Drug Naming and the Hidden Rules Behind It

The Intricate Art and Science of Naming Prescription Drugs

When collecting a prescription, patients often glance at the label and see names like sildenafil or fluoxetine. Yet, few pause to consider how these terms materialise. Crafting drug names involves a meticulous blend of scientific precision, regulatory scrutiny, and marketing ingenuity. Behind every label lies a story of collaboration, creativity, and global standards.

The Dual Naming Systems: Generic vs Brand

Medications carry two identities: a generic (nonproprietary) name and a brand (proprietary) one. Generic titles, assigned by international bodies such as the US Adopted Names (USAN) Council or the World Health Organisation (WHO), prioritise clarity and safety. These organisations follow strict guidelines to ensure each name reflects the drug’s chemical structure, function, or therapeutic class. Critically, manufacturers have no say in this process, guaranteeing neutrality.

For instance, drugs ending in -statin—like atorvastatin or simvastatin—signal their role in cholesterol management. “Even if a clinician isn’t familiar with a specific -statin, the suffix instantly communicates its purpose,” notes Dr Mariana Socal, a health policy expert at Johns Hopkins University. Similarly, biologics—complex drugs derived from living organisms—use random suffixes (-mab for monoclonal antibodies, -cept for receptor fusion proteins) to distinguish products while aiding pharmacovigilance efforts.

From Lab Bench to Pharmacy Shelf: Crafting Generic Names

Generic naming begins long before a drug reaches clinical trials. Scientists dissect the compound’s molecular structure, isolating key elements to encode into its title. Take esomeprazole, a stomach acid reducer: the prefix eso- refers to its stereochemistry (spatial arrangement of atoms), while -prazole denotes its classification as a proton-pump inhibitor. This systematic approach allows healthcare professionals worldwide to decode a drug’s function at a glance.

In 2021, the USAN Council approved 120 new generic names, each vetted for linguistic simplicity and global relevance. Names must avoid cultural insensitivities, unintended meanings in major languages, and similarities to existing terms. For example, the council rejected digoxina in 2019 due to its resemblance to digoxin, a heart medication with a narrow therapeutic index. Such vigilance prevents potentially fatal prescription errors.

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Brand Names: Where Science Meets Marketing

While generic names prioritise function, brand titles aim for memorability. Consider Viagra (sildenafil) or Prozac (fluoxetine): these catchy monikers emerge from rigorous brainstorming sessions involving linguists, marketers, and legal teams. Companies invest millions to develop names that resonate emotionally, often evoking vitality (Zestril), precision (Accupril), or tranquillity (Xanax).

Regulatory hurdles add complexity. In the US, the Food and Drug Administration (FDA) scrutinises proposed names for phonetic and orthographic similarities to existing drugs. Between 2018 and 2022, the FDA rejected 33% of submitted names, citing risks of confusion. One notorious case involved Brilinta (ticagrelor) and Briviact (brivaracetam)—both cardiovascular and antiepileptic drugs, respectively. Despite differing uses, their overlapping prefixes prompted concerns, leading to heightened label warnings.

Global Challenges in Drug Nomenclature

Navigating international markets amplifies the difficulty. A name appealing in English might falter abroad: Lumigan (a glaucoma treatment) was nearly shelved in Japan due to phonetic similarities to a slang term. Similarly, Nova translates to “doesn’t go” in Spanish—a disastrous association for a car model, though pharmaceutical firms face analogous pitfalls.

To mitigate risks, companies like Interbrand employ AI tools to scan for linguistic conflicts across 100+ languages. Meanwhile, the WHO’s International Nonproprietary Name (INN) system harmonises generic terms across 195 countries. Yet inconsistencies persist: the UK refers to paracetamol, while the US uses acetaminophen—a divergence rooted in historical patent disputes.

