How Drugs Get Their Names

Think of the drugs that have changed our world.

Viagra (sildenafil) ended the secret shame of erectile dysfunction--and at the same time offered a treatment for it.

Lasix (furosemide) was one of the first diuretics or water pills, vital to the treatment of hypertension and heart failure.  Leslie Z. Benet, PhD, the first president of the American Association of Pharmaceutical Scientists (AAPS), says  it made a a radical difference in the treatment of heart disease. "We have better drugs today, but that was the breakthrough in terms of really being effective."

Prozac (flouxetine) ushered in new era of antidepressants. Teh old-style treatments had challenging side effects, requiring life-altering changes. Prozac was safe, with few side effects--and the 'antidepressant nation' was born.

Zyprexa (olanzepine) was supposed to change the face of antipsychotic treatment, providing relief from disturbing schizophrenic symptoms, free from the frightening adverse side effect profile associated with previous antipsychotics.

Prilosec (omeprazole) was the first prescription proton pump inhibitor (PPI) to reduce the amount of stomach acid, change treatment of heartburn and gastric reflux disease forever. Who knew that extensive coughing, vomiting, and even colic in babies might be healed with the same medication?

Fosamax (alendronate), became the first approved drug to treat the bone thinning that leads to osteoporosis.

Each of these drugs is a tremendous success story. A significant aspect of that success is tied up in the drugs' names, as pharmaceutical companies well knew when they selected brand names, after vetting them, hiring branding companies, meeting with focus groups, and checking the names across dozens of languages to be sure they held up positively in other cultures.

Once upon a time it was enough merely to have a good product, and any name might do. Think of ADD medication Ritalin methylphenidate), which was invented in 1944 by chemist Leandro Painizzon. He romantically named the drug after his wife Marguerite, nicknamed Rita, who took it to help her low blood pressure which occurred while playing tennis.

Or what of Lithobid (lithium), named such after the Greek "Lithos," or stone, because it was first discovered in rocks?

Simple naming techniques didn't seem to hurt drugs decades ago, as ongoing sales of Ritalin and Lithobid well demonstrate.

But times have changed.

How are drugs named today

Today, naming medications is both an art and a science and taken seriously by pharmaceutical companies. Behind Lyrica, Cialis, Fosamax lie a complex and expensive effort to create a name that will stick in the public mind, subtly sell the product, and avoid something distressing in a foreign language.

But first. . . .before creativity, before salesmanship, before language testing--is the Food and Drug Administration.

An even before that first is the Hippocratic rule: First do no harm.

In the FDA's publication "Guidance for Industry Contents of a Complete Submission for the Evaluation of Proprietary Names," the reason that medication names have come to matter so terribly much in recent years becomes clear.

It turns out that in 2000, the Institute of Medicine (IOM) published a report stating that  44,000 to 98,000 deaths occur yearly due to medical errors, of which medication errors are the most common. In fact, 7000 deaths annually are caused by medication errors.

Six years later the IOM distributed a report further elaborating on the problem:  It seems that labeling and packaging issues, and the resulting confusion, are responsible for 33 percent of medication errors, including 30 percent of fatalities from medication errors.

Names pairs like Aciphex and Accupril, Anzemet and Avandamet, Aricept and Azilect--they're asking for trouble.

The IOM had a strong recommendation for the FDA to  “require pharmaceutical companies to test proposed drug names to identify and remedy potential sound-alike and look-alike confusion with existing drug names.”

Rejections of initial submissions of drug names due to similarity began promptly, and has made the process of naming more complex. AstraZeneca, for example, originally wanted the name "Losec" for its Prilosec, but the similarity with "Lasix" sent them back to the drawing board.

However, the screening process for names that sound similar is only the most recent addition to the already existing set of FDA regulations.

