Generic and Brand Names for Drugs HAROLD D. K A U T Z
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Council on Pharmacy and Chemistry, American Medical Association, Chicago 10, Ill.
The expanding number of complex chemical compounds for medicinal use requiring the application of convenient generic names, and the multiplication of brand names, increase the difficulty of selecting distinctive terminology for new drugs. The use of dissimilar generic names by different authorities or by different countries further aggravates this problem. Organizations adopting generic names and pharmaceutical manufacturers seeking trade-marks share in the responsibility for developing new terminology.
Generic names for drugs can be defined as recognized nonproprietary designations, available for unrestricted use, which are unprotected or for which trade-mark rights have been waived. When adopted for legally recognized publications, such as the " U . S. Pharmacopeia" or the " N a t i o n a l F o r m u l a r y , " they are frequently referred to as "official" names and may be so identified by affixing the abbreviation for those publications, U . S . P . or N . F . When adopted by the Council on Pharmacy and Chemistry of the A m e r i c a n Medical Association p r i o r to their admission to the "official" publications, they may be referred to as "council-adopted." When they are included only i n the council's annual publication, " N e w and Nonofficial Remedies," the abbreviation N.N.R. may be affixed. Reference also can be made to the generic terminology adopted for pharmacopeias or their equivalents that are published i n other countries. B r a n d names may be defined as trade names (including those protected as trademarks) that are applied to different d r u g products by individual manufacturers. The multiplicity of brand names for well-known drugs has magnified the difficulty of coining additional brand names as well as generic terminology for new drugs. Some pharmaceutical manufacturers employ a single trade name for each drug, whereas others coin a different brand name for each additional salt or dosage form of the same drug that is introduced on the market. The vast array of trade-marks for various penicillin salts and dosage forms is a monumental example of the confusion which results from this practice. Manufacturers defend i t on the basis that the physician wants a short name or symbol to simplify prescribing, whereas the doctor complains that the identity of the particular drug is difficult to recall for prescribing because there are so many names. Origin of Generic Names
Generic names may originate i n published reports of individual investigators as well as i n those of scientific organizations responsible for the selection of appropriate drug terminology. Some names, such as penicillin, bacitracin, and streptomycin, were suggested by their discoverers. Occasionally, the surname of the discoverer may figure i n the coining of a name as a means of honorary recognition, although this method of identification is more often applied to the naming of various l i v i n g forms than to the naming of drugs. Antibiotics such as penicillin and streptomycin were named on the basis of the microbiological source from which they are derived. The name bacitracin was selected to honor a seven-year-old patient named M a r g a r e t Tracey from whom the discoverer isolated the strain of Bacillus subtilis which produces the antibiotic. The scientific departments of drug manufacturers also frequently propose or 34
A Key to PHARMACEUTICAL AND MEDICINAL CHEMISTRY LITERATURE Advances in Chemistry; American Chemical Society: Washington, DC, 1956.
