by Tania Houspian, PharmD 2011 | firstname.lastname@example.org
Most patients know their medications by one of their two names. Even more patients will wonder why their medications need two names. Is it a first and a last name? Are they having an identity crisis? Why in the world can’t we just pick one name and all call it that? The answers to the questions above: are no, no and we do. For further explanation keep reading.
Get ready for a twist. Medications actually have three names. We apologize for lying to you earlier. One is the brand name, one is the generic name and the third is the correct naming for the chemical structure of the drug. Below is a table of common drugs with their brand, generic and chemical structure names.
The chemical names are derived using rules established by the International Union of Pure and Applied Chemistry (IUPAC). These rules allow scientists all over the world to name structures the same way so that any other scientist will know what structure is being referred to based on the name. These rules are something all sophomores in college taking organic chemistry have to know by heart (don’t ask us if we remember them all now). After reading the chemical name of these drugs, you can see why no one goes around using them (they definitely wouldn’t fit on the label of the bottle). When researchers first synthesize a chemical, they give it a simpler name that we refer to as the generic name. The simpler name is sometimes based on the chemical name. If you look at the chemical names for acetaminophen, metformin, or metoprolol we’ve bolded the letters in the chemical name that most likely served as inspiration for the generic name. On the other hand, if you look at warfarin or atrovastatin their generic names don’t coincide with the chemical name. Their names come from different back-stories which we’ll let you Wikipedia at your leisure if you’re interested in the history of drug naming. The generic and chemical names are thus interchangeable (although we recommend sticking with the generic names for pronunciation purposes). For example, metformin is always N,N-dimethylimidodicarbonimidic diamide. The two are bound forever.
The chemical name is always faithful to the generic name. The generic name, however, is a little more promiscuous. When a company develops a new drug, in addition to the chemical name and generic name, they give it a brand name. This brand name belongs to the company that trademarks it. For example, when someone calls metoprolol by its brand name, Lopressor, they are referring to metoprolol manufactured and distributed by the pharmaceutical company, Novartis. However, depending on which company manufactures it and what country you are in, metoprolol can have a different brand name. Below is a list of different brand names, manufacturers, and the country in which you’ll find this brand name for metoprolol.
See what we meant about the generic name being promiscuous? Since brand names are different depending on where you are in the world, it’s always good to know your drug’s generic name (consistency is key). Drug companies usually pick brand names that will either help patients remember what the drug is used for or something catchy to help with name recognition of their drug. You’ll also notice that the first letter of the brand name is always capitalized.
If it’s just about names, why do I have to pay more for brand name drugs?
If your elementary school experience was anything like ours, whoever grabbed the most popular play item first got to the set the rules (i.e. boys or girls can’t play). The pharmaceutical industry is a bit like that. When a pharmaceutical company discovers a drug, they patent it. This patent insures that they are the only ones who can make and sell the drug for the next 25 years (give or take a few years). The first 10-15 years of the patent are spent going through all the phases of the Food and Drug Administration (FDA) testing to ensure that the drug does what the company says it does and that its safe for humans to use. When the drug finally receives FDA approval, it can then be prescribed to and used by patients. At that point the pharmaceutical company has about 10 years left on their patent and they plan on making the most of it. Since the pharmaceutical company just spent millions upon millions of dollars discovering, producing and testing their new drug, they plan on recovering that money (and then some) while the patent is still in affect and thus they charge extortionist prices for their new medication. Yup, this is a monopoly in the clearest definition of the word.
However, after the 25-year patent has expired, other companies can apply with the FDA to start producing the drug. These new companies produce generic versions of the brand name drug. This simply means that they don’t assign a fancy brand name to the medication, opting for the standard generic name. The companies making generic versions of medication have to prove to the FDA that their version is identical in dose, strength, route of administration, safety, efficacy and intended use of the original drug…essentially an exact replica of the fancy brand name drug. Generics are identical to the brand name version except that the generic manufacturers didn’t have to pay money to research, develop and advertise the drug. The result is a significantly more affordable version of the exact same drug. With multiple competitors in the market selling the exact same drug, the price is driven even lower. You can purchase a month’s supply of a generic medication at wide variety of major retailers for a few dollars per month (Target, for example, sells a month’s supply for $4). You can be sure that the company who spent all their time and money discovering the drug is not happy about generic versions of their medication hitting the shelf. Before you start feeing sorry for them, we’ll assure you that they’ve found a solution.
Put yourself in the pharmaceutical company’s shoes. You discovered an amazing drug but the patent has expired and you’ve been priced out by generics. You don’t want to reinvest all the money and time it takes to develop a new drug. What do you do? Their brilliant solution is to make a minor alteration to the structure of an existing drug whose patent has expired. These “new” drugs are referred to as me-too drugs. Since the me-too drug has a slightly different structure, the drug is eligible for a new patent and is then protected for 25 more years. Most of the time, the “new” version of the drug works exactly the same as the original drug (with a few minor differences here and there that the drug company is sure to highlight). Despite the fact that it is essentially the same drug, the drug company will launch a huge nationwide ad campaign to convince everyone that their new drug is better than the original one. Sometimes they’ll go as far as to mount a smear campaign against the older drug so patients will want their new drug (which is notably still under patent).
This is Economics 101 at its finest…and you thought you were here for a science lesson.
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