The International Trademark Association Bulletin reviews, for its readers, the responsibilities of the FDA committee regulating pharmaceutical naming. It:

1. "Reviews proposed proprietary names to prevent terms that are misleading.
2. Names that are overly fanciful such that they imply unique effectiveness or composition are likely to be rejected.
3. Similarly, names that overstate product efficacy, minimize associated risks, broaden product indication or make unsubstantiated superiority claims should be avoided. In one famous example, [the committee] rejected the name REGAINE for a hair growth product as implying that the product would work for everyone. Ultimately, the product was branded as ROGAINE in the United States and REGAINE outside the United States."

Novo Nordisk discovered the FDA would stand its ground on the implication of superiority as well. They named its form of insulin (insulin aspart) NovoRapid, which was promptly rejected due to the implication that it acts more quickly than other similar drugs. Today it's NovoLog.

Additionally, The Student Publication of the Graduate Program in Science Writing at MIT asserts that a drug company's team of linguists checks a potential name for negative meanings in up to 40 languages in preparation for marketing.

And as if all of that's not enough, the name also gets checked against common medical abbreviations, generics, and medical products to make sure there's no overlap.

Luke Timmerman, the National Biotech Editor of Xconomy, explains the burden on drug companies:

"A good drug name is supposed to check lots of boxes. It should be easy for doctors to spell accurately when they scribble it down on a prescription pad. It should be memorable. It should be used in every country around the world without triggering some cultural confusion or sensitivity. It ought to be consistent with the science or clinical application that distinguished the product through years of development, yet the brand name shouldn’t be so geeky that it’s obtuse for patients. Ideally, you’d want it to trigger some relevant connection to your product."

So there are a lot of hurdles to jump through to find an acceptable name and get it approved. Drug companies might spend up to half a million dollars per product finding just the right name (and some spend well over that).

Let's take a look at what factors go into naming a product that can't make superiority claims, can't be misleading, and can't really imply effectiveness.

To return to our original list, we can start with a truly fanciful naming result--Viagra. With the 'vi' alluding to virility and thus manliness, others have hypothesized that the second part of the world recalls the 'Niagara' of Niagara Falls, and therefore the pill, so the name implies, elicits a rush of manliness.

Family Practice Notebook claims that Lasix got its name because it's only effective for 6 hours (LAst SIX). (Its other name,  Lo-Aqua, is really self-explanatory.)

Of Prozac, Anna Moore writes in The Guardian, it was given to Interbrand, which was the world's leading branding company, for the naming ceremony. Interbrand, she discovered, picked the name Prozac for its "zap: it sounded positive, professional, quick, proey, zaccy." It was a great success; the name is a household word.

William Trombetta, professor of pharmaceutical marketing at St. Joseph's University in Philadelphia, suggests that the 'Z' in Zyprexa is doing double-duty, claiming that it's a letter that both expresses control and sounds high-tech, as is 'x.' This, proclaims its name is the latest in technology, ready to take control of the antipsychotic market--and your delusions, as well.

Steve Manning, managing director of a San Francisco branding company, further explains the power of the 'X,' in that it "is associated with science fiction, high tech, computers, automobiles and drugs," as we realize when we think about "The X Files" or "The Matrix," so Zyprexa also ushers in a future era in antipsychotic treatment.  Perhaps Xanax, the drug that helps you escape, from the restrictions of your anxiety, developed its name through just such thinking.

Fosamax, that drug for osteoporosis, implies working against bone deterioration, with Os referring to bone, and Max meaning great, both from Latin.

In taking stock of drug names, most companies accomplish one or more of 3 tasks:

1. create an image (think of the poetic Lyrica [pregabalin to relieve nerve pain], suggesting harmony, peace, and beauty),
2. relate to a drug's composition or the generic name, or
3. suggest what the pill does. Some go beyond and even work to brand the company with the drug.

Imagery abounds in drug naming, often making use of foreign language words to lend authenticity.

The brand name of antipsychotic ziprasidone, Geodon, calls to mind the image of soothing the manic or psychotic person, by bringing them down (don) to earth (geo in Greek).

Sleep aid Lunesta (eszopiclone) makes us think of the moon (luna) and has enough of the word 'rest' in there to call it to mind--or perhaps it's taken from the Spanish word with which it rhymes--siesta.

