Adrenaline or Epinephrine? The Naming of Drugs – A Problem of Harmonisation for Scientific Journals

Adrenaline or Epinephrine? The Naming of Drugs – A Problem of Harmonisation for Scientific Journals

The Veterinary Journal 2002, 164, 1±2 doi:10.1053/tvjl.2002.0741, available online at http://www.idealibrary.com on Guest Editorial Adrenaline or Epi...

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The Veterinary Journal 2002, 164, 1±2 doi:10.1053/tvjl.2002.0741, available online at http://www.idealibrary.com on

Guest Editorial Adrenaline or Epinephrine? The Naming of Drugs ± A Problem of Harmonisation for Scientific Journals Although currently very topical, the debate on drug nomenclature in both human and veterinary medicine goes back a long way (George, 1996). For those of us who routinely read scientific papers, it is increasingly apparent that drugs can be given different names (e.g. adrenaline or epinephrine), sometimes in any two papers published in the same issue of a journal and usually depending on the origin or training of the authors (e.g. British, American, Australian or non-English speaking). The problem is of particular importance for pharmaceutical preparations and causes confusion both to practitioners and human patients (Bradley, 1996) as well as, in our profession, to animal owners. Of course the names of most common drugs, in all their forms, are generally recognised by those working in the particular discipline where the agents are routinely used. So, for example, in pharmacology we have isoproterenol (British Approved Name, or BAN) (British Pharmacopoeia Commission, 2002) and isoprenaline (International Non-proprietary Name, or INN ) (World Health Organization, 2001). Differences between British and American names have long been considered problematic. Sometimes the differences are minimal (oestradiol and estradiol ), but at other times the names may be quite dissimilar, as with tetracaine and amethocaine, or paracetamol and acetaminophen, which can be very confusing. In extreme cases, the same drug may have more than two names, as is the case with aminitrozole (INN ), whose BAN is acinitrazole and whose United States Accepted Name, or USAN, (United States Pharmacopoeia, 2001) is nithiamide. This may be quite bewildering, particularly for lesser-known compounds. It is worth pausing to consider how we have got to this seemingly irrational position. The confusion largely reflects the fact that no single organisation is officially responsible on a global basis for deciding the valid names of drugs and there is therefore no means of imposing an official and unique name

for pharmaceutical compounds. The World Health Organization (WHO) has tried to overcome the problem by introducing the International Nonproprietary Name programme, which is published in five languages (Latin, English, French, Spanish and Russian) (World Health Organization, 2001). The programme has enjoyed some success but has still to gain universal acceptance, not least because many developed countries have their own long-established nomenclature committees, which retain the right to choose whether to adopt the WHO recommendation, keep their own name or even to introduce a novel, distinct name. The United States has its own Accepted Nomenclature, the USAN, and so for US-based scientists, publishing in US journals, life is fairly straightforward. However, for those of us working in non-English speaking countries, the situation has become very complex. In Italy, for example, some British Approved Names (e.g. adrenaline instead of epinephrine) are still used, but alongside other International Non-proprietary Names (e.g. lidocaine instead of lignocaine). Italy, like other Member States of the European Union (EU), now needs to look to Brussels to take a lead in this controversial arena. Since 1953, when the first International Nonproprietary Names for pharmaceutical substances was published, the cumulative list has increased such that it now includes more than 7000 names, and this figure is increasing by some 100±150 new names each year. Fortunately, through continuing cooperation between the WHO and national committees, several important national names, registered for example as BANs, USANs, Japanese Adopted Names ( JAN ) or DeÂnominations Communes FrancËaise (DCF ) now conform to the International Nonproprietary Names programme. But, there is still no agreement over a further 100 or so compounds (Navarro, 1996), and several of these are important and commonly used drugs, most of which were

1090-0233/02/$ ± see front matter # 2002 Published by Elsevier Science Ltd.

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GUEST EDITORIAL

approved before the WHO's programme had been introduced. The exceptions should however be seen in the context of the 7000 substances over which agreement has been reached. Although WHO's International Non-proprietary Names cannot be imposed on any single country, it should be noted that its use is now mandatory in the European Union. A European Commission directive (92/27/EEC) states that International Non-proprietary Names, and not British Approved Names, should appear on the labels and leaflets of medicinal products (Anon., 1992). On this basis, it seems reasonable to expect that, in time, EU Member States will be required to adopt names compatible with the International Non-proprietary Names programme. In the 1990's, the Editor, Dr. Andrew Higgins, started gently to transform The British Veterinary Journal into a truly international journal, which is now called The Veterinary Journal. As a member of the Executive Committee of TVJ, I believe it would be valuable for the Journal to adopt the International Non-proprietary Names programme. This would serve to avoid misunderstandings, would better harmonise papers and would provide a further step in the process of internationalisation. As a first step, when a drug has different names, authors could be required to place the alternative name(s) in brackets after the International Non-proprietary Name at the first use in the text. The Veterinary Journal has the opportunity to be a pioneer amongst veterinary journals by taking this important step towards harmonising the naming of drugs in scientific papers. It will also serve to improve standardisation and will provide a further indication of international scientific teamwork. Moreover, the adoption of a uniform nomenclature

for drugs will facilitate refereeing procedures, avoiding futile discussions and controversies. Finally, as on medicine packages, data sheets and leaflets, use of the International Non-proprietary Name in TVJ will be of help to practitioners by clarifying what has become an unnecessarily tangled web. GIOVANNI RE Department of Animal Pathology Division of Pharmacology & Toxicology University of Torino Via L. da Vinci 44 I-10095 Grugliasco, Torino, Italy E-mail: [email protected]

REFERENCES ANON. (1992). Council Directive on the labelling of medicinal products for human use and on package leaflets. (92/27/EEC) (1992). Official Journal of the European Communities L 113 (31 March), 8±12. BRADLEY, N. (1996). BMJ should use ``paracetamol'' instead of ``acetaminophen'' in its index. British Medical Journal 313, 689. British Parmacopoeia Commission (2002). British approved names. London: HMSO. GEORGE, C. F. (1996). Naming of drugs: pass the epinephrine, please. British Medical Journal 312, 1315±6. NAVARRO, F. A. (1996). Naming of drugs. Differences between nomenclatures are much greater than editorial suggested. British Medical Journal 313, 688±9. United States Pharmacopoeia. USP Dictionary of USAN and International Drug Names. Rockville: USP. World Health Organization (2001). Denominations communes Internationales (DCI) pour les substances pharmaceutiques. International non-proprietary names (INN) for pharmaceutical substances. Geneva: WHO.