December 15, 2018
Why Are Drug Names So Crazy?

Why Are Drug Names So Crazy?

by Wellness Letter  

Everyone agrees that drug names are becoming ever more crazy. For instance, why all those X’s and Z’s in brand names (Pradaxa, Xarelto, Xeljanz, Zyprexa)?

Generic names can be even more mouth-boggling. Can you remember that acetaminophen is the generic name for Tylenol, and can you pronounce it? If you want to get it when visiting Europe, however, you’ll have to ask for paracetamol. Both of those names get their syllables from a chemical name of the compound: para-acetylaminophenol.

But the names of most generics (like brand names) are largely or completely made up and illogical, except that some related drugs share a suffix, such as “-statin” at the end of cholesterol-lowering drugs like simvastatin (Lipitor) or rosuvastatin (Crestor), and “-azepam” for tranquilizers like lorazepam (Ativan) or temazepam (Restoril).

Tongue-twisting generic names are a big problem since the vast majority of drugs are now dispensed as generics, leading to growing concerns that if names are mispronounced or misread and drugs misidentified, patients could be harmed. Avoiding such confusions is one of the rationales for electronic prescriptions.

A recent editorial in JAMA Internal Medicine by a physician in Seattle, Dr. Daniel Frank, tackled the problem of “unpronounceable pharmaceuticals” in a lighthearted but heartfelt manner. New drugs are given their generic names by a group called the U.S. Adopted Names (USAN) Council, which is supported by the American Medical Association (AMA) and works with drug companies to choose the names and decide how they should be pronounced. (To complicate matters, the World Health Organization also manages generic names and occasionally decides on different ones than USAN.)

Dr. Frank points out that some drug names sound like former Soviet republics (ustekinumab) or rich Italian desserts (canagliflozin) and that even specialists often disagree on pronunciation. “Drug companies might prefer an unpronounceable generic to pair with their zippy trade name,” he notes, so that patients keep asking for Crestor instead of rosuvastatin, Lunesta instead of eszopiclone, or Pradaxa instead of dabigatran (the last is not yet available as a generic).

He is particularly perturbed by the inscrutability of the official pronunciation of many generic names as determined by USAN. He’d like USAN to provide online audio clips and clear phonetic spellings, along with perhaps “rhymes with” and other hints. “Lowbrow? Maybe, but good for patient care,” he notes.

We’re already up to some six- or seven-syllable generic names. Isn’t it time for USAN, the AMA, and pharmaceutical companies to simplify drug names?

This article first appeared in the UC Berkeley Wellness Letter.

Also see New Drugs Not Always the Best Drugs.