Try wrapping your tongue around the prescription anti-seizure drug levetiracetam. How about the antifungal medicine isavuconazonium? Try the anti-clotting drug abciximab. Crazy, right? Who comes up with these bizarre generic drug names? Why do they do this to doctors, nurses, pharmacists and patients? These names are not the exceptions. There are way too many hard to pronounce prescription drugs being sold these days.
Why Generic Drug Names Should Matter to You!
Are you sick and tired of unpronounceable drug names? If you think it’s bad now, just wait. When modern pharmaceuticals become available generically in several years, it will become next to impossible. Hard to pronounce prescription drug names are becoming the norm.
Can you imagine asking your pharmacist to fill a prescription for dapagliflozin to control your diabetes? Even the brand name Farxiga is a tongue twister. The harder it is to pronounce your medicine the greater likelihood mistakes will be made.
Medical mistakes are considered the third leading cause of death in the United States (BMJ, May 3, 2016). It has been estimated that more than 400,000 people die each year from preventable harms (The Journal of Patient Safety, Sept. 2013). A substantial number of those deaths are caused by drug mistakes or adverse drug reactions.
We have written about this tragedy in this article:
Will Medical Mistakes Kill You or Someone You Love?
The Good Old Days:
In the past, pharmaceutical companies came up with catchy brand names that were easy to remember and pronounce. Consider Valium, Elavil or Lomotil. You did not need a degree in medicine or pharmacy to figure out how to pronounce these medications.
Even though the generic names were a little trickier, most people could stumble through them. The generic name for Valium is diazepam. It is an anti-anxiety drug. Amitriptyline is the generic name for Elavil, an antidepressant. Lithium is prescribed for bipolar disorder. The brand name Lithane was logical, easy to pronounce and remember.
As brand names lost their patents and insurance companies required generic substitutes, patients had to learn how to deal with generic names. Instead of Prinivil or Zestril for high blood pressure, people discovered that they were taking lisinopril. The cholesterol-lowering drug Lipitor was actually atorvastatin. Zoloft, to ease depression, was known to doctors and pharmacists by the generic name sertraline. Such generic drug names, while somewhat challenging, are more or less pronounceable.
That is changing with a new generation of pharmaceuticals. It will make it virtually impossible for patients and even health professionals to pronounce generic names. What happened? Why are there now so many hard to pronounce prescription drug names?
Really Hard to Pronounce Prescription Drug Names:
Blame the name game on drug companies and USAN (United States Adopted Names). In 1961 the AMA (American Medical Association) and the USP (United States Pharmacopeial Convention) got together to come up with logical generic drug names. The American Pharmacists Association (APhA) got into the game in 1964 and the FDA sent a representative to USAN starting in 1967. You will note that there is no patient representative on the USAN Council.
The goal of USAN was to come up with generic drug names based on chemical structure and biological activity. And by the way, they were supposed to also be “simple.” Yup, you heard that right. Here is an official description of the mission of the United States Adopted Names (USAN) Council (Schiffman, D.O., 1990 In: The Terminology of Biotechnology):
“The goal of the Council is to produce simple, short, unique, and useful names that can be used without restriction in the public domain.”
Drug companies must submit an application to USAN for a new generic drug name. There is very little incentive for a pharmaceutical manufacturer to negotiate for a “simple, short or useful name.” In fact, one might argue that there is a disincentive. If a generic drug is hard to pronounce or remember, the branded name might stick longer.
Drug companies spend hundreds of thousands of dollars developing catchy brand names. They want the brand name to be simple, short, useful and memorable. That’s because a great name can help make a drug hugely successful. Think Prozac, Viagra or Crestor. After the patent has expired on the brand name, the company generally does not care if anyone can pronounce or remember the generic drug names. Fluoxetine is the generic name for Prozac. Sildenafil is the generic name for Viagra and rosuvastatin is the generic name for Crestor. Would you agree that these generic names don’t “pop” the way the brand names do?
Can You Pronounce These Drug Names?
The bestselling medicine in the world (from a dollar point of view) is Humira. It is prescribed for rheumatoid arthritis, psoriasis and Crohn’s disease, among other serious health conditions. Just try pronouncing the generic formulation: adalimumab. (Here’s the cheat sheet: ay da lim’ yoo mab.)
The anticoagulant Xarelto can be managed with a little practice. You have probably heard it advertised on television. It is prescribed for people with nonvalvular atrial fibrillation, deep vein thrombosis and pulmonary embolism (blood clots in the lungs). Here’s the generic name: rivaroxaban.
Even doctors have trouble with these names. Pradaxa is not too hard to manage. But nearly everyone misprounounces its generic name, dabigatran. The emphasis is on GAT and the last two syllables rhyme with cat fan. But most people, including physicians, tend to put the emphasis on BIG.
Where things get really challenging is with the new-generation of immunotherapy cancer medicines. Many of them are what is called monoclonal antibodies (“mabs”). Here are some examples: nivolumab (Opdivo), pembrolizumab (Keytruda) and ipilimumab (Yervoy). It might help to know that the last two syllables come out as You-mab, but that won’t do much good for the first part of the name.
Some of the new diabetes drugs also have nearly unpronounceable generic names: empagliflozin (Jardiance), dapagliflozin (Farxiga) and canagliflozin (Invokana). Here again, the last two syllables are always pronounced the same, as “FLOWS in” (Frank, JAMA Internal Medicine, online Jan. 8, 2018). That still leaves you with a mouthful to figure out in the first part of the name, and they do not roll easily off the tongue.
How Will You Cope with Hard to Pronounce Prescription drug Names?
Once the patents expire on such medicines, as they inevitably do, everyone has to wrap their mouths around the generic names. If a physician telephones a prescription to the pharmacy, the pharmacist or pharmacy tech may have difficulty figuring out what drug is being prescribed. You will have to be extra cautious to make sure you are getting the right drug in the right dose with the right instructions.
For safety’s sake, we make this plea to the pharmaceutical manufacturers, the AMA, the USP, the FDA, the APhA and the people who serve on the USAN Council:
Please pay attention to generic names as well as the brand names. All drug names need to be distinctive–and pronounceable. Why not follow your own guidelines to make sure all generic drug names are “simple, short and useful.” Anyone who believes that pembrolizumab or empagliflozin fits that bill needs to spend some time talking to patients.
Share your own thoughts about brand name and generic drug names in the comment section below. If you watch any television you have no doubt seen commercials for brands like Farxiga, Xeljanz, Otezla, Xarelto and Taltz. What is it with all the Xs and Zs anyway?