Choosing the name Victoza (liraglutide injection), a drug used for type 2 diabetes, cost makers Novo Nordisk a cool billion. The chief officer describes the appeal: "You want names with a feminine touch, something that connotes caring. Victoza is a soft word," he said. "It's also reminiscent of 'victory' over the disease."

You can hear the word 'able' in Abilify (aripiprazole), a drug for bipolar and schizophrenia that will, assumedly, make you more capable of handling your life.

James L. Dettore, president of a branding company based in Miami that can lay claim to Lipitor, Clarinex, Sarafem and Allegra, focus-tested the Prozac derivative name with women with Premenstrual Dysphoric Disorder and came up with the image-heavy Serafem, from the holy angels, the seraphim, but with, he explained, a softer, more feminine-sounding ending.

His, too is Levitra (vardenafil), another drug for erectile dysfunction, with 'le' coming from 'elevate' (and alluding to masculinity in French, he says), and vitra referring to vitality.

The British Stilnoct (zolpidem), a drug for insomnia the U.S. knows as Ambien, is named after the German stille Nacht.

In the performance world an intermezzo is a brief dance or music show put between the sections of the longer performance. Thus it's no surprise that the new drug to treat disrupted sleep (that brief period of life between the longer waking hours, which are the main part of the show of life) is called Intermezzo (zolpidem tartrate sublingual tablets).

And what of Celebrex (celecoxib), which holds most of the word 'celebrate,' and implies the drug will have you ready to party, in your new, pain-free existence from arthritis?

Dendreon's new prostate cancer treatment is Provenge (sipuleucel-T).  The 'pro' suggests protect or proactive or even just a general positive connotation. Venge, then, seems as if it comes from avenge or revenge or vengeful, giving the sense that the drug is going to most certainly take care of that cancer!

Mark Skcoultchi in Pharmaceutical Executive suggests that allergy medicine Claritin (loratadine) implies clarity, and the mental and physical lucidity that comes when eyes and nose and sinuses aren't clouded and stuffed.  "Similarly," he writes, "Allegra (fexofenadine) speaks to the patient community through both its tone—calming and comforting—and the associations it draws with music and harmony. At the same time, the name provides a strong reference to the condition it’s used to treat—allergies—and thus succeeds in reaching professionals as well."

Relationships to drug composition or generic names abound, as well.

The name of menopause drug Premarin (conjugated estrogens) derives from the pregnant mares’ urine that is the origin of its composition.

Lipitor is a lipid-lowering drug; the final syllable 'or' comes from its generic name atorvastin.

Antipsychotic drug Haldol's name is merely a convenient shortening of the generic haloperidol.

Coumarin is a chemical found in plants that has strong anti-coagulant properties. The drug made from that chemical, Coumadin (warfarin), is used to prevent blood clots in humans.

Diflucan is used to treat fungal infections, which you wouldn't know from its name--but you would see how the name came to be if you knew that the drug's generic is fluconazole.

Ultram, for moderate to severe pain, is tramadol in its generic form.

And then, of course, many drugs' names work to express the medication's purpose.

The laxative you take before your colonoscopy is to make your colon visible--hence it's called Visicol (sodium biphosphate/sodium phosphate).

Advair (no generic available) refers to “advantage air for asthma,” which seems to skate the border of implying superiority, but clearly has successfully gotten away with it for years.

Flonase (fluticasone nasal), an allergy medicine, should stop your nose from flowing.

Tamiflu (oseltamivir phosphate) clearly is meant to tamp down the flu.

A vigil is defined as "a period of keeping awake during the time usually spent asleep," so is it any wonder that modafinil, the drug used to treat excessive sleepiness, is called Provigil?

The word 'neuron' in Neurontin (gabapentin) makes us think of the drug's aim, which is to treat nerve pain.

Estraderm patches (estradiol transdermal) secrete estrogen. The patch goes on the dermis (skin).

If your body doesn't produce enough thyroid hormone on its own, you will clearly need Synthroid (levothyroxine), as a synthetic thyroid hormone.

Glucotrol (glipizide) controls blood sugar, or glucose, in those with type 2 diabetes.

