(By James Harbeck,
The Week, 13 August 2013)
Asvasiran. Bremabecestat. Gedatolisib.
Lulumab pegol. Nexbolizumab. Uprosertib. Orilotimod. Vepoloxamer. What are they? Aliens? Goblins? Diseases? A spelling
bee contestant's nightmare? Nope.
They're names for drugs. Not brand
names, though. They're the names for the active ingredients. You may have noticed that every brand-name
drug has a second name — for instance, Prozac® (fluoxetine). That
second name, fluoxetine, is a name for the active ingredient, which is the same
whatever the brand or generic form. And
believe it or not, these syllable-heavy second names are actually convenient
nicknames. It's much easier to say fluoxetine than to say (RS)-N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propan-1-amine.
When a drug
company researches and patents a drug, it gets to suggest what the generic name
should be. It makes an application to the United States Adopted Names Council
(other countries have similar councils and they generally try to cooperate).
And that is what those alien-looking words are that I started with: generic
names that have been applied for and are under consideration. So can these drugs be named just any old
thing? Is there anything preventing a company from calling its active
ingredient supercurol? Well, yes. The U.S. Adopted Names Council. It has
some rules, including the following:
"Prefixes that imply 'better,'
'newer,' or 'more effective;' prefixes that evoke the name of the sponsor,
dosage form, duration of action or rate of drug release should not be
used."
"Prefixes that refer to an anatomical
connotation or medical condition are not acceptable."
Certain letters or sets of letters also
aren't allowed at the beginning of new generic names. These include me, str,
x, and z.
Every name has
two main parts. The back half of the drug name is the same for all drugs in a
particular class — for instance, there are a whole raft of cholesterol-lowering
drugs that end in -vastatin: atorvastatin (Lipitor), fluvastatin
(Lescol), rosuvastatin (Crestor), simvastatin (Zocor), and several others. Some
other class suffixes include:
-oxetine for a class of antidepressants, such as
fluoxetine (Prozac)
-sartan for a class of blood-pressure-lowering drugs,
such as losartan (Cozaar)
-afil for a class of drugs used for erectile
dysfunction, such as sildenafil (Viagra)
-lukast for a class of anti-asthma drugs, such as
montelukast (Singulair)
-azepam for a class of anti-anxiety medications, such as
diazepam (Valium)
-coxib for a class of anti-inflammatory pain relievers,
such as celecoxib (Celebrex)
-dronate for a class of drugs that prevent calcium loss,
such as alendronate (Fosamax)
-formin for one class of diabetes drugs, such as
metformin (Glucophage), and -glitazone for another class, such as
rosiglitazone (Avandia)
-prazole for a class of stomach acid reducers, such as
esomeprazole (Prilosec)
-conazole for a class of anti-fungals
-vir for antivirals, with a number of subclasses,
including -amivir for a class that includes the anti-flu drug zanamivir
(Relenza), -ciclovir for a class that treats herpes (such as famciclovir
(Famvir)), and -navir for antiretrovirals for HIV treatment, such as
indinavir (Crixivan)
-stat for enzyme inhibitors, with a whole bunch of
subclasses — for instance, -becestat means it's a beta secretase
inhibitor (doesn't that help you? It would if you were a pharmacist)
So where do these
suffixes come from? They used to often be based on the full chemical name, but
now they're sometimes based on particular descriptive terms: -mab for monoclonal
antibodies, -sertib for serine/threonine
kinase inhibitors, -mer for polymers, or -imod for immunomodulators.
And sometimes they're just made up. If you're the first company to come up with
a drug in that class, you may get to set the pattern that all the others who
come after have to follow.
As to the prefix
(what comes before the suffix to identify the individual drug), you can make it
pretty much whatever you want — subject to the USANC's rules and approval. And
then it's just up to the clinical trials to show it's effective… and to
doctors, patients, and marketing departments to make it successful. Or not. But
if it is, you can bet everyone will call it by the brand name anyway.
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