“I have always stuck up for Western medicine. You can chew all the celery you want, but without antibiotics three quarters of us would not be here.” — Hugh Laurie

It all started innocently enough. A friend mentioned that he found it interesting that the letter X is increasingly being used to make the Z sound – especially in the names of new medications, like Farxiga — and suggested I write a piece about X and maybe some of its alphabet-ending friends.

So I started out by looking at the names of certain medications that are on the market these days and soon I was hooked. I’d quickly forgotten all about those last few letters of the alphabet and became immersed in a mission to find out just exactly what went into coming up with the generic and brand names of the medications most of us have to take these days.

It seems that since the 1960s the United States Adopted Name Program (USAN) has been assigning generic (nonproprietary) names to all active drug ingredients sold in the United States. The agency’s goal is to avoid confusion by avoiding drug names that are too similar to existing names, and to make sure the med’s name communicates accurate information about its action or use.

As medicines’ chemical-derived names became too “complex (and) unmanageable,” regulations were established so their names now include a stem — usually at the end of the name — that denotes a chemical structure, indication or action at a specific receptor.

For example, the generic name of Viagra is “sildenafil,” whose stem or suffix, “afil,” means it helps control blood flow. (Nonproprietary names begin in lowercase; trade names begin with a capital.) The medication’s prefix, “silden,” was chosen because it’s different than other generics yet pleasant enough so the drug’s name isn’t too difficult to pronounce.

The American Medical Association reports that there are currently more than 600 stems and substems that have been defined for classes of drugs. And all that is just for coming up with a new drug’s generic name.

Coming up with the brand name for a new mediation seems to be another story altogether — kind of a combination of science, black art and of course marketing. According to information at Pfizer.com, “Once the patent expires and generic products can be introduced into the marketplace, they use the generic name, whereas our brand name is only able to be used by us.”

“The (brand) names,” the site continues, are meant to be representative of the drug in some way.” For instance, the name of the nerve and muscle pain med Lyrica “calls to mind lyrics or music,” Viagra “elicits vitality and vigor,” and the breast cancer treatment IBRANCE (which for some reason Pfizer spells in all capitals) “summons inspiration, embrace, vibrancy.”

According to a piece on the National Institutes of Health website, “Pharmaceutical companies tend to favor names that are easy to pronounce in many languages and don’t mean something offensive in another culture.” The letters H, J and W are often avoided when creating brand names because they’re difficult to pronounce in some languages.

On the other hand, meds for women may more frequently include the letters L, M or S because they “produce a softer sound (Alesse, Yasmin, Seasonal).”

Conversely, X, Y and Z are often used “because they give a drug a high-tech sciencey sounding name (Xanax, Xyrem, Zosyn).” (Xanax is probably my favorite drug name because it’s a palindrome and its Xs are pronounced differently.)

So that’s some of what I learned about how drugs get their names (there’s a lot of information out there). Next time I might actually look deeper into just what’s up with those popular X, Y and Z characters.

Jim Witherell of Lewiston is a writer and lover of words whose work includes “L.L. Bean: The Man and His Company” and “Ed Muskie: Made in Maine.” He can be reached at jlwitherell19@gmail.com.

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