The high stakes of drug names

Branding: Years of thought and millions of dollars go into naming medications - a profitable investment if done right, but a perilous one if companies aren't careful.

Medicine & Science

March 01, 2004|By Frank D. Roylance | Frank D. Roylance,SUN STAFF

Prescriptions in hand, you head for the pharmacy, glancing at your doctor's scribbling.

Does that say Aloxi or Alrex? Axert or Azopt? Is that Iressa or Inspra? Rescula or Reyataz?

With more than 17,000 trademarked medications on the market, and only 26 letters in the alphabet, it's no surprise that drug makers resort to bizarre names such as these. But the search for drug brand names has become far more than a brainstorming session with letter-dice.

It's a complex and costly process that can take years. Companies want brand names to be memorable and positive. But they can't promise too much. And, most critically, they must be distinctive enough to avoid confusion and serious medication errors.

Finding a name costs plenty - between $75,000 and $250,000, depending on the scope of the project, said James L. Dettore, chief executive of the Brand Institute, one of the biggest drug-name consultants in the business. But he insists that's a bargain, compared with the $900 million it costs to bring a typical medication to market.

The stakes are huge. Successful brand names are enormously valuable to a company. But more importantly, lives may be at stake if the medication's name fosters confusion.

"Drug companies certainly don't want to do harm, because that hurts them," said David J. McCaffrey III, an associate professor of pharmacy administration at the University of Mississippi. "Today, [drug naming] is definitely part of their risk-management strategy."

Mistakes and injury do occur. A 2001 study published in the journal of the American Society of Health-System Pharmacists found 52 deaths reported to the FDA between 1993 and 1998 that were blamed on sound-alike or look-alike medication names.

A doctor's scrawl on a prescription pad easily makes Lamictal (a seizure medicine) look like Lamisil (for toenail fungus). But bad handwriting has even made look-alikes of the apparently dissimilar Avandia (for diabetes) and Coumadin (a blood thinner), said Timothy Lesar, director of pharmacy at the Albany Medical Center.

Lesar said up to 15 percent of the more than 300 medication errors his hospital records annually are related to drug names. And with hundreds of new medicines each year, he said, "it's clearly getting worse."

The search for a drug name typically begins years before the product is released.

Manufacturers may take thousands of possible names to their branding consultants. They use proprietary software to screen each one against sound-alikes or look-alikes. There are trademark checks and "linguistic" searches for unwanted meanings in foreign languages.

Drug-namers watch for strength- and dosage-matches. Prozac and Prilosec would be easier to confuse if both were sold as 10-milligram pills given once a day.

Sometimes, however, a good name trumps potential conflicts. Eli Lilly and Co. was smitten by ciel, the French word for sky, when it looked for a name for its new product for erectile dysfunction. Lilly reworked ciel into Cialis (pronounced see-AL-is). But the company's name-smiths soon heard from several worried people in Australia, Canada and Europe who shared the drug's name. Although they pronounced their surname See-lis, said Lilly spokeswoman Carole Copeland, "they were concerned that their children would be the subject of jokes."

After "discussions" with the Cialises, she said, the company decided to keep the name.

Drug naming is often a linguistic tug of war with regulators. Successful marketing demands a name that is memorable, positive and promising. But the FDA won't approve one that promises more than clinical data say it can deliver.

An antibiotic named Killzall would never clear the FDA, said Susan M. Proulx, president of Med-E.R.R.S., a consultant on medical error prevention. Similarly, the popular hair-restorative drug sold in Europe as Regain had to be marketed in the United States as Rogain.

Proulx favors meaningless names - the less a drug name implies, she figures, the less there is to mislead. But she says, "What they've become is more subtle in their promoting."

Although Pfizer says that didn't figure into its equation, Viagra suggests vitality and Niagara Falls. Levitra, another pill for erectile problems, hints at levitating and vitality.

Internet counterfeiters profit from name confusion. After Cialis was released, they wasted no time coining names for their illegal "generic" knockoffs: Sialis, Apcalis, Regalis and Vigalis.

Other choices are more pedestrian. Lipitor, which lowers blood fats, or lipids, is a combination of lipid and atorvastatin, its active ingredient.

There are also "blank canvas" names, such as Avara. "It doesn't communicate overtly," Dettore said. "But you see rheumatoid arthritis is the ra in the name." The rest is there to make it "a more upbeat, futuristic type of name, very warm and friendly."

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