Working with prescription drugs every day, I constantly find myself pausing over their obscure names that are oftentimes impossible to pronounce. Xeljanz? Idarucizumab? Tecfidera? How did these crazy names come to be, and who can we blame? I was interested, so I went down the rabbit hole…
Drugs have (at least) three names.
Right when a drug is developed, the naming process begins, starting with the chemical name.
- Chemical name: This is usually the first name a drug is given and is the most complex! This name usually describes the atomic or molecular structure of the drug. For example, the chemical name for Sudafed is dl-threo-2-(methylamino)-1-phenylpropan-1-ol. Don’t worry, I can’t pronounce it either.
- Generic name: This is also referred to as the non-proprietary name. On GoodRx we often show the generic in parenthesis after the brand name; for example, Motrin (ibuprofen). Generic names are assigned by the World Health Organization and the United States Adopted Names council (USAN), and are usually a shorthand version of the drug’s structure or mechanism of action (how it works). Generic/nonproprietary names were created to eliminate the use of the chemical names in the clinical setting. For instance, ibuprofen’s clinical name is (RS)-2-(4-(2-methylpropyl)phenyl)propanoic acid. I would much rather talk to my doctor about taking ibuprofen, than trying to pronounce that. Wouldn’t you? Yeah, I thought so. So although the generic name can sometimes be confusing, just remember, it could be way worse.
- Brand name: Also called the proprietary name, this is the name that is intended for you, the patient! The brand name is intended to suggest the drug’s function, and is ultimately approved by the FDA. However, like most things in the pharmaceutical world, coming up with the brand name is a long and arduous process.
The confusing world of branded drug names
A drug’s brand name is developed by the company manufacturing the drug. However, more often than not, drug manufacturers work with companies that specialize in naming drugs. As you might expect, gaining approval for the brand name is the most difficult step to clear in the naming process. Good brand names should work in every country, be easy for doctors to spell and remember, and shouldn’t cause any trademark disputes.
Branded drug names should be unique
The FDA also requires that brand names be unique and distinct from others in every language. This is to prevent drug-mix ups by doctors and patients, and is usually the more time consuming step in the naming process. Manufactures often come up with as many as 3,000 potential names before they narrow it down to one.
This may seem like a silly guideline, but take Celebrex and Celexa for example. Yes, these two look different, but one bout of messy handwriting or mix up in pronunciation could cause your pharmacist to give you an antidepressant over your arthritis medication. In fact, drug mix-ups like this one are so dangerous that the Institute of Medicine has estimated that around 1.5 million people are injured or killed each year by prescription mix-ups, which can be caused by confusing naming. So, it is in your best interest that the naming process be this complex!
Creating a marketable name
In addition to creating names that adhere to the FDA’s guidelines, manufacturers also aim to create names that are marketable. Take Viagra for instance. It has become such a household name that it is even in the Oxford English Dictionary. Created by Pfizer, the goal was to name their drug for erectile dysfunction (ED) with a word that conjured images of its desirable effect, and they succeeded. Although there are many theories as to where the name Viagra came from, it sounds similar to words like “vigor” and “vitality,” adjectives that may convince those suffering from ED to give it a try. Although most drug names can’t possibly become as household as Viagra, it is yet another factor that manufacturers must consider in the drug naming process.
What is the moral of the story from all of this? Don’t feel bad if you cant pronounce your medication. You’re not alone.
Institute of Medicine. Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually; Report Offers Comprehensive Strategies for reducing Drug-Related Mistakes. July 2006.
Doctors are commonly asked how to keep from spreading genital herpes from one partner who has it, to another who doesn’t, even without lesions.
Asymptomatic (no sores) shedding of Herpes Simplex Virus (HSV) is known to occur. This means you can transmit HSV without having actual sores on your genitals—but you can take action to prevent transmission.
Let me start out by saying three important things:
- Condoms are the best way to prevent transmission.
- If you have an active sore on your genitals, don’t have sex until it clears.
- Most of what we know comes from studies on folks with HSV type 2 (HSV-2) so we assume it’s the same as with HSV-1 but there is no science behind that yet.
Here are the main things to know about reducing the risk of transmitting HSV from an infected person to a non-infected partner:
- Suppressive therapy with a valacyclovir 500 mg pill once daily is beneficial in decreasing transmission to an uninfected sexual partner.
- How do we know that? In 2004, a large study published in NEJM (New England Journal of Medicine) studied 1484 heterosexual couples: one partner had HSV-2 infection and the other didn’t. The HSV infected people took either 500 mg of valacyclovir once daily or nothing (placebo) for eight months.
- The susceptible partner (the partner who had never had genital lesions from HSV) was evaluated monthly for clinical signs and symptoms of genital herpes.
- Taking valacyclovir 500 mg daily led to a reduction in transmission of genital HSV-2 to the uninfected partner.
- What are the chances I’ll get HSV from “asymptomatic shedding” from my partner? After 8 months of being sexually active with a partner who has asymptomatic HSV infection, 16 of 741 (3.6%) who didn’t take valacyclovir developed an outbreak of herpes—compared to only 4 of 743 (1.9%) in those whose partners were taking valacyclovir 500 mg daily.
- Valacyclovir 500 mg taken daily reduces to almost zero the days when HSV-2 DNA is detected in genital secretions, which is why it helps prevent transmission.
- Does it matter if the genital ulcers are from HSV-1 or HSV-2? Remember, valacyclovir has not been studied in those with genital lesions due to HSV-1 though we assume the reduction in risk is similar. Half of new cases of genital lesions are caused by HSV-1 so the old idea that HSV-1 is the mouth and HSV-2 is the genitals no longer applies.
