These aren’t made-up words but the generic names of potentially life-saving drugs. Such convoluted names don’t lend themselves to being memorised, much less for a person to recall them at the pharmacy. This is why the companies manufacturing or distributing them come up with brand names that are easier to pronounce.
But these brand names are more arbitrary than the generic names of the drugs, which are determined according to some rules.
Any marketed drug has three names. The chemical name is the first and most complex name assigned to a drug, and is based on its molecular structure. Second, a generic or non-proprietary name is usually a shorthand version of the drug’s structure or mechanism of action. Third, the brand, or proprietary, name is the more pronounceable of all.
Chemical names are long, complex and difficult to memorise. Several chemical names can exist for a single drug, and have nothing to say about its therapeutic action. For example, paracetamol has the chemical names N-(4-hydroxyphenyl) acetamide, 40-hydroxyacetanilide and p-acetamidophenol.
Generic or non-proprietary names eliminate the use of chemical names in clinical settings. It is easier for a doctor or a patient to talk about N-(4-hydroxyphenyl) acetamide if they’re calling it paracetamol.
So in 1953, the World Health Assembly, the governing body of the WHO, passed a resolution that asked an expert committee of the WHO to “undertake the selection and approval of non-proprietary names for drugs”.
Earlier, drugs were named after divine entities, prevailing socio-cultural practices, the name of the scientists, and important discoveries. Morphine gets its name from the Greek god Morpheus. Anandamide, a neurotransmitter, was named after the Sanskrit word ananda, meaning bliss.
In the last few years, however, drug-naming has become a lot more complex.
The WHO’s programme on International Non-proprietary Names (INN) regulates the approval and use of generic names. The idea is that there should be a single name for a pharmaceutically active substance around the world, providing a common basis to identify it. Generic names are public property: nobody can own any rights to their use. The names should also comply with certain rules.
Generic names have three components: a stem, a prefix and an infix.
The stem is usually the suffix that identifies the pharmacological group or action of the drug. The stem “-profen” in ibuprofen indicates that it is an anti-inflammatory drug. The “-mycin” in streptomycin indicates that it is an antibiotic produced by the Streptomyces strains of bacteria. The “-caine” in lignocaine indicates that it is a local anaesthetic. The stems “-vir” and “-mab” in investigational COVID drugs remdesivir and tocilizumab denote that they are antiviral and humanised monoclonal antibodies, respectively.
Prefixes are used to separate one drug from another in the same class and so demand a measure of creativity. For example, in sildenafil and vardenafil, the prefixes are “sil-“and “ver-”. In ibuprofen, the prefix is “ibu-”.
Infixes usually don’t have any pharmacological significance, although they have been used to further sub-classify some drugs. In sildenafil and vardenafil, “-den-” is the infix. Ibuprofen doesn’t have an infix.
Generic names also can’t be too long, should have a distinct sound and spelling, and should indicate a relationship to substances with the same pharmacological actions. Perhaps most importantly, they should not have anatomical, physiological or pathological connotations. For example, a generic name starting with “cancer-” wouldn’t be acceptable.
Finally, generic names are restricted to a few languages: Arabic, Chinese, English, French, Latin, Russian and Spanish. In addition, to help with pronunciation, they’re advised to avoid the letters ‘h’ and ‘k’; and use ‘i’ instead of ‘y’, ‘f’ instead of ‘ph’, ‘t’ instead of ‘th’ and ‘e’ instead of ‘ae’ or ‘oe’. This is why the INN for ‘amphetamine’ is ‘amfetamine’.
According to the AMA Journal of Ethics, “The assignment of generic names to pharmaceuticals in development is an important prerequisite to marketing a drug.” But the marketing itself uses brand names. These names are owned by the entity that owns the patent on the drug, and are private properties.
In most cases, manufacturers pick the brand name after defining the drug’s formulation and dosage – and register them at the corresponding national patent office. A single drug can have different brand names in different countries, and sometimes more than one name within a country.
Brand names, unlike generic names, are not tied to specific stems, making room for more creativity. They can be based on abstract ideas, pleasing sounds, even that they could make a positive impression. For example, ‘Lasix’ is used to reduce fluid build-up in the body. Its name comes from the fact that its effects on the body last six to eight hours. ‘Premarin’ is an estrogen-replacement drug made from pregnant mares’ urine, which is rich in estrogen.
However, this doesn’t mean brand names can run wild. As such, they must be easy for doctors everywhere to spell and for patients to recall. They shouldn’t give way to trademark disputes either. (In the US, manufacturers define brand names in consultation with the US Adopted Names council.) The names also shouldn’t make overt claims about what the drug does nor promote its parent company.
According to the US Food and Drug Administration, branded drugs are 80-85% more expensive than generic drugs.
Drug names, like the drugs themselves, pass through rigorous checks before healthcare workers and the people can use them. The next time you come across a new drug, its name may have more to tell you before you need to open Google.
Niranjana Rajalakshmi is a veterinary microbiologist.