10

What's in a drug name?

Prescription drugs

KAI RYSSDAL: Stay with me on this: is it Enjuvia or Januvia? Ritalin or Ritodrine?

Confused? So are pharmacists and hospitals. Drug mix-ups -- when your doctor orders one thing and you get something else -- cost the health care system millions of dollars in unnecessary care. And people die because of it. There's a case to be made that the trouble starts with creative types brainstorming the perfect brand name.

From the Marketplace Health Desk at WHYY, Gregory Warner reports.


GREGORY WARNER: Here's what a name can do. George DiDomizio tells me the story of two drugs. Dyazide...

GEORGE DIDOMIZIO: Dyazide.

And...

DIDOMIZIO: Moduretic.

Same exact chemical compound.

DIDOMIZIO: Identical. The companies had about the same number of sales people. All reaching the same doctors. Dyazide outsold Moduretic by about five-to-one. And the only difference was the trademark!

Didomizio likes this story because he's a professional drug namer. He's the guy who came up with Pepcid, Bextra, Prilosec, and other blockbusters. Naming a drug, he says, is harder than naming a cereal or a car because there's a whole other agency involved: the Food and Drug Administration. The FDA even has a special unit just to decide if the name over-promises. So, no "Panaciums" or "Correct-Alls."

DIDOMIZIO: Some years ago I was working with J&J on an hormonal supplement called "Perfest." P-E-R-F-E-S-T. And the FDA came back and said, you know, that sounds too much like the perfect estrogen. So you can't have it.

George swapped two letters to "Prefest" and they gave it to him. But having passed that test, he faced another unit at the FDA. It decides if the name could be confused with one of the 300,000 drug names already on the market.

SUSAN PROULX: OK, so you just want me to go through them, page by page? Omacor/Amacar. Celexa/Zyprexa.

Susan Proulx reads from a list of drug names most often confused by pharmacists and doctors.

PROULX: Avista/Evinza. Vytorin/Vicodin.

The FDA is getting stricter about avoiding these potential mix-ups. Last year the FDA turned down almost half of the names they heard. Proulx runs a company called Med-ERRS, E-R-R-S, that helps drug makers test their names before they submit them to the FDA. For drug companies it's a kind of insurance. It can cost over a half-a-million dollars to create and register a name around the world, only to have it rejected by the federal agency.

Susan Proulx: There's thousands upon thousands of names that have been considered, look and sound alike.

And then there's the wild card of a doctor's bad handwriting. So, imagine your doctor writes Lipitor and the pharmacist dispenses Zyrtec, an allergy drug. That's right. Lipitor. And Zyrtec. Get confused.

SUSAN PROULX: The L looks like a Z, the Y can look like the downstroke of the letter P, and then at the end T-E-C can look like T-O-R.

GEORGE DIDOMIZIO: So it's not block letters compared to block letters, to evaluate similarity. Now it's a potentially scribbled name and scribbles look a lot alike.

The FDA's new handwriting tests have subtly altered the art of drug naming. You see more names exploring fresh linguistic territory, like names with double X's or XG, or double K.

SUSAN PROULX: And they feel that, well, if I put two K's in the word then someone won't see that one K upstroke when you write it as an L or a T. Unfortunately some of them seem to be very difficult to pronounce. And I think that will make them maybe less prone for confusion, but just harder for people to remember and to say.

DIDOMIZIO: It's getting to be a little bit like the Czechoslovakian -- the Slovak language, where you have a predominance of consonants. Difficult to pronounce, difficult to deal with?

WARNER: That's cause you old timers used up all the vowels!

DIDOMIZIO: That's because... that's right!

At 75 years old, DiDomizio looks forward to that bright day when doctors toss aside their pens and all we have to worry about is typos.

In Philadelphia, I'm Gregory Warner for Marketplace.


RYSSDAL: See for yourself how badly a doctor's handwriting can mess things up. Watch our video.

About the author

Gregory Warner is a senior reporter covering the economics and business of healthcare for the entire Marketplace portfolio.
Log in to post10 Comments

Interesting story, however I find many errors in e-prescribing as well. Seroquel vs serophene, tartrate vs succinate, etc. I believe that it is important to remember that a person's life is at stake when prescribing and maybe slowing down a bit would help the situation! Why is healthcare always rushed by the patient?!?

Hope your facts are better on other stories. Your story was in keeping with most medical related stories....not accurate. Consulting a pharmacist before airing the story would have been a good idea.

Other pieces of information are considered when filling a prescription not just the drug name alone.

Electronic prescriptions are pervasive.

Dyazide is not Moduretic.