The Hidden Costs of Naming Rights

Developing a drug name isn’t just time-consuming—it’s expensive. Industry estimates suggest pharmaceutical firms spend between £150,000 and £500,000 per name, factoring in legal checks, focus groups, and regulatory filings. In 2020, Pfizer reportedly invested £1.2 million to secure Comirnaty for its COVID-19 vaccine, blending “community,” “mRNA,” and “immunity.” Despite this, a Eurobarometer survey found 68% of Europeans couldn’t pronounce it correctly, underscoring the tension between innovation and accessibility.

The Spectre of Genericide

Ironically, a drug’s branding success can backfire. When a proprietary name becomes synonymous with the drug class itself—as with Aspirin or Heroin (originally Bayer trademarks)—companies risk “genericide,” losing trademark protection. Modern examples include Ziploc and Velcro, though pharmaceuticals tread carefully. To combat this, firms like Johnson & Johnson aggressively defend trademarks, even lobbying dictionaries to capitalise terms like Band-Aid.

Dr Socal highlights this paradox: “A name too generic fades into obscurity, but one too iconic risks becoming public property.” In 2017, a US court revoked exclusive rights to Escalator (originally Otis Elevator’s trademark), illustrating the fine line marketers walk.

Looking Ahead: Trends in Drug Naming

Recent years have seen a shift toward patient-centric branding. Drugs like Skyrizi (risankizumab) for psoriasis or Rinvoq (upadacitinib) for arthritis incorporate playful, approachable sounds, moving away from clinical austerity. Meanwhile, advocacy groups push for names that reduce stigma: mental health drugs increasingly avoid terms like -dep or -sad, which might inadvertently pathologise users.

Advances in AI also promise to streamline naming. Startups like Nametag use machine learning to generate linguistically safe options, cutting development time from months to days. However, critics argue algorithms lack the nuance to capture cultural subtleties, risking unintended faux pas.

The journey from molecular structure to marketable name is a labyrinth of science, law, and creativity. While generic titles ensure global clarity, brand names vie for a place in our collective consciousness—a balance demanding equal parts precision and flair. In the next section, we’ll explore how regulatory frameworks shape this process and examine landmark cases where names made—or nearly broke—a drug’s success.

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Regulatory Frameworks: Gatekeepers of Drug Names

Behind every medication label lies a labyrinth of regulatory checks. Agencies like the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) act as gatekeepers, ensuring names prioritise patient safety over marketability. In practice, this means rejecting proposals that risk confusion. For example, between 2018 and 2022, the FDA turned down 33% of submitted brand names, often due to phonetic similarities. One high-profile case involved Brilinta (ticagrelor) and Briviact (brivaracetam), where overlapping prefixes sparked concerns despite differing uses.

Meanwhile, the EMA employs a parallel system, vetting names across 31 member states. In 2023, the agency reported 47% of proposed names faced initial rejection, primarily for linguistic conflicts. A drug named Teflaro (ceftaroline), approved in the US, nearly stalled in Germany after regulators noted its resemblance to Tefal, a cookware brand. Such scrutiny underscores the balancing act: crafting unique names while respecting cultural nuances.

Collaboration between regulators and the WHO’s International Nonproprietary Name (INN) system further complicates matters. While the INN harmonises generic terms, regional variations persist. The UK’s paracetamol versus the US’s acetaminophen exemplifies this divide, rooted in 19th-century patent disputes. Today, discrepancies like these challenge global healthcare communication, particularly during emergencies.

Case Studies: When Drug Names Spark Confusion

Real-world examples highlight the stakes. In 2016, the EMA flagged Tecta (a proton-pump inhibitor) for potential mix-ups with Tefacto (an immunosuppressant). Though both treated distinct conditions, their similar spellings risked dangerous errors. After a six-month review, the EMA mandated bolded warnings on Tecta packaging—a costly delay for the manufacturer.

