Keeping You On Your Zs and Qs

From the standards bodies to the FDA to the airwaves, the weird processes that go into naming prescription drugs—and why so many use relatively obscure letters, like Z and X.

By Ernie Smith

Today in Tedium: A while back, I caught something interesting on the blog of a Pulitzer Prize-winning author. Andrew Marshall, a writer for Reuters who serves as a correspondent in Southeast Asia, had a need for an anti-diarrheal medication while in Burma, a country that has put him in the crosshairs of food poisoning multiple times. (I’m okay with not learning the specifics of his medical ailment.) With that in mind, he had purchased a drug with an unusual name when he was in nearby Thailand—Tedium. Yes, Tedium. The drug, essentially a regional variant of Imodium A.D., is kind of hilariously suited for this particular name. “It not only alleviates the condition but, in a single word, captures the experience,” Marshall wrote. And I guess I’ve sort of been wondering: How do drugs get named? And why do drug names carry a certain flow to them, despite seemingly sounding like gibberish words? That’s a question I needed to answer for myself—and for today’s Tedium (the newsletter, not the anti-diarrheal). — Ernie @ Tedium

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The year Eli Lily introduced the antidepressant drug Prozac, one of the most famous drugs in the history of medicine, in part because it’s one of the first modern drugs named the way it is. The drug, with the scientific name fluoxetine, was a pop-culture phenomenon when first introduced, and became shorthand for a strategic, drug-based approach for dealing with mental health—something taken for granted today, but a new idea upon its release. The word essentially means nothing, but it was familiar and memorable enough that it came to be used in a number of pop-culture use cases.

Prescription Drugs

(James Yarema/Unsplash)

One drug, three names: The many different strategies for classifying a prescription drug

Objectively, Tedium is a great name for an over-the-counter drug. It’s simple. It’s memorable. It’s relatively easy to pronounce, and the ailment it covers is extremely common.

But it has a problem that makes it a bit of an outlier in terms of modern medicine—it’s an extremely common, easy-to-trademark name that has likely been used in lots of other settings.

This is something lots of drug companies pay top dollar to avoid, in part because the scale at which they work is so high that they can’t risk being pulled into a trademark lawsuit over a repeated name.

As noted in a CNN article from 2016, as many as 5,000 names might be tested for a given drug, with the goal of helping to narrow down options that might be effective for properly naming a drug.

Of course, there’s usually not just one name for a medication, but three:

  1. The chemical name. The name, fully broken down into its complex chemical form. In the case of Prozac, it’s N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propan-1-amine, a name I’m sure you’ll remember by the end of the piece.
  2. The generic name. This name, built with the original chemical form in mind and narrowed down upon with the help of the United States Adopted Name Council, a collaborative body of the American Medical Association, the American Pharmacists Association, and the U.S. Pharmacopeial Convention, Inc. This body, which has support from the U.S. Food and Drug Administration, will help choose a unique name that the pharmaceutical will go by globally, with the goal of easy classification. The name this body chose for Prozac was fluoxetine.
  3. The brand name. This is the part that can get costly. Through heavy research, the drug company will go through a number of options for the drug name, with words researched for their ability to be trademarked as well as their ability to work well on a global scale. When you run a multibillion-dollar drug-making giant, one does not want to run into a Tedium situation with a pharmaceutical, where additional meaning can be applied to the drug’s name.

The good news is that generic drugs tend to follow a general convention that for pharmacists makes them easy to categorize and follow.

“A globally recognized naming process makes an otherwise confusing name game more manageable. It helps the medical community easily learn and categorize newly approved medications and reduce prescribing errors by providing a unique, standard name that reflects each active ingredient in the drug,” explained Jasmine Cutler, an assistant professor of pharmacotherapeutics at the University of South Florida, in a piece in The Conversation earlier this year.

Because it’s narrowed down by an agreed-upon standards body, it takes away some of the challenges that can arise when trying to find or classify a specific drug.

Of course, those challenges are still very much there—in the form of the brand names themselves.

“The more drugs that come out every year, the more novel the names need to be. … What you see approved today is very much a result of the environment in which we work.”

— Scott Piergrossi, the president of creative at the Brand Institute, a firm that specializes in coming up with creative trademarks and brand names, in a 2014 interview with CNBC. The problem, says Piergrossi, wasn’t quite so bad when just a handful of drugs got named—Prozac, for one, had an extremely simple name in comparison, because it was early to such naming conventions. Later drugs were not so lucky, and that’s part of the reason you see so many Z’s and X’s in brand-name pharmaceuticals.

I’m convinced the Ozempic brand jingle is cursed.

Why finding the right brand name for a prescription drug is often quite complex

We live in a world where drug names need to be marketed, where doctors are seen as captive audiences, and where advertising can make or break a product’s overall potential.

The process of nailing a brand name for a commercial drug is actually quite complex, because it needs to not only get approved by the company itself and not run into any show-stopping trademark issues, but then it must get approved by major regulatory bodies across the world. The Food and Drug Administration, for example, has the ability to reject a name and force a restart of the entire naming process.

The FDA’s approach to all of this has been called something of a “black box” over the years, as drug-makers don’t have a lot of control over the process and the FDA tends to reject a lot of names.

