Name That Drug
Last reviewed and revised on September 12, 2012
By Robert H. Shmerling, M.D.
Did you ever wonder where drugs get their names? I have, especially when I can't figure out how to say or spell a medicine's name or when I'm trying to identify one by a patient's description. It can be very confusing.
Every drug has at least 3 names:
You'll rarely hear or need to know the chemical name unless you're a researcher or a chemist. It's derived from the chemical components and structure of the drug and tends to be difficult to pronounce and highly technical. For example, aspirin is acetylsalicylic acid and Viagra is get ready 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1Hpyrazolo[4,3-d]pyrimidin-5-yl)-4-ethoxyphenyl]sulfonyl]-4-methylpiperazine citrate. No wonder you never hear about chemical names!
The generic name is chosen by the drug's maker. For years, it may be known only by a series of letters and numbers until it's finally approved and ready for selling. For example, a drug called D2E7 was eventually given the generic name adalimumab (and the brand name, Humira), now a commonly prescribed drug for rheumatoid arthritis.
The generic name is chosen according to guidelines that stress the name's usefulness to healthcare providers, and its simplicity and individuality. While the aim is to make generic names user-friendly names that are short, easy to pronounce, and "sound good" you might wonder how the asthma medications zafirlukast and montelukast became the generic names for Accolate and Singulair. (My own theory is that these generic names were chosen specifically because they are not easy to say or remember. That way, doctors and patients would be more likely to remember the brand names, which are much easier to pronounce and remember).
In the United States, once a generic name is chosen, it must be approved by the U.S. Adopted Name (USAN) Council (a group sponsored by the American Medical Association, the United States Pharmacopeial Convention and the American Pharmacists Association) and then by the World Health Organization (WHO).
Drugs that have similar actions may share a part of their name, called a "stem":
Stems make it possible to identify the type of medication from its generic name even when you've never heard of that particular drug. For example, medostatin is a drug distributed outside of the U.S. Although I've never heard of or prescribed this medication, the stem -statin is a clue that it's a cholesterol-lowering drug similar to lovastatin.
The brand name is created by the manufacturer often with help from marketing experts and must be approved by the U.S. Food and Drug Administration (FDA). Drug companies can spend up to $1 million to come up with just the right name. They will test the name with small groups of consumers, check to make sure no other drug (or healthcare product) has the same or very similar name, and determine that the name is likely to be acceptable to the FDA. Even after going to such lengths, more than a third of proposed names were turned down by the FDA in 2004.
Drug companies want their products to be known by the exclusive brand names they create rather than the generic names, which competitors can use to market their version of a drug later. For this reason, you will rarely hear an advertisement for a generic drug or hear a pharmaceutical company use the generic name. Drug ads will go out of their way to link a drug's brand name with the condition it treats. For example, have you ever heard of "the little purple pill"? Does it make you think of heartburn, Prilosec (generic name: omeprazole) or Nexium (generic name: esomeprazole)? If so, the advertisers have done their job well. These are brand names for medications used to treat gastroesophageal reflux disease or GERD. They are much more expensive than generic omeprazole, although there is little difference in effectiveness or safety. The prescription sleep aid "Lunesta" (generic name: eszopiclone) seems to be a combination of the Latin word for moon (luna) and the Spanish word for nap (siesta). Both words bring to mind images of nighttime, rest and tranquility. Not a bad choice for a sleep medication.
It might seem as though this process is overly complex. After all, the drug company just wants a name that's easy for you to remember, easy to pronounce and readily associated with the condition. They go to great trouble and expense to come up with these names expense that is passed on to consumers in the form of high medication costs, by the way. And that's after the long and difficult process of getting the drug approved in the first place. Why should it be so complicated to name a new drug?
There are a number of reasons, but none are as important as safety. Drugs with names that look alike when written or sound alike when spoken can lead to tragic mix-ups. Every doctor and every hospital knows of cases when the wrong drug or wrong dose was given (or nearly given). Well-trained, careful, and conscientious doctors, nurses and pharmacists can easily make a medication error when the names of two or more drugs are readily confused. And it can happen to patients as well. You might take the wrong drug because of similar names on the bottles. Or a family member might take one of your medications by mistake because the names are similar.
Here are just a few examples of "look alike/sound alike" drug names:
In this last case, not only are the names similar, but Celexa and Celebrex were both approved in 1998 further adding to the potential for confusion between them.
The similar-sounding drug names and drug mix-ups make it easier to understand why the FDA conducts "field tests" of newly submitted drug names and why they reject so many. They write, type and speak the proposed name over and over in realistic settings to see if it's clear or it's easily confused with another drug. The name is spoken over the phone to pharmacists, just as a doctor might call a prescription in for a patient.
More and more new drugs are being approved than ever before, which has increased the number of new drug names dramatically. This makes it even more crucial to avoid look-alike and sound-alike names.
It's likely that the FDA will require pharmaceutical companies to do more testing before submitting a new drug name to be sure it's acceptable. If a name is too confusing, it might be changed. Or a drug company might test several names to see which is least confusing. Over time, guidelines will probably be refined, especially as research identifies the types of drug names that are most prone to errors and confusion. Finally, it's likely that the FDA will ask drug companies to monitor newly approved drugs for signs of trouble with the name well after the drug is approved. If mix-ups are common, the name may have to change. This has already happened: Prilosec was originally called "Losec" but potential confusion with "Lasix" (a common diuretic medication) led to the name change.
Other efforts are underway to prevent drug mix-ups when the names or spellings of two drugs are similar. For example, when ordering a drug online, many hospitals and clinics use a program that reduces the chances of picking the wrong one. It emphasizes the differences between drugs and includes the generic name automatically. If I choose Celexa, it offers up "CeleXA (citalopram)" and Celebrex comes up as "CeleBREX (celecoxib)."
It's important for you and your doctors to know the brand and generic names of any and all medications you take. If you aren't sure about which medications you should be taking or whether the prescription you are filling is correct, ask your doctor and your pharmacist. There is a lot to know about each of your medications, including its purpose, how much you take (dose), how often (frequency) and how long you need to take it (duration). But medication safety begins with its name.
Considering how important it is to take the right medications the right way, getting the name right is the least you and your doctors and pharmacist can do.
|More What Your Doctor Is Saying Articles|