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K A U T Z — G E N E R I C A N D BRAND NAMES FOR DRUGS
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introduce generic terms that are recognized by the council and other agencies respon sible for the selection of drug nomenclature. Indeed, the majority of generic names for drugs considered by the council are initiated by proposals of pharmaceutical manufacturers. The council encourages such cooperation prior to the placing of new drugs on the market so that satisfactory terminology can be employed at the outlet, including early use of accepted terminology i n the medical literature; thus, generic names, rather than trade names, code numbers, or less convenient chemical names, can be used i n scientific reports on new compounds. When new drugs are referred to repeatedly only by experimental numbers, abbreviations, or the system atic chemical name, such designations tend to acquire "generic" status, i n the sense that they represent the only "common or u s u a l " name as interpreted under the label ing provisions of the Federal Food, D r u g , and Cosmetic A c t . Similarly, when only a brand name has been used to identify a drug, i t may gradually lose its ownership status under the amended trade-mark l a w and come to be regarded as a generic term. The name aspirin is i n this category, and because of greater convenience, i t is generally preferred over the official designation, acetylsalicylic acid. Likewise, the repeated use of the abbreviation B A L ( B r i t i s h A n t i Lewisite) has hampered the establishment of the more chemically descriptive pharmacopoeial name, dimercaprol. Generic vs. Chemical Names
Simplified generic names are becoming more imperative as the number of comp'ex chemical compounds introduced for medicinal use is expanded by systematic research. W i t h simple inorganic compounds, such as ferrous sulfate, systematic cheirical names are sufficiently easy to remember and convenient for use i n speak ing and w r i t i n g ; i t is both unnecessary and undesirable to coin other desig nations when simple chemical compounds are employed as drugs. F o r such com pounds, simple chemical names are to be preferred as generic names. However, the coining of contracted names, such as epinephrine or procaine, for complex organic compounds is essential to replace the systematic but unwieldy chemical nomencla ture. When properly coined and properly introduced into scientific literature, short generic names for complex compounds then become synonymous, by definition, w i t h the complete chemical terminology, and can be used conveniently i n place of the latter, even i n chemical publications. Whenever practicable, i t is desirable to coin generic names that bear some recognizable resemblance to systematic chemical ter minology. Thus, some effort should be made to provide a terminal suffix, such as " o l " for an alcohol or phenol, to connote accurately the type or class of chemical to which the compound belongs. Similar attention should be given to systems of nomenclature for other basic sciences, as i n the selection of names for biological and other substances which cannot be completely defined chemically. If possible, generic names also should be so coined that they avoid any misleading connotation as to identity. Thus, the " o l " suffix i n the adopted designation cyclocumarol is somewhat misleading for a deriva tive of coumarin which does not contain a hydroxyl group. When chemical identic fication is p a r t i a l l y or wholly obscured, a suitable designation usually can be adopted on the basis of current knowledge. F o r example, the name vitamin B has been used pending the development of the chemically derived term cyanocabalamin. However, as i n the case of the chemically derived generic designations for certain other drugs, some time is required to displace the early terminology and there may be some confusion. i 2
Isomeric Chemical Compounds
A special problem arises i n the selection of generic names for chemical com pounds capable of existing i n several isomeric forms, two or more of which may exhibit promising pharmacological properties. In such instances, i t may be de sirable to anticipate the introduction of several isomers of the same compound i n devising a name for the first one made available f o r clinical use. U n t i l recently, attention to this aspect of generic terminology has received little consideration. Thus, the "official" designation epinephrine for Z-epinephrine does not connote the levo isomer to which it refers, whereas the term arterenol, formerly employed. to A Key to PHARMACEUTICAL AND MEDICINAL CHEMISTRY LITERATURE Advances in Chemistry; American Chemical Society: Washington, DC, 1956.
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A D V A N C E S IN CHEMISTRY SERIES
designate the levo isomer of norepinephrine, has been expanded recently to levarterenol to indicate its stereoisometric identity. The name methadone likewise does not suggest the racemic (oil) form of that analgesic compound, although this may be considered to be understood as i t is for amphetamine. While the matter is of greater importance to chemical taxonomists than to physicians or pharmacists, consideration is warranted so that confusion between drug and chemical terminology is avoided. I n many instances, where not more than one or two forms are found to have clinical use, the particular isomer i n the names need not be specified particu l a r l y i f other terminology has become firmly established.
