DEAR DR. ROACH: How do pharmaceutical companies arrive at the names of their drugs? — M.G.
ANSWER: Every new drug starts with three names: a chemical name, a generic name and a brand name. The chemical name can be extremely long and difficult to remember or pronounce, even for experts. A generic name is meant to convey some information about the drug, and a brand name is used for marketing. It is designed to be easy to remember and sometimes relay something about the drug.
The chemical name is devised under a very specific set of international rules. These are never used by physicians or consumers. In the U.S., the generic name is proposed by the drugmaker and approved by the United States Adopted Names Program (USAN).
The goal of the USAN is to create a name that is “euphonious and memorable.” The generic name must avoid certain letters (Y, H, K, J and W) that aren’t used in some languages, and it can’t be seen as marketing. For example, it can’t include the drug company name or use a superlative like “best,” and it must avoid medical terminology.
The brand name is developed by the company requesting approval for the drug and identifies it as the exclusive property of that company. These are intended to be catchy and easily remembered by physicians, and often indicate the intended use of the drug: “Leschol” is a cholesterol-lowering drug, for example. The USAN has the authority to approve generic and brand names (or not).
In my role as a medical teacher, I insist that my students and residents learn and use the generic names, not the brand, although there are a few exceptions — “Paxlovid” is much easier to say than “ritonavir-boosted nirmatrelvir.” Generic names often indicate class of drug, which is information that can be helpful.
There are a few brand names, forgotten by most, that I still respect, like “Hyperstat,” a brand of diazoxide, designed to bring blood pressure down fast (dangerously so, as we now know), and the “Sublimaze” brand of fentanyl, used in anesthesia (and unfortunately now as a drug of abuse).
DEAR DR. ROACH: My LDL cholesterol is 4.39. Do I need to take statins? The doctor prescribed me simvastatin 40 mg. — A.A.
ANSWER: A note to many of my readers: 4.39 is not a typo. Much of the world uses international units for cholesterol, which is mmol/L (millimoles per liter), while the U.S. and some other countries use mg/dL (milligrams per deciliter). They are easily interchangeable using the factor 38.67, so your level is 170 mg/dL.
This, by itself, is not high enough to recommend medication therapy. However, if you had other risks, such as older age, high blood pressure, diabetes or smoking, you might have a high enough risk to make your prescribed simvastatin likely to help prevent a heart attack. Almost everybody who has already had a heart attack should be on a statin drug.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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