How did Viagra become ‘Viagra’? Through this fascinating process

When you pick up a prescription of Viagra, Lunesta, Advair, or Paxlovid, you might wonder how drugs get their mystifying brand names. Do pharmaceutical executives sit around a conference table and blurt out sounds or syllables or scribble them down until they conjure a unique name that suits the drug they’ve developed? The reality is not that simple.

Even though people enjoy poking fun at pharmaceutical brand names, says Scott Piergrossi, president of Creative at the Brand Institute, a name-development firm based in Miami, they should understand that drug brand names incorporate safeguards that minimize medication errors caused by name confusion. “The names are very well thought out in a hugely iterative process,” he says.

Although the naming of a drug may appear whimsical, “it’s a very regimented process,” says Suzanne Martinez, a Chicago-based strategist at Intouch, a pharmaceutical marketing agency.

There is a steady demand for snappy new drug names. “There are 30,000 drugs on the market in the U.S., and the U.S. Food and Drug Administration approves 50 novel brand names every year,” says Todd Bridges, global president of the Drug Safety Institute, the regulatory arm of the Brand Institute, and former director of the Division of Medication Error and Prevention Analysis at the FDA. Every year, he adds, it becomes more challenging to get new brand names approved.

Playing the name game

In broad strokes, the drug-naming process includes a creative phase, involving an agency or firm that specializes in brand strategy and marketing to develop potential names; an assessment phase involving professionals from the drugmaker’s commercial, regulatory, and legal departments; and regulatory procedures involving legal reviews and approval by the FDA.

“Naming is an art and a science,” says Martinez. “Both sides of the brain go into it.”

On the creative side, brand strategists and other imaginative types try to come up with names that are appealing and will resonate with the consumer in both messaging and tone. This involves linguistic, legal, and written challenges. At the same time, they want to avoid any prefixes or suffixes that may have negative, derogatory, or offensive connotations.

That can be complicated because the pharmaceutical business crosses borders and “most of the time [drug companies] are looking for one name that can work globally,” Martinez says. After all, a name or syllable that might make sense in the U.S. may be a no-go in a European market. For example, “mist” has positive connotations in English, but it means manure in German.

In the naming business, “we call these permavoids—roots to permanently avoid,” Piergrossi says.

To develop a name that’s likely to satisfy all parties—including the decision-makers at the pharmaceutical company and regulatory bodies in multiple countries—the agency’s strategic and creative team spend months brainstorming hundreds of possible names for one drug. Then that list is gradually whittled down and presented to decision-makers at the pharmaceutical company, and finally the FDA.

“On average, pharmaceutical companies spend hundreds of thousands of dollars developing a drug name,” Piergrossi says, and the whole process typically takes two to three years, though it was faster for COVID-19 drugs.

When developing names, sometimes strategists will try to embed a reference to the biology behind the drug. For example, the cancer drug Xalkori is an ALK—short for anaplastic lymphoma kinase—inhibitor, while Zelboraf, used to treat melanoma, is a molecule that inhibits the BRAF gene.

“They sound like alien names, but they can cue physicians to their mechanisms of action,” says R. John Fidelino, head of innovation and impact at The Development, a brand strategy and marketing consulting firm in New York City.

An emotional touch

Sometimes companies want the name to stir up an emotion or be more aspirational—as was the case with Advair, which suggests an advantage when it comes to air and breathing. Fidelino participated in the naming of Viagra, which was the first pill that worked to address erectile dysfunction. The name was chosen because “it expresses vim, vigor, and vitality that a man was looking to experience and achieve in overcoming erectile dysfunction,” says Fidelino.

But there’s a fine line because the name can’t make an exaggerated claim, be promotional, or overstate the drug’s efficacy—suggesting a cure, for example.

As part of the drug-naming process, pharmaceutical companies often want to highlight what’s unique about a particular medication. “Every drug that comes to market has an aspect of innovation—many times it’s unprecedented in terms of the disease it treats or it uses a mechanism of action that’s completely new,” explains Fidelino.

Piergrossi was involved in the naming of Latisse, a prescription treatment to help people with thin, or too few, eyelashes grow more. The “La” alludes to the word “lash” and the “tisse” evokes the French impressionist, Henri Matisse. As a result, Piergrossi explains, Latisse “almost has a styling effect associated with it.”

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In creating the name Lunesta, for insomnia, Piergrossi and his team wanted to include the word “lune,” to evoke a feeling of lunar influences and a sense of restoration and sleep, he explains.

By contrast, generic drug names are based upon specific syllables—called stems—that are strung together to convey information about the chemical structure or action of a medication. For example, bebtelovimab is a newly approved monoclonal antibody drug that can be used to treat COVID-19; like other monoclonal antibodies, the name ends in -mab. In the U.S., these are assigned by the United States Adopted Names Council as a prerequisite to marketing a drug. “The stem at the end of the drug indicates the class of medicine,” Martinez says. “It is like a mini scientific formula in a name.”