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Misleading Names
Generic as well as brand names, except those for serums and vaccines, should be coined to avoid any obvious connotation of diseases for which they are to be used. Physicians who do not wish to reveal to patients the nature or purpose of a pre scribed remedy would find this difficult i f obliged to use therapeutically suggestive names for prescribing drugs. Another inherent objection to such names lies i n the possibility that they may become misleading i f the drugs to which they are applied are found to have other uses. Misleading names can lead to dangerous confusion i n dosage or method of administration. The further significance of the suggestiveness of names is illustrated by certain classes of drugs which have acquired pharmacological connotations through long association w i t h a particular scheme of terminology. F o r example, the " c a i n e " ending, usually employed for naming local anesthetic agents, has been applied whether or not i t accurately reflects a strictly correct chemical classification of a l l such compounds. The misleading " a l " ending, long employed for naming barbiturates as well as other sedative agents, is also i n this category. Thus, through long usage the connotation of sedative action inherent i n the " a l " suffix tends to pre-empt its application to an aldehyde unless that type of compound happens to have some sedative or hypnotic action. Despite the inaccurate connotation of the " a l " ending when used i n names for nonaldehyde compounds, its association w i t h barbiturates cannot be effaced readily. F o r these reasons, i n the naming of isomers, efforts to improve imperfect d r u g nomenclature already estab lished should be approached w i t h caution to avoid provoking further confusion. Problems in Drug Nomenclature
Although some of the older generic terminology is admittedly longer and more difficult to learn than a catchy trade name, its use offers ultimately less of a burden to the memory than attempting to recall one of a variety of trade names, some of which may apply only to particular dosage forms of the same drug. Often, however, the first trade name introduced gets a "head s t a r t " on other names, including the generic name, w i t h the result that a new drug becomes better known by its brand name than by any other terminology. Physicians who wish to use only generic names for prescribing can specify a particular manufacturer's product when de sired by affixing the name of the firm to the generic name of the drug. The recent trend to adopt more convenient generic names for drugs may en courage their more general use and discourage the use of ambiguous symbols i n place of established nomenclature. The multiplication of generic names for the same drug presents less of a problem than i t does for trade names. Nevertheless, the existence of more than one generic name or synonym also tends to create confusion, par ticularly i n the scientific literature. The difference i n generic names for drugs used i n various countries has led to the creation of a Subcommittee on International Nonproprietary Names of the W o r l d Health Organization. This agency seeks to recommend common generic terminology for drugs on a world-wide basis, through the cooperation of its member countries, although i n certain instances domestic conflicts cannot be avoided. In some cases conflicts of international names w i t h domestic trade-marks are involved. The u n fortunate occurrence of trade-marking generic names outside the country of origin presents an international problem. The efforts of the W o r l d Health Organization and of the Combined T r a d e - M a r k Bureau of the A m e r i c a n D r u g Manufacturers Association and the A m e r i c a n Pharmaceutical Manufacturers Association to dis courage this practice are highly commendable, but so f a r these have met w i t h only p a r t i a l success. A Key to PHARMACEUTICAL AND MEDICINAL CHEMISTRY LITERATURE Advances in Chemistry; American Chemical Society: Washington, DC, 1956.
K A U T Z — G E N E R I C A N D BRAND NAMES FOR DRUGS
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Future Outlook
F o r the future, a more judicious attitude toward the introduction of brand names on the part of the pharmaceutical industry is desired to avoid further ag gravation of the problem of selecting distinctive generic terminology for new drugs. Some manufacturers have found it expedient to reuse old trade-marks formerly applied to abandoned products. When this practice results i n the applica tion of a name to another drug, further confusion is created, especially i f the name already has appeared i n published literature on the drug to which i t was formerly applied. The problem of finding nonconflicting terminology cannot be solved through the reuse of old names. The difficulties must be met by more f r u g a l use of trade marks and a cooperative attitude i n the selection of uniform generic nomenclature; otherwise, the vast storehouse of terms that can be derived f r o m the language eventually may become exhausted. The mutual efforts of responsible agencies on nomenclature, both here and abroad, provide encouragement that improvements i n drug terminology w i l l parallel the advance of future therapeutic discoveries. RECEIVED
September
13,
1954.
A Key to PHARMACEUTICAL AND MEDICINAL CHEMISTRY LITERATURE Advances in Chemistry; American Chemical Society: Washington, DC, 1956.
