Editor ’ s Corner
What ’ s in a ( Drug ) Name ?
S
The content of the Editor ’ s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated .
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HAKESPEARE CLAIMED that a rose by any other name would smell as sweet . A medication with a confusing name , though , can cause a fatal mistake . That ’ s why pharmaceutical companies exert so much effort creating clear and distinctive contemporary drug names , sometimes with peculiar results .
The drug-naming process is complicated – with multiple steps and people involved – and is reminiscent of the 1970s “ Schoolhouse Rock !” jingle about the gauntlet “ just a bill ” must travel to become a law .
A promising new molecule developed in a pharmaceutical company lab almost always begins life with an internal letter and number designation , derived from a screening library or a numbered series of chemically similar compounds . The alphabetical portion of this developmental name may reflect the molecule ’ s mechanism of action ( e . g ., “ Signal Transduction Inhibitor # 571 ” was “ STI-571 ” long before it was “ imatinib ”). But , more commonly , it is shorthand for the company that developed it ; so , LY3009104 / INCB28050 is a JAK2 inhibitor developed by Lilly and Incyte , while PF-04449913 is a hedgehog pathway inhibitor developed by Pfizer . ( That one raises its hand to “ PF-04449913 ” when the teacher calls roll , but is known to its friends by the less pretentious “ 913 .”)
Molecules that aspire to be drugs also go by lengthy chemical names , which almost no one ever uses , generated using the formal rules of the International Union of Pure and Applied Chemistry ( IUPAC ). Additionally , they get logged into many different chemical and pharmaceutical databases – the Royal Society of Chemistry ’ s bizarrely named “ ChemSpider ,” KEGG ( Kyoto Encyclopedia of Genes and Genomes ), the Chemical Abstract Service , and so on . Each of these databases uses its own unique identifier system .
Once a drug enters later-stage clinical trials and has a chance of regulatory approval , a good non-proprietary “ generic ” name is needed , using natural language rather than letters and numbers . This is where things can get interesting .
The Rules of the Name Just as Adam was tasked with naming the animals in the Garden of Eden , drug companies get first crack at proposing a new drug ’ s generic name .
Names may be informed by chemical structure and IUPAC name , development history , or mechanism of action . Companies can choose to outsource drug-name creation to a committee or to a specialist naming company such as Miami-based Brand Institute . When I was once a member of a drug name focus group , I heard that the drug that secretly incorporated part of an executive ’ s ex-girlfriend ’ s name did not make it out of phase I testing due to excess toxicity . I could have predicted that .
I don ’ t know if God vetoed any of Adam ’ s animal name ideas , but once a company has made a drug name proposal , a delicate negotiation with regulators ensues . The drug ’ s name can ’ t overpromise – we ’ ll never see a “ kurall ” or “ panaceon ,” for instance . Drug names rarely include the name of a disease or a body part , but that seems to be a matter of taste rather than a rule . A drug name shouldn ’ t mean something in a major language – a lesson Chevrolet learned the hard way with their Nova , which translates to “ it doesn ’ t go ” in Spanish . ( An apocryphal tale has it that sales of the Chevy Nova were poor in Mexico .) The immunomodulatory ( IMiD ) drug “ lenalidomide ” was originally going to be called “ cenalidomide ,” but cena means “ dinner ” in Italian , and changes to that recipe had to be made .
Most importantly , generic and brand names should not be easily confused with existing drug names . A drug that improves left ventricular ejection fraction in women will never be called “ Cardifem ,” because that would be far too easy to mix up with the brand name for diltiazem , “ Cardizem .” There are already too many similarly-named drug pairs that can cause problems : sulfasalazine and sulfadiazine , dextromethorphan and dexamethasone , Lamictal and Lamisil , Valtrex and Valcyte , to name a few .
Once chosen , the pharmaceutical company submits newly proposed generic names to national nomenclature committees . In the U . S ., the official committee is the five-member United States Adopted Names ( USAN ) council , housed within the American Medical Association . The International Nonproprietary Names ( INN ) program of the World Health Organization also creates a unique set of drug names that are globally recognized and , unlike trademarked brand names , public property .
Above all , organizations like USAN and INN are concerned with name clarity , which is why , for instance , drugs that by rights should have an alpha in them ( e . g ., epoetin alpha or darbepoetin alpha ) instead use the seemingly incorrect alpha , since there are far ( phar ?) more ways to mispronounce ph than f .
Difficulty with ph is also why IUPAC ’ s α- ( N-Phthalimido ) glutarimide became “ thalidomide ” rather than “ phthalidomide .” ( This name has the side benefit of cutting down on accidental spitting in the clinic when discussing the drug .)
Decoding Drug Names With new biologics and small molecules , there is often a code that regulates which name fragments or stems will comprise the final drug name . For example , only the ri- is unique to rituximab . The rest of the name tells us that rituximab is an anti-tumor ( -tu- ), chimeric murine / human ( -xi- ), monoclonal antibody ( -mab ).
Most small-molecule tyrosine kinase inhibitors ( TKIs ) end with -tinib , histone deacetylase inhibitors end with -stat , and proteasome inhibitors end with -zomib . Beyond oncology , we have all the glucocorticoid -onides , proton pump inhibitor -prazoles , anti-lipid -statins , and many other families that share a surname .
There is always room for cleverness like vemurafenib , which targets a V-to-E ( ve- ) mutation ( -mu- ) in BRAF V600E ( -raf ), commonly observed in hairy cell leukemia and certain lung cancers .
14 ASH Clinical News May 2018