Behind potent drug names, a complex mix of ingredients

Drug names start out as alien words: random collections of syllables that can sometimes seem almost as mind-boggling as the complicated chemistry and biology that went into the development of the new medication.

They are the public face of products that can take many years and hundreds of millions of dollars to develop. Over time, they often become household names: Think Prozac or Viagra. But drug names start out as alien words: random collections of syllables that can sometimes seem almost as mind-boggling as the complicated chemistry and biology that went into the development of the new medication.

Earlier this year, one such feat of linguistic alchemy took place at Cambridge-based Vertex Pharmaceuticals Inc., where an experimental drug to treat hepatitis C, which had been known for years as either VX-950 or telaprevir, was finally dubbed Incivek.

Looking behind the curtain at how drug names are born provides a window into a side of the drug industry that most people interact with but few understand, a process that is both art and science, and requires a delicate balance of regulatory, legal, and linguistic concerns.

“A name in the health care space, it can actually transform our relationship with medicine, with our disease, with our health,’’ said R. John Fidelino, executive director for creative at the health care division of Interbrand that created the name Prozac.

Fidelino cites the example of Prozac, an easy-to-pronounce, uplifting name that turned depression into a disease that people could talk about. Instead of getting a prescription for an unpronounceable drug that sounded like a chemical compound, people had a new word that had none of the negative associations that came with the disease, he said.

To get there, pharmaceutical companies and brand-name consultancies go through exercises that run the gamut from silly to serious. Name generation can draw on exercises that get creative juices flowing, such as “What animal would this cancer drug be, if it were an animal?’’ as well as in-the-field experiments to ensure that spelling errors or handwriting mistakes wouldn’t result in medication errors.

Pamela Stephenson, vice president of marketing for Incivek, said that much of the work stems from the need to come up with a distinct name that somehow personifies the character of the drug. Vertex decided its drug was a kind of hero: a strong drug that knocks out hepatitis C virus.

“We like the fact there’s a ‘c’ in the name - we wanted to relate it to hepatitis C,’’ Stephenson said. “The ‘k,’ the hard-sounding ending is a strong-sounding name. . . . The brand identity is what image does this conjure up in your mind when you think about [the drug]. . . . The ‘hero’ nature was this was such a breakthrough in its ability to clear the virus.’’

Companies also do experiments to make sure that the potential drug name doesn’t look or sound similar to other medicines. They need to guard against the possibility that a patient seeking a cardiovascular drug, for example, could accidentally end up with a similar-sounding painkiller. So, in tests, potential drug names are spoken aloud to doctors, who write them down on a mock prescription pad. The prescription is then presented to pharmacists, who then interpret the written name, reporting what drug they would use.

The hardest element of a drug name may be meeting the wide array of regulatory guidelines, as well as ensuring that a name doesn’t have negative or offensive meanings in other languages, since many drugs are sold globally.

30 to 40 percent of the names that are submitted to the US Food and Drug Administration are rejected. Names aren’t allowed to make an unsupportable claim about the product and can’t be similar to existing names. But they also have to survive a detailed linguistic analysis: Are the names pronounceable in other languages? Do they have negative or confusing cultural meanings?

Because drug makers don’t always know how a drug will be used in the future, there is also an effort to come up with names that are like a blank canvas.

Fred Paster, vice president of new product planning at Millennium: the Takeda Oncology Co. in Cambridge, said that “blue-sky’’ names are especially important for cancer drugs, where a drug initially improved to treat one type of cancer might eventually be used in multiple types of the disease.

“I have been on a number of these efforts, where the indication of the day or the lead indication is driving a number of name ideas, but they’re not very robust because you might find a new indication,’’ Paster said. “You want a name that’s got the flexibility to last the life cycle of the product.’’

Ultimately, the art of drug naming is to find the right combination of syllables that will communicate something about its essence, resonate with patients and doctors, and not overpromise.

“There are also risks to drugs,’’ Fidelino said. “So you need to ensure that for all the benefits you convey to the name, that it’s respectful and responsible, given that some of these drugs can cause harm.’’

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