An article in the Globe and Mail earlier this week got me thinking about the names that drug companies give to their products. The article talks about diclofenac, a commonly prescribed non-steroidal anti-inflammatory that some researchers believe is quite dangerous. As odd ad the word “diclofenac” is, it was the even stranger name of a similar drug that really made me wonder: “etoricoxib”.
What is going on? Who could coin such a monstrosity, and more to the point, why would they? I picture a big pharma Eden, where some utterly exhausted Adam, strung out on caffeine and out-of-date benzedrine, is reduced to banging random syllables together as the legion chemical chimeras parade past him for their naming. In fact, there is some method to the madness, I learn.
Methods, plural, I should say, because all drugs, or almost all of them, are binomial: each has a clattering Klingon cognomen — the generic name such as “etoricoxib” — and each has as well a dulcet proprietary name. (There’s actually a third name, the chemical name, but only chemists use that, because they’re like this: “7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one”.) And the methods used to derive them are poles apart.
The generic names, created to allow health workers to talk about the same drug without becoming confused by various manufacturers’ proprietary names, are developed, in the United States at least, according to a scheme established by the United States Adopted Names Council [USAN], a scheme they describe as a “logical nomenclature classifications based on pharmacological and/or chemical relationships.” Names are proposed to the Council and those “adopted” are added to the list There’s also a helpful pronunciation guide.
As USAN explains:
[M]ost new names consist of three parts: a prefix, an infix and a stem.
Prefix: Means nothing; differentiates drug from others in class
Infix: Used occasionally; further subclassifies
Stem: Indicates place in nomenclature scheme; novel stems suggest novel drug action; drugs with the same stem are related
. . . . As an example, consider sildenafil (Viagra™), vardenafil (Levitra™), and tadalafil (Cialis™). The -afil stem is formally defined as for PDE5 (phosphodiesterase 5) inhibitors. The -den- infix indicates that sildenafil and vardenafil have similar chemical structures. The prefixes are sil-, var- and tadal-.
There’s a long list of approved stems, where I find that “-coxib” describes “cyclooxygenase-2 inhibitors” and has been used in celecoxib, parecoxib, valdecoxib, as well.
Turns out that making up proprietary names — Viagra, Lipitor, Lunesta — is in a way closer to my mad Adam and his bag of syllables. One member of the US Food and Drug Administration called these drug brand names “a rhythmic cacophony of unpronounceable syllables and emphatic-sounding letters.” Speaking of which — letters, that is — X and Z are apparently back in, after a brief hiatus. (Note that USAN forbids generic names that begin with X and Z, as the initial sounds are too easily confused.) Marketing firms and focus groups tell the drug companies that words beginning with those two are more memorable. And the same advisers would say, as one commentator put it, that along with X and Z, N Q and K “connote cutting edge science”; the letters “‘S.’ ‘M,’ ‘V,’ ‘L’ and ‘R’ are ‘soft’ letters, which the names of drugs for women are likely to include”; and “[m]edications marketed to men are more likely to contain a ‘hard’ sound like ‘T,’ ‘G,’ ‘K’ or ‘X’.”
See for yourself. There’s a wonderful online name generator that will agglutinate a drug name for you at the click of a button. Wordlab’s Drug-O-Matic has provided me with Kifloxiril, Vistisu, Dyrid and Anagin. I think I’d use the first to tackle ringworm or lice, the second for varicose veins, the third for something involving a friend, and the last for the morning after. What’s your take?