The superfluous, a very necessary thing. --voltaire
I sat at the small square desk in the corner of the exam room holding a crinkled plastic shopping bag stuffed with a variety of prescription medication containers. My new patient had just handed them over to me. I looked closely at the bag. This might take awhile, I thought.
I dumped the contents of the bag onto the desk and began to sort through the array of empty bottles, tubes of cream and hand-held inhalers. The labels disclosed that the prescriptions originated from various doctors and many different places. And they were all labeled with generic names. I soon realized that I was going to need a Physician Desk Reference to look up some of the generic names that were unknown to me.
"Metaproterenol sulfate inhalation aerosol, that would be your Alupent," I said, setting it aside as I started a list. He was nodding. "And this is pirbuterol acetate inhalation aerosol. I think that is a Maxair inhaler." He confirms, "That's right." So far so good. We go on.
"OK, this is a tube of ciclopiroxolomine and this one is desoximetasone and this one is fluocinonide. I'm going to have to look these up." I do. "OK, we have Loprox cream, Topicort and some Lidex. Pretty strong stuff." He is nodding, "Yes."
I pick up one of the bottles. "This one is triprolidine hydrochloride 2.5 mg and pseudophedrine hydrochloride 60 mg, I think that's Actifed. And this one is isometheptene mucate 65 mg, dichloraphenazone 100 mg and acetaminophen 325 mg, that would be Midrin. Do you get headaches?" He nods vigorously, "Oh yes, terrible headaches."
"Let's see, enalapril maleate-hydrochlorothiazide, that's Vaseretic. You have high blood pressure." Again he nods, "Yes, but I ran out of my medicines and I'm not taking anything now. I need to get back on something."
"This one is guanafacine hydrochloride, that's Tenex, for blood pressure, and indapamide, Lozol, also for blood pressure. And triamterene 75 mg/hydrochlorothiazide 50 mg, I think this is Maxide. It's for blood pressure too, and you say your not taking any of these medications right now?" Again nodding, "That's right, I need to get back on."
"Alright, acebutolol hydrochloride and amiloride hydrochloride-hydrochlorothiazide, I'm not sure what these are, I need to look these up." Thumbing through the massive PDR tome, I find what I am seeking. "OK, here it is, it's Sectrol, that's a beta-blocker, for blood pressure too, and the other one is Moduretic, for blood pressure as well. I'm not sure you're going to be needing all of these medicines for your blood pressure."
"Oh good," he replies. "I don't think I was on the right kinds of medicines. Besides, I don't like to take pills." I think to myself, "I can tell."
"And the last two, cyclobenzaprine hydrochloride and orphenadrine citrate. Do you know what they're for?" He takes the bottles and looks them over while I turn the pages in the PDR. "They're for my spasms, I think."
"Here we are, Flexaril and Norflex. You're right, they're muscle relaxers. Have you had back problems?" He nods vigorously again, "Oh yes, terrible backaches."
I finished writing the list of medications, then picked up the plastic grocery sack to replace the odd mixture of medication containers. "Whoops, looks like I missed one." I fished out the elusive, solitary, empty prescription bottle.
I read off the label to myself, "Perphenazine-amitriptyline hydrochloride, what is this? I know amitriptyline hydrochloride, that's Elavil, a tricyclic antidepressant, but perphenazine. It must be some kind of neuroleptic, a type of phenothiazine. What an interesting combination, there must be a lot of side effects with this medicine, how strange."
I ask, "What do you take this for?" He looks over the bottle. "Oh, them's for my nerves, the little blue pills." I look them up. "Oh, OK, this is Triavil, I've heard of this. The perphenazine is called Trilafon. I've never used it. Kind of an older drug."
The medication list was finished. I refilled his sack and handed it back to him. "Well, that's all of them." He speaks up, tentatively, trailing off, "Just one other thing doc." I hesitate, then, "Yes?"
He screws up his forehead, squints his eyes, purses his lips and with what seems like great effort tries to remember something. "There is this one other medicine that I need but I can't remember its name." I wait quietly, not moving.
He goes on. "I think it begins with pro something. It sounds like pro, pro, pro something. I can't remember." His shoulders sag in defeat.
I open the book and turn to the "pro" section. "Procan," I offer. "No, that's not it," he replies. "Wait," I say, "it would be labled with the generic name, not the brand name, silly me. How about procainamide hydrochloride." He shakes his head, "No."
"Prochlorperazine? No, that's Compazine. You wouldn't be on Compazine. Promethazine hydrochloride? No, that's Phenergan; you wouldn't be on that either. How about propafenome hydrochloride, which is Rythmol? That's for the heart." He is shaking his head, "No, no."
"Propoxyphene napsylate?" The name floats out into the air. His face relaxes, his eyes brighten, he slowly raises a finger, points to me, a smile breaks across his weathered face, "That's it doc, propoxyphene napsylate, that's what it is! Yes sir, propoxyphene napsylate. I need some of those." Of coarse you do, I think to myself.
Darvocet-N 100. I should have known. Patients never make me play the "guess what drug I'm thinking" game unless it's a controlled substance. Never for something as boring as Pen-V-K or Naprosyn. Generic names, I'm ready to pull out my hair or scream or something.
There is an urgent call from the hospital regarding a sick patient. I take the call and hear about a patient with congestive heart failure in volume overload. I order Lasix 20 mg IV push, then I hang up the phone and reflect.
I am not sure how long generic furosemide has been available, but it has been around for as long as I can remember. Yet, I always have and I am nearly certain that I always will, order furosemide by saying Lasix, even when furosemide will actually be what is given; I don't mind if it is substituted. So, I ask myself, "Why?
It is simple. Because no one will ever wonder what I mean if I say Lasix. However, if I order Lasix by its generic name furosemide, I can guarantee that the day will come when someone will wonder what it is that I am asking for.
I think that if drugs were always referred to by the brand names that they were given by their original patent holders that patients and practitioners would overall end up being considerably less frustrated, make less mistakes and waste less time. Medical care might be delivered more safely and the experience of its practice might be generally more satisfying.
What's in a name? A lot.