\" ON \"{$table->name}\" (\"" . implode( '", "', $constraint->columns ) . '")'
 			);
@@ -3081,7 +3080,7 @@ private function execute_alter() {
 			} elseif ( 'ADD' === $op_type && $is_index_op ) {
 				$key_name          = $this->rewriter->consume()->value;
 				$sqlite_index_type = $this->mysql_index_type_to_sqlite_type( $mysql_index_type );
-				$sqlite_index_name = "{$this->table_name}__$key_name";
+				$sqlite_index_name = $this->generate_index_name( $this->table_name, $key_name );
 				$this->rewriter->replace_all(
 					array(
 						new WP_SQLite_Token( 'CREATE', WP_SQLite_Token::TYPE_KEYWORD, WP_SQLite_Token::FLAG_KEYWORD_RESERVED ),
@@ -3565,7 +3564,12 @@ private function get_key_definitions( $table_name, $columns ) {
 
 			$key_definition[] = 'KEY';
 
-			$key_definition[] = sprintf( '`%s`', $key['index']['name'] );
+			// Remove the prefix from the index name if there is any. We use __ as a separator.
+			$index_name = strstr( $key['index']['name'], '__' )
+				? explode( '__', $key['index']['name'] )[1]
+				: $key['index']['name'];
+
+			$key_definition[] = sprintf( '`%s`', $index_name );
 
 			$cols = array_map(
 				function ( $column ) {
@@ -4188,4 +4192,18 @@ public function rollback() {
 		do_action( 'sqlite_transaction_query_executed', 'ROLLBACK', (bool) $this->last_exec_returned, $this->transaction_level );
 		return $this->last_exec_returned;
 	}
+
+	/**
+	 * Create an index name consisting of table name and original index name.
+	 * This is to avoid duplicate index names in SQLite.
+	 *
+	 * @param $table
+	 * @param $original_index_name
+	 *
+	 * @return string
+	 */
+	private function generate_index_name( $table, $original_index_name ) {
+		// Strip the occurrences of 2 or more consecutive underscores to allow easier splitting on __ later.
+		return preg_replace( '/_{2,}/', '_', $table ) . '__' . $original_index_name;
+	}
 }