Vaccines Decavac and Tenivac (tetanus and diphtheria toxoids) help patients remember to return every ten years for booster shots.

Privigen (immune globulin) packs several naming goals into its three syllables. The name incorporates the condition it treats (primary immunodeficiency), what it is (intravenous immunoglobulin, or IVIG), and an ending that implies it's a “next generation” therapy.

Mark Skcoultchi adds another component to the selection of drug names: establishing product commonalities and enhancing brand awareness.

Thus companies name drugs after themselves and each other

For example, he notes that Amgen's Neupogen (filgrastim), an anti-infective, and Epogen (epoetin), an anemia product, are purposefully similar.

"By using a common root," he suggests, "the company builds a product family which, in turn, contributes to the credibility and strength of each individual brand."

Roxane Labs owns patents to Roxilox (acetaminophen and oxycodone) and Roxanol (morphine).

Sandoz AG makes Sandimmune (cyclosporine) to prevent transplant rejection, Sanorex (mazindol), which helps with weight loss, and Sansert (methysergide), to treat severe recurring headaches. [Note: The brand Sansert has officially been pulled in the U.S.]

Think, too, of Forest Pharmaceuticals' Lexapro (escitalopram oxalate), a cognate of Celexa's (citalopram), which incorporated the first three letters of the first drug's name into its own, just like it incorporated a considerable amount of its formula.

Certain classes of drugs are easier to interpret than others.

Antidepressant names, for example, are relatively simple to comprehend, using a mixture of techniques.

Viibryd (vilazodone), a new drug for depression, was meant to express to doctors that it was a hybrid compound, that could treat depression in two ways, and also call to mind 'vitality' for those with less of a scientific bent.

Zoloft (sertraline) synthesizes  the uplifting “loft” with the Greek prefix 'zo,' meaning 'life.'

Pax means peace in Latin, leading a restful feeling to Paxil (paroxetine).

Wellbutrin (buproprion) goes without saying, but the 'but' can also allude to 'buttressing' that 'well'-ness. [In fact, this name is so expressive of what the drug does that its approval caused some raised eyebrows. Bill Trombetta, professor of pharmaceutical marketing at St. Joseph's University in Philadelphia, expressed surprise that the FDA approved a name that sounds like a promise of wellness.]

Effexor (venlafaxine) instills confidence that it will be nothing if not effective.

However, as sensible as all the names in this piece are, numerous people have suggested that the restrictions by the FDA are catching up with drug companies, leading to something chaotic and nonsensical in perplexing new names  like Edarbi (azilsartan medoxomil) for hypertension or Zytiga (abiraterone) for prostate cancer, that seem to have no rhyme or reason.

Bruce Seeley, Seattle Genetics’ executive vice president of commercial operations, notes, “I’ve named quite a few products in my history, and it’s increasingly difficult to find an attractive name that doesn’t sound like something else, or have a patient safety issue associated with it. [The FDA is currently rejecting four out of every 10 name proposals, in order to avoid medication mix-ups.]

Or doesn't go back to one of the FDA's original no-nos. The FDA wouldn't approve Avikine, a rheumatoid arthritis drug whose generic name was infliximab, because it deemed the name too descriptive. The FDA asserted that the name implied the drug targeted cytokines, or proteins that serve as messengers between cells. The rejection delayed the launch of the drug by half a year. Don't the manufacturers have enough other problems getting prescriptions to market?

Akivine was reincarnated as Remicade.

Debora Bowes, a biotech consultant, is clear about the name's reference. It “doesn’t mean anything. It has no attachment to any mechanism of the product, any property of the product. It’s just a name.”

That's may be how we come to find ourselves with Lok Pak (heparin) to prevent blood clots, Docefrez (docetaxel) to treat certain types of cancer, Xgeva  (denosumab) for cancer-related bone fractures, Incivek (telaprevir) for Hepatitis C,  or Duexis (ibuprofen and famotidine) for arthritis.

Unless something changes, we may very well have much less Visicol and Tamiflu, and much more gibberish in our future.