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The problem with cloppy doggerel

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I recently attended a meeting on cardiology at which someone asked a question about clopidogrel, putting the emphasis on the third syllable (clop-i-DOG-ruhl). In his reply, the speaker accented the second syllable (cluh-PID-uh-grel), as stipulated by the British Pharmacopoeia Commission’s ‘British Approved Names’ book. The contrast between the two pronunciations caused a few smiles around the lecture room.

Does it matter that a drug name, such as clopidogrel, can be pronounced in two different ways? Yes it does, because a variant pronunciation of a name may be misheard as a different drug altogether, with the possibility of error.

We already risk confusion between drugs with similar sounding names, such as fentanyl and the much more potent sufentanil. Multiple pronunciations for a single drug name just add to the potential for error.

And it is not just a question of where to place the accent. Even if we agree on which syllable to emphasise, there is still the problem of how to pronounce certain vowels. You say “tomayto”; I say “tomahto”. Sticking with clopidogrel for the moment, how would you pronounce its brand name, Plavix? Is it PLAY-vix or PLAV-ix, or maybe PLAH-vix?

Similarly, would you use a long vowel or a short vowel for the first letter of brand names such as Azactam, Azopt, Azulfidine, Edex and Equanil? And can you explain your choice?

Unless the pronunciations determined by the innovators and the regulatory authorities are spelt out for us, we are likely to pronounce many drug names in multiple ways, with a risk of confusion and error.

For both generic and brand names, we need guidance on pronunciation whenever alternatives may be possible. Such guidance should appear routinely in summaries of product characteristics, in patient information leaflets and in the British National Formulary. It would be useful, too, in professional journals’ announcements of new products and in reference works such as ‘Martindale’.

A freely accessible and well publicised internet guide would also be invaluable. Health professionals should certainly not have to fork out £150 for a copy of ‘British Approved Names’ to find out that there is no such drug as “cloppy doggerel”.

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