How do prescription drugs get such crazy names?

Asvasiran. Bremabecestat. Gedatolisib. Lulumab pegol. Nexbolizumab. Uprosertib. Orilotimod. Vepoloxamer.

What are they? Aliens? Goblins? Diseases? A spelling bee contestant's nightmare?

Nope. They're names for drugs.

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Not brand names, though. They're the names for the active ingredients.

You may have noticed that every brand-name drug has a second name — for instance, Prozac® (fluoxetine). That second name, fluoxetine, is a name for the active ingredient, which is the same whatever the brand or generic form.

And believe it or not, these syllable-heavy second names are actually convenient nicknames. It's much easier to say fluoxetine than to say (RS)-N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propan-1-amine.

When a drug company researches and patents a drug, it gets to suggest what the generic name should be. It makes an application to the United States Adopted Names Council (other countries have similar councils and they generally try to cooperate). And that is what those alien-looking words are that I started with: generic names that have been applied for and are under consideration.

So can these drugs be named just any old thing? Is there anything preventing a company from calling its active ingredient supercurol? Well, yes. The U.S. Adopted Names Council. It has some rules, including the following:

• "Prefixes that imply 'better,' 'newer,' or 'more effective;' prefixes that evoke the name of the sponsor, dosage form, duration of action or rate of drug release should not be used."
• "Prefixes that refer to an anatomical connotation or medical condition are not acceptable."
• Certain letters or sets of letters also aren't allowed at the beginning of new generic names. These include me, str, x, and z.

Every name has two main parts. The back half of the drug name is the same for all drugs in a particular class — for instance, there are a whole raft of cholesterol-lowering drugs that end in -vastatin: atorvastatin (Lipitor), fluvastatin (Lescol), rosuvastatin (Crestor), simvastatin (Zocor), and several others. Some other class suffixes include:

• -oxetine for a class of antidepressants, such as fluoxetine (Prozac)
• -sartan for a class of blood-pressure-lowering drugs, such as losartan (Cozaar)
• -afil for a class of drugs used for erectile dysfunction, such as sildenafil (Viagra)
• -lukast for a class of anti-asthma drugs, such as montelukast (Singulair)
• -azepam for a class of anti-anxiety medications, such as diazepam (Valium)
• -coxib for a class of anti-inflammatory pain relievers, such as celecoxib (Celebrex)
• -dronate for a class of drugs that prevent calcium loss, such as alendronate (Fosamax)
• -formin for one class of diabetes drugs, such as metformin (Glucophage), and -glitazone for another class, such as rosiglitazone (Avandia)
• -prazole for a class of stomach acid reducers, such as esomeprazole (Prilosec)
• -conazole for a class of anti-fungals
• -vir for antivirals, with a number of subclasses, including -amivir for a class that includes the anti-flu drug zanamivir (Relenza), -ciclovir for a class that treats herpes (such as famciclovir (Famvir)), and ­-navir for antiretrovirals for HIV treatment, such as indinavir (Crixivan)
• -stat for enzyme inhibitors, with a whole bunch of subclasses — for instance, -becestat means it's a beta secretase inhibitor (doesn't that help you? It would if you were a pharmacist)

So where do these suffixes come from? They used to often be based on the full chemical name, but now they're sometimes based on particular descriptive terms: -mab for monoclonal antibodies, -sertib for serine/threonine kinase inhibitors, -mer for polymers, or -imod for immunomodulators. And sometimes they're just made up. If you're the first company to come up with a drug in that class, you may get to set the pattern that all the others who come after have to follow.

As to the prefix (what comes before the suffix to identify the individual drug), you can make it pretty much whatever you want — subject to the USANC's rules and approval. And then it's just up to the clinical trials to show it's effective… and to doctors, patients, and marketing departments to make it successful. Or not. But if it is, you can bet everyone will call it by the brand name anyway.