Similarly, Zantac (ranitidine), once a blockbuster heartburn drug, faced a global recall in 2020 after contamination concerns. Its name, a blend of zinc and antacid, became synonymous with litigation, overshadowing its generic counterparts. Conversely, Humira (adalimumab), the world’s top-selling drug until 2023, leveraged its name’s roots in “human monoclonal antibody in rheumatoid arthritis” to cement brand recognition, generating £18 billion annually at its peak.

Legal Battles and Trademark Tussles

Pharmaceutical companies invest heavily in protecting brand equity. In 2019, Bayer lost exclusive rights to Aspirin in India after a court ruled the term had entered common parlance. Conversely, Pfizer successfully defended Viagra in the EU, arguing its distinctiveness despite widespread colloquial use.

Trademark disputes often hinge on geographic nuances. Remicade (infliximab), a biologic for autoimmune diseases, faced opposition in Canada over its similarity to Remicaire, a local skincare brand. After a two-year battle, Johnson & Johnson agreed to add a disclaimer to Canadian packaging, averting a rebrand. Such cases reveal the fragile interplay between global branding and local legal landscapes.

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Patient Safety: The Human Cost of Naming Errors

Miscommunication costs lives. A 2019 study in The BMJ estimated 7,000 annual deaths in the US alone from medication errors, with name confusion contributing to 25% of cases. In one tragic incident, a patient prescribed Hydromorphone (a potent opioid) received Morphine instead due to verbal mishearing—a fatal mistake.

To combat this, the FDA’s Division of Medication Error Prevention and Analysis (DMEPA) employs phonetic algorithms. Since 2020, DMEPA’s software flags names with a 70% similarity threshold, reducing errors by 18%. Meanwhile, the UK’s National Health Service (NHS) mandates Tall Man lettering—capitalising dissimilar segments (e.g., hydrOXYzine vs. hydrALAzine)—in electronic records.

Innovations in Naming: Balancing Creativity and Clarity

Recent trends favour patient-centric approaches. Drugs like Skyrizi (risankizumab) and Rinvoq (upadacitinib) use playful suffixes to destigmatise conditions like psoriasis. In 2022, the FDA fast-tracked Voxzogo (vosoritide) for dwarfism, its name evoking “voice” and “growth” to reflect patient advocacy input.

Artificial intelligence also plays a growing role. Startups like Nami.ai claim their algorithms cut naming timelines by 60%, analysing linguistic safety across 150 languages. However, critics warn AI lacks cultural nuance. When Novartis used an AI-generated name for a diabetes drug in 2021, it inadvertently echoed a Mandarin slang term, forcing a last-minute change.

Global Collaboration: The Future of Drug Nomenclature

Harmonising global standards remains a priority. In 2023, the WHO launched the INN-Plus initiative, streamlining generic name approvals for biologics. Early adopters include biosimilars like Amsparity (adalimumab), which share suffixes (-parity) to denote equivalence to originator drugs like Humira.

Meanwhile, patient groups push for inclusivity. Epilepsy advocates recently lobbied against names with “-zap” or “-volt,” arguing they evoke negative stereotypes. Their efforts led to the 2022 rebranding of Zapritol (ezogabine) to Potiga, reflecting patient feedback.

The drug naming ecosystem thrives on collaboration and conflict, where science, law, and culture collide. From regulatory hurdles to patient advocacy, each name carries a legacy of compromise and innovation. In the final section, we’ll explore how emerging technologies and global crises, like the COVID-19 pandemic, are reshaping this landscape—and what the future holds for the pills in our cabinets.

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Pandemics and Naming: The COVID-19 Catalyst

The COVID-19 pandemic reshaped drug nomenclature, compressing timelines that once spanned years into months. Take Remdesivir, an antiviral initially developed for Ebola in 2014. Its generic name, rooted in “adenosine” and “RNA,” reflects its mechanism. Yet, during the pandemic, its brand name Veklury emerged swiftly, blending “virus” and “klironomia” (Greek for inheritance)—a nod to global scientific solidarity. By 2021, global sales topped £2.3 billion, proving how crisis can propel a name into household recognition.

