Ever wonder how the little blue pill called Viagra got its name? Why generics often have tongue-twisting monikers? Jeanette Y. Wick, a senior clinical research pharmacist with the National Cancer Institute, explains the complexities of naming prescription drugs in an article in the January/February issue of the Journal of the American Pharmacists Association.

There are more than 9,000 generic drug names and 33,000 trademarked drug names in use in the United States, Wick notes. Proprietary names average 10.4 letters and 3.53 syllables. Generics run longer, averaging 14.4 letters and five syllables.

Generic drug names are chosen by the United States Adopted Names Council (USAN), an outfit sponsored by the American Medical Association, the United States Pharmacopeial Convention and the American Pharmacists Association. The World Health Organization's International Nonproprietary Name Committee also must approve the selected names.

The USAN aims to choose simple, informative and unique appellations. The first several letters are meant to be unique, to distinguish one drug in a particular class of medications from another. The beginning sound is followed by a stem, or sequence of letters, that is common to the drug class.

That's why the popular arthritis medicines Celebrex (celecoxib) and Bextra (valdecoxib) and Merck and Co.'s Vioxx (rofecoxib) all have generic names containing the -coxib stem. Each belongs to a class of drugs known as the cox 2 inhibitors.

The resulting alphabetic cryptogram may seem bewildering to a layperson. But to a pharmacist or prescriber, the name should contain important clues about a drug's properties and actions or chemical composition.

Similarly, USAN assigns the suffix -mab to all monoclonal antibodies, a class of drugs that targets a specific antigen in the body, such as cancer cells. That rule of drug nomenclature has yielded names such as infliximab, adalimumab, rituximab and trastuzumab.

Unfortunately, many health professionals, including pharmacists, are not aware of the linguistic rules that underlie the naming of generics, Wick explains.

"At some point, pharmacists get the message by immersion. They start figuring out the drugs that end with -mab are monoclonal antibodies," she observes. "But wouldn't it be so much better if we didn't have to be immersed to understand it?"

Brand names, by contrast, are much zippier, chosen by the drug maker, subject to U.S. Food and Drug Administration approval, to appeal to patients. The FDA rejects a third of the hundreds of names proposed each year, forcing drug marketers back to the drawing board.

The FDA forbids marketers from using names that imply efficacy, Wick explains. So today's pharmacy is chock full of pills with names that subtly and indirectly convey an idea.

Pfizer Inc.'s erectile dysfunction treatment Viagra, for example, suggests vitality and rhymes with Niagara, connoting force and endurance, Wick says.

The name Levitra, a competing product co-developed by Bayer AG and GlaxoSmithKline, by contrast, drips with European cache. "Le" is French for "the" and vitra suggests vie, which is French for life. Levitra also sounds similar to the word libido.

Other naming quirks include the use of the strong-sounding consonants P, T, D, K, Q, and hard C, as well as fast sounds like X and Z. Prozac, the world's most widely prescribed antidepressant, incorporates both of those linguistic features.

Safety experts worry that the expanding pharmaceutical pipeline will yield dangerously similar names, Wick says.

A number of efforts are under way to reduce the incidence of medical errors stemming from similar-looking and similar-sounding names, says Michael R. Cohen, president of the Institute for Safe Medication Practices, a nonprofit group that monitors medication errors.

Some of the big drug makers are contracting with companies that will test their proposed drug names with real pharmacists, Cohen says. The FDA also is performing this type of testing in-house. "They want to make sure they're not approving a name that's a problem," he says.

To avoid becoming the victim of a medical error resulting from drug-name confusion, Cohen encourages consumers to know the name of the drug their doctor has prescribed, its strength and the drug's purpose.

Cohen is aware of several errors involving mix-ups of the oral diabetes drug Avandia and the anticoagulant Coumadin. While legible in print, the names can appear similar in badly written cursive. The first A in Avandia, if not fully formed, can read like a C. The final a may appear as an n.

Patients can help avoid that kind of confusion, Cohen says: "They should insist that the doctor write the purpose of the drug on the prescription."

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