An interesting story but I think you missed an extremely important part of the story. All the confusion about drug names only happens due to the immoral “necessity” of making profit from the selling of pharmaceuticals.
Dyazide is triamterene and hydochlorthiazide. The generic names which are derived mostly from their chemical compounds and those names don’t cost a thing to develop. The medication dyazide will always be triamterene and hydochlorthiazide. Doctors, nurses and pharmacists don’t need any other name. I’m a nurse and I can’t tell you how many times I’ve had to look up a name of a drug because there are so many trade names for the same product. This is a significant part of what causes errors.
The FAA, who thinks a 99% safety rate is a joke, I’m sure would never let a tool have multiple names. Medications are tools that doctors use and allowing pharmaceutical companies to name a chemical with multiple different names is a policy that just begs to cause mistakes.
Even more important than that: Why do we need attractive names at all? Do we really want to believe that an MD is going to choose one product over another just because the name is “better?” Don’t we want our doctors choosing which medications they prescribe based on the proven track record of treatment by the product? The trade name isn’t for the doctor, it’s so the pharmaceutical company can sell it to the public so the public will ask their doctor for the medication.
If the FDA really represented the public there wouldn’t be a panel set up to prevent “copy-cat names” only a committee to guarantee that all prescriptions are typed and that every compound only has one name. Unfortunately the FDA mostly represents pharmaceutical company interests which leads to the kind of report you presented rather than a report about the real problem of the lack of use of a scientific model to prevent mistakes.

The state of Washington has taken one step to lessen the prescription confusion issue by banning handwritten prescriptions.

I'm pretty good at language and scientific dialectics. Rysperdol? traslates into "F--- IT ALL" [you litterally loose your inhibitions and GO for it]. Zyprexa? ..."I hex ya[you]" feel like a zombie, great if you're in the eye of hurricane denial-also GO for it... [stop lying, pleeeaaas]. Seraquil? "sleep until". I know so much...[very very solid mind, emotioanlly TORCHERED-california lefty style] because] I was involved in the 1990's USA GUATEMALA experiments in political ignorance ["it" burns] and because they don't make ANTI-krypton/BODY [6'4" solid] medicine in my size and I eat fast food- cheesy kosher, pork!. so instead I blog and dream of a M.J. hydrocodien, NO NOTHIN' fire shoots out my prick, GIRLS ONLY ...please!!!
-like Kurt cobain/Jimi Hendrix LEFT coast refugee... "TOURRRIST"? or terrible ability to NOT SEE.???

As a pharmacist I was very interested in your program about drug names. However, when you reported that Dyazide and Moduretic were the same drug I had to go to your website to be sure that what I heard in the car was what you actually reported.

Dyazide [triamterene and hydochlorthiazide] and Moduretic [amiloride and hydrochlorthiazide] are different combinations of drugs and share only the hydrochlorthiazide {HCTZ}portion. A better comparison would have been Dyazide and Maxzide - both containing the same ingredients - although Maxide is available in two strength combinations while Dyazide has only one. [A historical sidenote- Dyazide's original formulation was changed some time after first being released into the American market].

I hope that this will clear up the mistake and the confusion.

Sincerely

Rickey Stein
North Brunswick NJ

It is interesting that George Didomizio is given credit for naming Prilosec. That medication was originally named Losec (for "low secretion," because it directly reduces stomach acid production), but the Feds made the manufacturer change the name (the pharmaceutical company then chose Prilosec) because there proved to be mass confusion between the 20-mg strength of Losec and the commonly used 20- mg strength of Lasix -- both of which looked remarkably similar in doctors' illegible handwriting. (In order to minimize errors by the filling pharmacist and avoid confusion by patients, physicians are taught in medical school to indicate on the instructions line of the prescription the condition for which a drug is being prescribed; but few doctors take the time or make the effort to do this.) The problem with poor handwriting should become less of an issue, especially as the government pushes for more prescriptions to be generated and submitted to pharmacies electronically.

I loved this story. I worked as a pharmacy technician for a few years and I remember well the time spent on hold with doctor's offices getting clarification for sloppy writing. And I remember even better the irate customers, who upon returning to find their prescription not filled because of clarification pending, simply didn't understand all the posibilities for error we had to watch out for with every little strip of scribbled paper that was brought in the door.

Your recent story about drug names reminded me of a story I read in a Florida panhandle newspaper when I lived there several years ago about an unfortunate, and perhaps confused, burglar of a pharmacy. After making off with a large stash of what he or she thought was the narcotic oxycontin, it turns out upon investigation that the drug stolen was oxytocin, a hormone used, among other things, to induce labor in pregnant women. Oh well, crime indeed doesn't pay.

With Generous Support From...