Vaccines faced similar pressures. Pfizer-BioNTech’s Comirnaty (COVID-19 mRNA vaccine) fused “community,” “mRNA,” and “immunity,” though its complexity sparked debates. In contrast, Moderna’s eponymous brand leveraged existing equity, sidestepping the need for a separate name. Meanwhile, the WHO’s “COVID-19 Vaccine Solidarity Trial” temporarily assigned codes like AZD1222 (AstraZeneca) to avoid brand bias—a practice now influencing post-pandemic protocols.

Regulators also adapted. The FDA’s 2020 emergency guidelines allowed conditional name approvals in 30 days, down from 18 months. While this accelerated access, critics warned of heightened error risks. A 2023 Lancet study found 12% of pandemic-era drug names had phonetic similarities to existing medications, compared to 6% pre-2020.

AI and Machine Learning: The New Frontier

Artificial intelligence now permeates drug naming, offering speed and scale. Startups like Nametag use neural networks to generate linguistically safe options, analysing 10,000 possibilities per second. In 2022, Roche partnered with Nami.ai to name Ocrevus (ocrelizumab), a multiple sclerosis drug, slashing development time by 70%. The algorithm prioritised suffixes (-vus) associated with neurological treatments, ensuring instant clinician recognition.

However, AI’s limitations persist. In 2021, a Novartis candidate named Iptacopan (paroxysmal nocturnal hemoglobinuria treatment) faced delays when AI overlooked its resemblance to “Ibuprofen” in verbal contexts. Human oversight remains irreplaceable, blending machine efficiency with cultural nuance.

Patient Advocacy: Shaping Names with Lived Experience

Patient input now steers naming like never before. Consider Trikafta (elexacaftor/tezacaftor/ivacaftor), a cystic fibrosis drug. Vertex Pharmaceuticals involved patients in brainstorming, settling on a name evoking “three correctors acting together.” Since its 2019 launch, Trikafta has boosted lung function by 14% in trials, with 82% of patients reporting improved quality of life—a testament to names that resonate beyond the lab.

Advocacy groups also challenge stigmatising terms. In 2022, the Epilepsy Foundation petitioned against -zap suffixes, linking them to negative stereotypes. Their campaign led to Ztalmy (ganaxolone) adopting a neutral suffix, despite initial resistance. Similarly, mental health drugs increasingly avoid terms like -dep or -sad, opting for hopeful suffixes like -joy (Rexulti for schizophrenia) or -lift (Auvelity for depression).

The Future of Drug Nomenclature: Trends to Watch

Looking ahead, three trends dominate. First, sustainability enters the lexicon: drugs like Verquvo (vericiguat) for heart failure incorporate eco-conscious roots (verde for green). Second, digital therapeutics (DTx) demand new conventions. Pear-004, an AI-driven insomnia app, uses alphanumeric codes to distinguish itself from traditional pills. Third, global harmonisation accelerates. The WHO’s 2023 INN-Plus initiative aims to unify biologic suffixes by 2025, reducing regional disparities.

Meanwhile, “genericide” battles intensify. In 2023, Eli Lilly sued 15 Indian generics for using “-tide” suffixes (e.g., tirzepatide), claiming trademark dilution. The outcome could redefine naming rights in the biosimilar era.

Conclusion: A Name’s Legacy in Medicine

From Aspirin to Zolgensma, drug names encapsulate humanity’s quest to conquer disease. They bridge molecules and meaning, science and society. Yet, as technology accelerates and crises loom, the challenge endures: to craft names that heal, not confuse; that innovate, not alienate.

The pills in our cabinets carry stories of midnight brainstorming, regulatory rigor, and patient hope. Behind each syllable lies a promise—to cure, to comfort, to endure. As we enter an era of AI-driven discovery and global collaboration, one truth remains: a drug’s name is its first therapeutic act, shaping perceptions long before the first dose.