Xalkori? Zelboraf? Yondelis? Why New Drug Names Are So Strange

Health and medicine explained.
Aug. 22 2013 2:46 PM

With a Name Like Xalkori ...

New drug names aren’t just bizarre—they’re dangerous.

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Believe it or not, the recession might have something to do with the proliferation of these head-scratching brand names. During tough financial times, Fidelino says, many drug manufacturers skip human consultants and use computerized algorithmic name generators because they just want something that will get quick approval from the FDA and don’t care how ridiculous the name looks or sounds.

While this might make short-term sense, Leben says the companies using this strategy miss out on crafting a brand name that can retain value for the life of the drug, even after its patent expires. “Like one’s choice of words when introducing a friend, a brand name can communicate so much,” Leben says.

However, spending five years developing a highly communicative, aesthetically pleasing brand name is only going to become more challenging in the years to come. Because the FDA requires all drug names to look and sound unique, any time a new drug comes on the market it reduces the linguistic real estate available for the next drug. In this crowded field, turning to quick and easy computer-generated names becomes more and more tempting.

What worries some doctors and pharmacists is that while drug names are becoming more confusing and less intuitive, more drugs are falling through the FDA’s regulatory cracks.

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Yes, that’s right: The FDA’s screening process is not perfect.

Even though the administration can strike fear in the hearts of pharmaceutical companies (and their stockholders), it occasionally lets slip some look-alike and sound-alike names. Think of Zantac and Xanax, Paxil and Plavix, Neulasta and Lunesta. Those three pairs are all on a list of medications that doctors and pharmacists have reported as being confused for one another. The list, compiled by the Institute for Safe Medication Practices, is eight pages long.

Medication confusion is nothing to scoff at. If cancer patients think they’re taking Neulasta to boost their immune system after chemotherapy, but they’re unwittingly taking the sleeping pill Lunesta instead, that can have serious consequences. According to my analysis of the FDA’s database of adverse drug events, there have been 174 incidents of drug name confusion since the beginning of 2009. Of these, 16 resulted in death and at least nine more caused life-threatening illnesses.

(The FDA wouldn’t grant me an interview for this story, but it did refer me to these white papers on its name approval process.)

Medication confusion is an especially acute hazard for physicians in certain drug-heavy fields. One day last year, Marc Garnick, an oncologist at Beth Israel Deaconess Medical Center in Boston who specializes in treating prostate cancer, was looking over the treatment options for castration-resistant metastatic prostate cancer, a highly advanced form of the disease. “It became just sort of uncanny to me that the trade names of so many of these drugs were so similar,” he says.

These are the five drugs approved at that time for people suffering from this form of cancer: Jevtana, Xgeva, Zytiga, Xtandi and Zometa.

“There’s this proclivity to begin drugs with either an X or a Z,” Garnick says, “and it’s somewhat confusing.”

Garnick was becoming frustrated with this trend, so he wrote a letter voicing his concerns to the New England Journal of Medicine, which published it earlier this year. The FDA responded several months later with its own letter, stating that all of the new prostate cancer drugs “underwent a thorough safety analysis” and that “a review of recently approved and pending proprietary names did not find a disproportionate number of names commencing with X or Z.”

Garnick was satisfied. After reading the FDA’s response, he was confident that the issue was on its radar and that the administration would take steps to make drug names less confusing.

Then, a few weeks later, Garnick saw that a new, sixth drug had been approved to treat castration-resistant metastatic prostate cancer.

Its name: Xofigo.

“The oncology field is proliferating with very exciting new drugs that need to be named and need to have distinguishing characteristics,” he says. “I don’t understand why five out of six begin with X or Z.”

Garnick is no Don Draper, but he thinks big pharma and the FDA need to up their branding game.

David Schultz is a freelance health and science journalist based in Washington, D.C. Contact him at the website davidbschultz.com.