A number of months ago, we did an episode on how a drug comes to market, with the help of our Healthcare Triage intern, Pharm.D student, Rachel Hoffman. She also helped us out with our episode on Flibanserin. We have lots of questions from you about drugs: What's the difference between a generic and name-brand drug? Why do people care? What's the difference with biologics? With Rachel's help, we're going to tackle those in the upcoming weeks.

Let's start at the beginning - what's in a name? That which we call a drug by any other name would be so... effective? Brand name and generic drugs, are there any differences between 'em? Who regulates them? And what's with all the names anyway? That's the topic of this week's Healthcare Triage...

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 All drugs have at least three names: the chemical name, the generic name, and at least one brand name. To confuse matters more, the same drug may have different brand and generic names in different countries. So everyone knows acetaminophen, right? It's also known as paracetamol. Acetaminophen and paracetamol are both generic names for the same drug. In the United States, we use the former. The most common brand name for that drug in the United States is Tylenol^®. Healthcare professionals will sometimes document use of this drug with the abbreviation APAP. This is derived from the drug's chemical name, N-acetyl-para-aminophenol. That's why brand, and generic, names are so handy. Nobody has time to say acetyl-para-amino-whatever. Okay, so what's with all the crazy names? They don't seem to be chosen for ease of pronunciation. I mean, obinutuzumab? Wh-wha? Some of these just sound like comic-book characters. I would totally buy the issue where valtrex-mavicoranon-dancetron, or an epic fight to the death. They sound ridiculous, but when you consider the number of drugs out there, it's easier to understand why we have to come up with such, let's call them "creative", names. 

For safety reasons, drugs need to have distinctive spellings and pronunciations. As of 2013, the FDA had approved more than 1,450 drugs. That is an incredible number of unique names. I can't even think of 20 friends that all have different names. I'm pretty sure I know at least ten "John"s. So where do these names come from? 

Early in pharmaceutical development, a drug company may refer to a compound by its chemical name, or an abbreviation. During Phase I or Phase II of the clinical trials, they'll apply for a generic, or non-proprietary name. In the United States, this is done through the United States Adopted Name Council (or USANC), a group of pharmacists and physicians that represent various professional organizations and regulatory bodies. The Council takes into account various elements of the drug's chemistry, and mechanism of action, when assigning the name. Drugs with the same mechanism of action will have the same common stem, usually at the end of the name.

Take statins, for instance. Though they all have varying chemical structures and differ in the degree to which they lower cholesterol, drugs like simvastatin, atorvastatin, and rosuvastatin all work the same way in the liver, by inhibiting HMG-CoA reductase to reduce cholesterol bio-synthesis.  

Another example are drugs that target viruses, ending in -vir. Like valacyclovir, sometimes used for shingles or herpes. And tenofovir, which can be used for Hepatitis B, or in combination with other antivirals for HIV.

But it's possible that other countries could give other names. Thankfully, the World Health Organization (WHO) keeps everyone on the same page by managing and assigning international, non-proprietary names, or INN. The WHO works closely with national naming commissions, like the USANC, to develop a suitable International Non-proprietary Name for a drug molecule. This takes a good deal of collaboration, but it's rare that an International Non-proprietary Name differs greatly from a National Non-proprietary Name. 

Oftentimes, the spelling of International Non-proprietary Names is no different from country to country. When that's not possible, Latinized pronunciations are translated to other languages like Chinese, Russian, and Arabic. We haven't even discussed brand names. Again, the rules are different from country to country. In the United States, brand names have to be approved by the FDA before the drug can come to market. This is to ensure that the name is different enough from pre-existing drugs. Aside from that, the pharmaceutical company has a lot of autonomy in picking the brand name. Companies don't really share their naming strategies, but brand names often hint at the way a drug works, how it should be taken, or its desired effect. 

And that's just the names! Are there differences beyond the words? That's the topic of next week's Healthcare Triage.

Healthcare Triage is supported in part by viewers like you through patreon.com, a service that allows you to support the show through a monthly donation. Your support helps us make this bigger and better. We'd especially like to thank our Research Associate, Cameron Alexander, and our first-ever Surgeon Admiral, Sam. Thanks Cameron! Thanks Sam! More information can be found on patreon.com/healthcaretriage.