They do offer some guidance on this, which was most recently updated in 2020, and recommends agains such things as name similarities, reusing names of discontinued products, or modifying existing names. As the document puts things:

Selecting a proprietary name is a critical element in drug product design and development because end users may rely, in part or in whole, on the proprietary name to identify which product, among thousands of available products, is intended for or used by a particular patient. Proprietary names of drug products are commonly used by physicians and other health care professionals to prescribe or discuss a drug, and for this reason, accurate identification by the end user is essential. If end users cannot easily distinguish a proprietary name from other drug names that are similar phonetically (sound-alike names) or in their spelling or orthographic appearance (look-alike names), or if the drug name is otherwise confusing or misleading, the patient might receive the wrong product, or it might not be possible to correctly identify the product used.

There are a few fairly legitimate reasons for this, and they tie all the way back to the creation of the FDA in 1906. You may remember how, in the late 19th and early 20th century, it was common for medications to make bold claims about what they did and the ailments that they could cure. The problem is, these drugs could be addictive, misleading, even deadly if poorly used. The Pure Food and Drug Act, passed in 1906 and leading to the creation of the FDA, was implemented specifically because of this, and updates to the original law over the years, most notably the Federal Food, Drug, and Cosmetic Act of 1938, gave the original law teeth.

The latter law passed after a public outcry after a pediatric drug that used an ingredient similar to antifreeze led to more than 100 deaths, and created a stringent process that is followed today.

The process that the latter law implemented gives the FDA the ability to turn down names if they’re perceived as being wrong or misleading. But that’s not the only factor. There are so many drugs out there that there is a true risk that a person might take a medication thinking it’s something else, and then run into dangerous or unwanted side effects.

As you might imagine, this creates a highly complicated process that takes a lot of time to work through. But on the other hand, it’s both important as well as a small piece of the overall pie. See, the FDA isn’t the only regulatory body that name has to get past—if the pharmaceutical-maker’s dreams are for that migraine drug to get used outside of the U.S., they have to also get the drug approved by every other country.

And the problems can get very specific, as branding expert Brannon Cashion told the Chicago Tribune in 2015.

“Sometimes it’s one letter that can make a name legally not viable or risky,” Cashion told the newspaper. “They may approve a name in Europe, but then by the time it’s approved by the FDA, there’s an issue. It might be a conflict with a product only marketed in the U.S. and isn’t an issue in Europe.”

And of course, the name is a small part of that. The overall cost of drug development is not cheap, with estimates varying from as low as $985 million (found in a recent study) and as much as $2.8 billion (based on older research estimates). And while naming a prescription drug is not cheap—estimated between $250,000 and $2.5 million according to branding expert Jeremy Miller—it is minuscule compared to what it costs to make the full drug itself.

And while some drugs are more common than others—if you’re American, you probably know the theme song to your favorite diabetes drug commercial by heart at this point—the fact is that the prescription drug industry has to build for very specific use cases, so the drugs, as they get more obscure grow ever-more-complex to name.

But sometimes, a drug plays a high-profile role, and as a result it must hit with a specific sort of snap. At the time of Cashion’s interview with the Tribune in 2015, the first biosimilar to hit the market, Zarxio, had just been released, and the name was one that a lot was invested in.

“If the name would have been soft or obtuse or difficult, especially as the first approved, it would not have been something that people would have latched on to,” Cashion added. ”This name has this sort of invitation where people are like ‘Wow.’”

Drug names need to be unique for branding purposes, but not to the point where the target audience—doctors and pharmacists—cannot remember them. That pool of 5,000 names often gets winnowed down to something closer to 10 almost immediately, likely for that very reason.

In some ways, the need for catchy names is, while not necessarily a uniquely American problem, one that Americans are particularly well-suited to receive.

Because healthcare is not a universal given like it is in some parts of the world, it means that marketing is necessary.

And since 1997, drug companies have been allowed to promote their products, by name, in a direct-to-consumer format on broadcast media, which meant that just as Viagra was going through the approval process with the FDA, it was being positioned with a name that was short, snappy, and memorable, making it a natural choice for the television advertising that could now take place in the U.S. market. Sure, they have to list the side effects, but at least they get to advertise.

This is a still-controversial debate. The American Medical Association is all about taking drug ads off TV, even as it’s been allowed for a quarter century.

A commercial for Ambien, one of the early big hits of the prescription drug advertising era.

Outside of the United States and New Zealand, this never happens, and when Oprah’s high-profile interview with Megan Markle and Prince Harry aired in 2021, a lot of curious British watchers pulled in U.S. feeds so they could watch the interview, and found themselves shocked by the unusual nature of prescription drug advertising in the U.S.

Trend forecaster Ayesha A. Siddiqi decided to highlight this with a Twitter thread of Brits who found the ads dystopian and unusual because of the strict rules for how ads are displayed on television—complete with side effects. In an interview with Insider, she explained that she was helping to highlight a broader point about how drug marketing affects the way that medication is offered and used.

“One of the most interesting recurrences in the British reactions to American live TV was shock at the idea of ‘advertising medicine’—to have even phrased it that way was so conspicuously not American,” Siddiqi told the outlet. “In the U.S. people are tasked with being informed customers, rather than simply beneficiaries of a healthcare system—with all the inequalities of access that implies.”

Hey, at least look at things this way: At least Americans aren’t having to buy an anti-diarrheal medication named Tedium. I would be out of a good name.


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Ernie Smith

Your time was just wasted by Ernie Smith

Ernie Smith is the editor of Tedium, and an active internet snarker. Between his many internet side projects, he finds time to hang out with his wife Cat, who's funnier than he is.

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