Trade Names or Generic Names?

To the Editor:

I enjoy reading your journal, but I find one aspect particularly irksome. I am referring to your insistence on using only generic names for commonly used drugs. In your recent article on vomiting (March’s Parent Coach, “Managing a Child’s Vomiting: Which Outpatient Therapies Are Best?” by Jennifer J. Zatezalo and Linda S. Nield, MD), ondansetron was mentioned 20 times. We order Zofran, nurses give Zofran, and patients take Zofran. Our patients take Benadryl, Tylenol, and Strattera, not diphenhydramine, acetaminophen, and atomoxetine. Recently, other journals have decided to publish brand names alongside generic ones. Perhaps it’s time to speak to us in our language. Let’s be honest: The next time you have a headache, are you really going to reach for two extra-strength acetaminophen tablets?

David Wisotsky, MD, CEO and Medical Director

Tenafly Pediatrics, Tenafly, New Jersey

In Reply:

Dr. Wisotsky raises an interesting point about the use of proprietary and nonproprietary or generic names in the medical literature. In certain situations, Consultant for Pediatricians uses a medication or device’s trade name—for example, in direct quotations or in discussions of a specific product or formulation. Nevertheless, a number of reasons explain our near-exclusive use of nonproprietary medication and product names in Consultant for Pediatricians.

Dr. Wisotsky’s example of atomoxetine (Strattera) is a medication that very neatly has a single corresponding U.S. brand name. But the approach to two of his other examples, Zofran and Benadryl, is much less straightforward. In the United States, ondansetron once had been available exclusively under the trade name Zofran. But since Zofran went off patent in 2006, generic versions of ondansetron have become widely available here. Moreover, while our primary audience is U.S. pediatricians, the online content of Consultant for Pediatricians is freely available to and widely accessed by users outside the United States, where ondansetron has dozens of proprietary names, from Adom-O in India to Zemitron in Tunisia. Our use of the generic name obviates any possible confusion across international borders.

The case of Benadryl brand of diphenhydramine is even more complicated, given the wide array of products bearing the brand name, including oral, topical and parenteral formulations; over-the-counter and prescription versions; formulations with different salts (hydrochloride and citrate) and correspondingly different dosages; and products containing other active ingredients in addition to diphenhydramine (eg, phenylephrine). Using generic terms helps remove any doubt about which formulation of a medication is being discussed.

Other factors contribute to our general avoidance of the use of brand names. Because the products mentioned in articles also might be advertised in Consultant for Pediatricians, our eschewing brand names when appropriate avoids any suggestion of bias or industry involvement in a clinical article. Logistics is another good reason to stick to nonproprietary names: The most thorough approach would be to list every available brand name of a medication—an approach that is impractical at best.

Finally, like many other medical publications, Consultant for Pediatricians turns to the AMA Manual of Style, 10th edition, for style questions like this one. Section 15.4.3 of the manual offers a strong advice on the matter: “Because the medical literature is read internationally and confusion about the intended drug could lead to patient harm, the nonproprietary name should always be used and the proprietary name should almost never be used in the medical literature.”

Michael Gerchufsky, ELS, CMPP

Managing Editor