The naming of drugs is a curious matter.
My husband had an unconventional friend who let his cat pick his first kid’s name. He wrote down the options on pieces of paper, crumpled them up, and set them down in front of the cat. There was a finish line, and the first ball of paper to be batted across it won.
Consider Filspari™, Jaypirca™, Jesduvroq, and Orserdu™. My husband and I watch the news at night and are astonished at the fanciful and preposterous names of medications. This is a sampling of new drugs coming to market in 2023. We often wonder if the pharmaceutical companies let their cats devise the names of the meds.
Why am I bringing this up? Because in preparation for the ICD-10 Coordination and Maintenance Committee Meeting that was being held March 7 and 8, 2023, I reviewed the agendas. The first day was PCS (Procedure Coding System) day, and the second day was for ICD-10-CM diagnosis codes (although sometimes we start that on day one if we finish procedures early). The PCS had a list of new technology add-on payment (NTAP) procedure codes involving the administration of a therapeutic agent. They announced ahead of time that they planned to not discuss them during the meeting, but made them available in advance to review. Examples were administration of Glofitamab, Posoleucel, Rezafungin, and Quizartinib.
Drugs basically have three names (for you Broadway-philes, this reminds me of Andrew Lloyd Webber’s Cats): their chemical compound name, their generic name, and their brand name. The chemical name describing the actual molecular formula is often quite complex, and too cumbersome to be utilized in common use, and so a shorthand code name may be given. There are also databases that aggregate and categorize chemical compounds, such as ChemSpider ID.
The generic or non-proprietary name is intended to standardize drug identification globally, and is applied to the active ingredient of the drug. The United States Adopted Names (USAN) Council and the World Health Organization (WHO) International Nonproprietary Names (INN) must approve the generic name. The ending, or suffix, tells us what family a drug is from and can give information about its mechanism of action. For instance, “-mab” indicates monoclonal antibodies, “-pril” identifies an angiotensin converting enzyme (ACE) inhibitor, and “-olol” signifies a beta blocker. There are more than 600 stems and sub-stems that identify classes of drugs.
Some letters are avoided (H, K, J, W, and Y) because they have no analogs in certain languages. They can’t use the company’s name within the drug’s name and have to avoid promotional terms like “best” or “strongest.” They also avoid medical terminology, because they don’t want to limit the drug to a specific indication. For instance, they wouldn’t use “Onc-“ or “Uro-“ at the beginning of the generic name.
When they have a small set of contenders, the drug company submits them to USAN for (hopefully) approval of one. Once the U.S. name has been selected, the process is repeated with the WHO. The name they accept is published on an international list for the public to review. When a period of time has elapsed, barring objection from the public, the new nonproprietary name is released.
Then the real fun begins! The manufacturer gets to invest time and money deriving a mellifluous brand name that will capture the public’s attention and elicit positive feelings about the medication. I like the example of IBRANCE® (Palbociclib), a breast cancer drug, which purportedly is an amalgamation of “inspiration, embrace, vibrancy.” Supposedly Viagra® came from “vigorous” (stream) and “Niagara.” Latisse®, the eyelash growth drug, is a merger of “lash” and “Matisse,” the artist.
Again, the name can’t make an overt claim or be promotional, and shouldn’t include generic name stems. But they often try to convey the action of the medication, like Lopressor®, which is an antihypertensive medication or Glucotrol®, which is meant to control glucose levels. Sometimes, the brand name is a shortened version of the generic name, like Keflex for cephalexin.
The brand name has to be unique and can’t be too similar to another medication such that it might cause a dispensing error. It can’t look or sound like another drug. They even check handwritten samples and have people with a variety of accents pronounce the proposed name. This is another reason why wacky letters may be found in the names in odd places, like Rinvoq® or Xeljanz®. Personally, I think they should be sure the drug is pronounceable by the average consumer, too. The drug company does market research to see what healthcare professionals and John Q. Everyman think.
After conjuring up many options and taking a great deal of time (up to four years!), only one proposed name will be assessed by the Food and Drug Administration (FDA) at a time, so the drug company picks their favorite. A total of 20-35 percent of medication names are rejected on the basis of safety considerations. If it is rejected, they have to try again.
And I suppose, if all else fails, they can always fall back on asking the cat to choose a different name to submit next.
Programming note: Listen to Dr. Erica Remer when she cohosts Talk Ten Tuesdays, Tuesday, 10 Eastern with Chuck Buck.