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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


What Your Doctor Is Saying What Your Doctor Is Saying
 

Name That Drug


September 12, 2012

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center


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.

So Many Drugs, So Many Names

Every drug has at least 3 names:

  • A chemical name
  • A generic name
  • A brand name

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!

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Generic 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":

    • "-pril" – Medications including enalapril, lisinopril and captopril, among others, treat high blood pressure, heart disease and kidney problems. They are all ACE-inhibitors, so-named because they all inhibit the enzyme, angiotensin-converting enzyme.
    • "-statin" – These cholesterol-lowering drugs all inhibit a particular enzyme (called HMG CoA reductase) that is important in cholesterol synthesis. Examples include atorvastatin, lovastatin, and pravastatin, among others.
    • "-cillin" – This stem refers to a group of closely related antibiotics, including penicillin, ampicillin, and dicloxacillin.

 

    • "cef-" – A group of antibiotics, called cephalosporins (such as cefazolin, cefotaxime and cefaclor) use the "cef" stem at the beginning of the name (as a prefix), rather than at the name's end (as a suffix).

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.

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Brand Names

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.

What's in a Name?

Drug names must be screened to avoid suggesting something about the drug that's not true or that raises unrealistic expectations. For example, the FDA would never approve the name "Malignacure" because it implies that the drug might cure cancer ("maligna," a short form of "malignant," means cancerous). Until a cancer-curing drug is developed, this name might raise unrealistic expectations. Drug names have been rejected for less: The original name proposed for the osteoporosis drug "Boniva" was "Bonviva." The change occurred because Bonviva, which comes from the Latin bon and viva, could be assumed to promise "good life." The drug might make the bones stronger, but the FDA thought a good life was promising too much.

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.

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Why Is the Process So Complicated?

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:

  • Pitocin/Pitressin
    • Pitocin (generic name: oxytocin) is an intravenous drug used most commonly to induce labor
    • Pitressin (generic name: vasopressin) is an injectable hormone that may be given during cardiac arrest, septic shock, or for diabetes insipidus (a condition in which frequent urination develops due to a lack of the naturally occurring form of the hormone, vasopressin)
  • Amrinone/Amiodarone — The concern about mixing up these two drugs led to the highly unusual decision in 2000 to officially change the generic name of amrinone to inamrinone.
    • Amrinone (brand name:Inocor) is a medication that can improve the pumping function of the heart in people with heart failure
    • Amiodarone (brand name: Cordarone) treats an unstable heart rhythm (called ventricular arrhythmias)
  • Celexa/Celebrex
    • Celexa (generic name: citalopram ) is an antidepressant in the same family as Prozac.
    • Celebrex (generic name: celecoxib) is an anti-inflammatory medication for aches, pains and arthritis.

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.

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Drug Names of the Future

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)."

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The Bottom Line

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.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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