Who makes the final choice 

On the regulatory side, the drug maker’s attorneys evaluate legal and regulatory issues behind potential names. Part of the evaluation considers whether the name makes exaggerated claims or misstates the efficacy. Which is why we don’t see drug brand names with the word “cure” or “remedy” in them.

Ultimately, the FDA gives final approval of a drug’s brand name. To determine whether to approve a proposed name, one of the steps the FDA employs is a software program commonly referred to as POCA, which is short for: Phonetic and Orthographic Computerized Analysis. It uses an advanced algorithm to identify similarities between drug names, both when they’re spoken and written as a prescription.

This includes letters that are similar in cursive writing—such as L, T, and K that have an upstroke, explains John Breen, executive director of health strategy for the kyu Collective, a marketing services organization, in New York City.

In addition, the FDA’s name-approval process includes database searches for medication errors related to active ingredients in the drug, simulation studies with FDA-employed healthcare providers to test their response to proposed names, and consideration of possible failures, errors, or name confusion when it comes to prescribing, ordering, dispensing or administering the drug.

“There’s a reason why there’s a bit of wackiness when it comes to drug names,” Breen says. That’s because “it has become almost a survival of the fittest not necessarily from brand-building or commercial potential but from surviving the [name] approval process.”

Cases of mistaken identity

According to a 2018 report by the Institute for Safe Medication Practices, of the 6,206 medication-related errors reported to the ISMP between 2012 and 2016, nearly 10 percent were related to drug name confusion. That was a significant improvement from reports submitted between 2000 and 2004 in which 20 percent of medication errors were related to drug name confusion. These errors can occur as a doctor writes a prescription, as a pharmacist dispenses a drug, when a nurse administers, or when a patient takes medications—if they have two with similar-sounding names, for instance.

Among the examples of look-alike, sound-alike drug names that are often confused for each other are: Adderall and Inderal; Celebrex, Celexa, and Cerebyx; Paxil and Taxol; Zyrtec and Zantac. These are just a few examples from the Institute for Safe Medication Practices’ lengthy list of drug names that are frequently confused.

Between 2000 and 2009, the FDA’s Center for Drug Evaluation and Research (CDER) received approximately 126,000 reports of medication errors, “some of which are directly related to the similar sound and appearance of drug name pairs.” 

When name-related drug errors come to light, the FDA will sometimes ask a company to rename a medicine. This happened in 1990, in the case of Losec (for heartburn) and Lasix (a diuretic); subsequently, Losec was renamed Prilosec. In 2010, after reports of dispensing errors were made to the FDA, Kapidex (a heartburn drug) was renamed Dexilant to avoid confusion with Casodex (a cancer drug) and Kadian (a narcotic). And in 2016 the FDA approved a name change for Brintellix (an antidepressant) to Trintellix, in order to reduce the risk of confusion with Brilinta (a blood-thinning drug).

How does the FDA decide which drug’s name should be changed? “The one that was approved last has to change its name,” Bridges says. “You can imagine how this would affect a company—after spending all that money developing and marketing a name, then they have to change it.”

Meanwhile, the FDA continues to update its guidelines and standards for evaluating drug name safety, Martinez says. “The regulatory landscape is always evolving,” she adds, in an effort to avoid brand names that are potentially problematic. The FDA has a monitoring system called MedWatch to track both adverse effects from drugs as well as medication errors, including name confusion, Bridges notes.

Seeking brand names with staying power 

Just as brands like Kleenex and Xerox became synonymous with their products, a similar phenomenon sometimes happens with drugs. Over time, some drug brand names—such as Viagra, Xanax, Botox, and Lipitor—have become leaders in their categories, household words, and linked with their intended purpose. “People use them more often in their everyday vernacular than most other drugs,” Martinez says.

Sometimes brand names stick in the public’s mind and sometimes they don’t. Take the vaccines for COVID-19 as an example: Most people know if they received the Pfizer or the Moderna vaccine and were able to request subsequent vaccines or boosters accordingly. However, most people don’t ask for the Pfizer vaccine by its brand name, Comirnaty, or the Moderna vaccine by its marketed name, Spikevax, after these drugs earned full approval from the FDA.

To their credit, the names do evoke associations with how the vaccines work: COVID and mRNA for COMIRNATY; and the mechanism of action, using an mRNA vaccine to trigger production of the spike protein, for Spikevax.

The take-home message

Besides being intriguing, understanding what goes into naming a drug and how it might relate to the actual product may help you avoid your own name-confusion at the drugstore. If you start to think of Zantac as a drug that combats stomach acid—hence, the -ac at the end—you’ll be less likely to confuse it with the antihistamine Zyrtec (a look-alike name) or the benzodiazepine Xanax (a sound-alike name).

“We often try to build in layers of meaning to drug brand names,” Piergrossi says. “The more we can encode multiple concepts that relate to the product’s attributes or benefits without sounding forced or contrived, that’s the ideal scenario.” It’s true for pharmaceutical companies, health-care professionals, and consumers, alike.