Naming of drugsBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7058.688 (Published 14 September 1996) Cite this as: BMJ 1996;313:688
Differences between nomenclatures are much greater than editorial suggested
EDITOR,—C F George discusses the difficulties that will result from the European Commission's directive which states that the international non-proprietary name, not the British approved name, must appear on the labels and leaflets of medicinal products from January 1998.1 George underestimates the problem, however, in asserting that “in total, 41 drugs have a British approved name that is significantly different to their recommended international non-proprietary name.” I recently reviewed this issue and compared the official listings of the British approved names and the international non-proprietary names.2 If we ignore differences in spelling, such as cyclosporin (whose international non-proprietary name is ciclosporin) and oestradiol (estradiol), the number of important differences between the two nomenclatures is well over 100 (table 1); this figure includes some widely used drugs, such as actinomycin D, bupropion, chlorpheniramine, dipyrone, hydroxyurea, nicoumalone, plasmin, povidone, and thiopentone.
The World Health Organisation's international non-proprietary name programme was implemented to overcome this problem of synonyms. In practice, however, it has not achieved this objective, fundamentally because no single official organ is responsible for selecting the valid terms. The World Health Organisation publishes the international non-proprietary names in five languages (Latin, English, French, Spanish, and Russian), but many developed countries have their own nomenclature committees.
In the English speaking world, for example, the United States has its own United States adopted name.5 This may be the same as the international non-proprietary name but different from the British approved name (for example, phenobarbital) or vice versa (povidone), or it may be different from both of these (for example, isoproterenol, whose British and international name is isoprenaline). In extreme cases the same drug has three names, as with aminitrozole, whose British approved name is acinitrazole and United States approved name is nithiamide). In the European Union, which has 11 official languages, the situation is more complex, because several countries have their own list of approved names.
Whatever solution is adopted as a result of the new directive in 1998, clearly none of the member states of the European Union can, in the long term, expect to maintain an official name different from the international non-proprietary name. On the other hand, the World Health Organisation cannot impose on these countries a name that they consider to be unacceptable. The most logical solution would be to set up bilateral discussions between the organisation's experts and the national nomenclature committees with a view to the adoption of a single non-proprietary name for those drugs for which discrepancies exist.