- Is valacyclovir better than acyclovir or famciclovir? The three appear to have the same effectiveness for suppression of repeat HSV infections, yet only valacyclovir has the evidence listed above—where it has been shown to limit spread from infected person to non-infected person
Hope this helps.
Once-daily valacyclovir to reduce the risk of transmission of genital herpes.N Engl J Med. 2004 Jan 1;350(1):11-20.
According to the Centers for Disease Control and Prevention (CDC) approximately 36.7 million people worldwide are living with HIV, and only 17 million people are receiving medication to treat it.
HIV medication, also known as antiretroviral treatment (ART), has made serious advancements in recent years. In addition to reducing the side effects from ART medications, some treatments only require a once-daily pill, rather than a cocktail of drugs. These advancements are important as they make the regimens easier and increase adherence.
The newest advancement in antiretroviral medications is the approval of lopinavir/ritonavir, a less-expensive generic for Kaletra.
What is Kaletra (lopinavir/ritonavir) indicated for?
Kaletra (lopinavir/ritonavir) is prescribed, in combination with other antiretroviral agents, for the treatment of HIV-1 infections in adults and pediatric patients over the age of 14.
Kaletra is available in both oral solution and tablet form. However its generic, lopinavir/ritonavir, is only available as a 160 ml bottle of oral solution.
What are the most common side effects of Kaletra (lopinavir/ritonavir)?
Commonly experienced side effects include diarrhea, nausea, increased fats in the blood, or vomiting. Be sure to talk with your doctor if you are concerned about any of these side effects.
When will lopinavir/ritonavir be available?
The FDA approved lopinavir/ritonavir at the end of December 2016, and it is available in pharmacies now! It is less expensive than the brand name Kaletra, so speak with your doctor about switching to the generic.
What if I want to continue to use brand name Kaletra?
If you would like to continue taking Kaletra, be sure that your doctor handwrites “Brand Medically Necessary” on your prescription. This means that the pharmacy is not permitted to substitute and give you the generic product. If your doctor doesn’t indicate this on your prescription, you can also request it from your pharmacist before having your prescription filled.
Keep in mind that because the generic product is now available, your insurance company may not be willing to cover the cost of the more expensive brand medication. Be sure to check your prescription insurance company to find out if its covered before taking a trip to the pharmacy.
You can read more about lopinavir/ritonavir here.
A new treatment for household dust mites has been approved by the FDA! Odactra is the first sublingual allergen extract for the treatment of dust mite allergies. Dust mites are the most common trigger of year-round allergies and can cause coughing, runny nose, congestion, sneezing, and eye irritation in people with allergies. Typically, these mites are microscopic organisms that live in house dust, thriving in bedding and upholstered furniture. They can be extremely difficult to get rid of, even if you clean or dust on a regular basis, making medications like Odactra necessary for patients with dust-mite allergies.
How should I take Odactra?
Odactra will be available as a sublingual (under the tongue) tablet in a strength of 12 sq-hdm. It is only approved for use in adults 18-65 years of age, and is to be taken once daily by placing 1 tablet under the tongue and letting it dissolve. It is recommended that patients allow Odactra to refrain from swallowing for 1 minute as Odactra dissolves. According to the FDA, patients should begin to see an improvement in their allergies within 8-14 weeks.
Your first dose of Odactra has to be administered at a doctor’s office so you can be observed for at least 30 minutes after your initial dose. It is also recommended that that you wash your hands after handling an Odactra tablet and avoid food or drink for 5 minutes after taking the pill.
What side effects are associated with Odactra?
Common side effects include itching in the ears and mouth, nausea, and swelling of the lips and tongue. Your doctor should prescribe an auto-injectable epinephrine, like EpiPen, as there is a possibility of a severe allergic reaction from taking Odactra. Patients with severe or uncontrolled asthma should not take Odactra.
When will Odactra be available?
Odactra was approved by the FDA on March 1st, 2017. However, there is currently no anticipated release date. For more information on Odacra’s approval, you can read the FDA’s press release here.
Update 4/3/2017: The March 20th EpiPen recall has been expanded to include the United States and some Epipen Jr products. Mylan Pharmaceuticals initiated a recall for 80,000 auto-injectors in Australia, Japan and some European Countries due to a malfunction that could prevent the device from activating properly. This is potentially dangerous as it could prohibit the device from working properly during an emergency situation.
Since this recall now includes EpiPen and EpiPen Jr lots in the United States, it is important that you now check the lot number on your device. The EpiPens that are being recalled were distributed between December 2015 and July 2016. If you are concerned that your EpiPen may be impacted, call Stericycle at 1-877-650-3493 or visit the Mylan website here. You might be provided with a voucher code to receive a replacement product, as Mylan is replacing all impacted devices for free. At this time, the authorized generic for EpiPen has not been impacted by this recall.
If you product happens to be one of the ones recalled, make sure to continue to keep it with you until you receive the replacement product.
After months of being in the spotlight, EpiPen (epinephrine) is making news again, and as you might guess it’s not good.
On March 20th, 2017, EpiPen was recalled in several parts of the world including Australia, New Zealand, Japan and some European countries. This recall is due to a defect in the autoinjector that can prevent the pen from activating properly. So far, two cases have been reported where the EpiPen failed to activate in emergencies.
Because of this, four different batches, resulting in a total of 80,000 autoinjectors, were recalled internationally. Patients in these affected countries can trade in their recalled autoinjector for a new device at no cost. At this time, patients in the United States have not been affected by this recall.
As a patient, it’s important to inspect your medications, including all parts of the packing and included devices. Remember to review the expiration date, especially for products like the EpiPen that are only used on rare occasions. If you ever notice that your medication doesn’t look or smell right, contact the manufacturer or your pharmacist immediately.
You can read more about the EpiPen recall here.