Education And Debate

“Where name and image meet”—the argument for “adrenaline”

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7233.506 (Published 19 February 2000) Cite this as: BMJ 2000;320:506
  1. Jeffrey K Aronson, clinical reader (jeffrey.aronson@clinpharm.ox.ac.uk)
  1. Department of Clinical Pharmacology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE
  • Accepted 17 September 1999

Their white epinephrin, my crimes

Aldous Huxley, Island

Assuming that you don't want to call it dihydroxyphenylmethylaminoethanol, which name should you use—adrenaline or epinephrine? All the arguments and evidence suggest that you should prefer adrenaline.

Summary points

A European Commission directive requiring member states to use recommended international non-proprietary names for all drugs is soon to be implemented

For most drug names there will be little or no change

For around two dozen drugs the changes are more important; these will be dual labelled during the five year changeover period

It is intended that adrenaline (British approved name) will be changed to epinephrine (recommended international non-proprietary name)

The strong arguments for persuading the European Union to resist this particular change are based on usage, history, etymology, and, most importantly, risk of clinical errors

Naming names

All drugs have at least three different names.1

  • The chemical namemdash;whose form generally follows the rules issued by the International Union of Pure and Applied Chemistrymdash;for example, (R)-1-(3,4-dihydroxyphenyl)-2-methylaminoethanol.

  • The approved (official or generic) namemdash;which is usually the World Health Organisation's recommended international non-proprietary name (rINN). However, it may be some locally approved namemdash;for example, the British approved name (BAN), dénomination commune française (DCF), Japanese accepted name (JAN), or United States adopted name (USAN). The monster substance mentioned above is better known as adrenaline (British approved name) or epinephrine (recommended international non-proprietary name).

  • The proprietary (brand or trade) namemdash;which is the name given by a pharmaceutical manufacturer. For example, adrenaline is marketed in Britain as Epipen for intramuscular injection and as Eppy or Simplene eyedrops.

The chemical name is an unambiguous description of a drug's structure, but it is cumbersome and irrelevant to practical prescribing. As for brand names, pharmaceutical manufacturers make their own choices, although to avoid confusion between similar names of different drugs or formulations, these are …

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