{"id":41231,"date":"2018-01-26T16:30:46","date_gmt":"2018-01-26T15:30:46","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=41231"},"modified":"2018-01-31T11:53:28","modified_gmt":"2018-01-31T10:53:28","slug":"jeffrey-aronson-when-i-use-a-word-adrenaline-and-epinephrine","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2018\/01\/26\/jeffrey-aronson-when-i-use-a-word-adrenaline-and-epinephrine\/","title":{"rendered":"Jeffrey Aronson: When I Use a Word . . . Adrenaline and epinephrine"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Most therapeutic medicines have at least three different names.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The chemical name, whose form generally follows the rules issued by the International Union of Pure and Applied Chemistry (IUPAC). For example, (R)\u00ad1\u00ad(3,4\u00addihydroxyphenyl)\u00ad2\u00admethylaminoethanol; the chemical name is an unambiguous description of a drug&#8217;s structure, but it is usually cumbersome and irrelevant to practical prescribing, although there are a few exceptions, such as glyceryl trinitrate and acetylsalicylic acid.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The approved (official or generic) name; this is usually the World Health Organization&#8217;s recommended international non\u00adproprietary name (rINN), but it may be some locally approved name\u2014for example, the British approved name (BAN), d\u00e9nomination commune fran\u00e7aise (DCF), Japanese accepted name (JAN), or United States adopted name (USAN). Drugs with chemical names that are sufficiently simple have no INNs. The compound mentioned above is better known as adrenaline (BAN) or epinephrine (rINN).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Proprietary (brand or trade) names, which are names given by pharmaceutical manufacturers; for example, adrenaline is marketed in Britain for intramuscular injection as Emerade, Epipen, and Jext.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Since a 1992 directive of the European Community, the UK has used INNs, when available, as approved names, except in one case\u2014adrenaline. I have previously <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3091849\/\"><span style=\"font-weight: 400\">discussed<\/span><\/a><span style=\"font-weight: 400\"> the reasons in detail; they are related to risk, usage, etymology, and the history of the discovery of adrenaline.<\/span><\/p>\n<p><span style=\"font-weight: 400\">That the adrenal glands contained a substance with dramatic pharmacological effects was first shown in 1893 by George Oliver, a Harrogate physician, and Edward Sch\u00e4fer, professor of physiology at University College London. However, a name for the substance was not coined until John Jacob Abel in the USA prepared crude adrenal extracts in 1897 and called them epinephrin [<\/span><i><span style=\"font-weight: 400\">sic<\/span><\/i><span style=\"font-weight: 400\">]. Abel\u2019s paper, presented to the American Physiological Society in 1898 and published in <\/span><a href=\"http:\/\/www.physiology.org\/doi\/10.1152\/ajplegacy.1899.2.5.iii\"><span style=\"font-weight: 400\">1899<\/span><\/a><span style=\"font-weight: 400\">, began \u201cActing on Hyrtl\u2019s suggestion that <\/span><i><span style=\"font-weight: 400\">epinephris<\/span><\/i><span style=\"font-weight: 400\"> would be the best name for the suprarenal capsule, the author has given the name Epinephrin to the active principle isolated by him.\u201d Nowadays we spell it with an <\/span><i><span style=\"font-weight: 400\">e<\/span><\/i><span style=\"font-weight: 400\"> at the end. Epinephrine is Greek: \u1f10\u03c0\u03af (upon) + \u03bd\u03b5\u03d5\u03c1\u03cc\u03c2 (kidney), which in classical Latin becomes ad (placed on) + r\u0113n\u0113s (kidneys). Greek epinephrine = Latin adrenaline.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-41233 \" src=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2018\/01\/aronson_adrenaline.png\" alt=\"\" width=\"192\" height=\"235\" \/><\/p>\n<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-41234 alignnone\" src=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2018\/01\/aronson_adrenaline_2.png\" alt=\"\" width=\"353\" height=\"236\" srcset=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2018\/01\/aronson_adrenaline_2.png 416w, https:\/\/stg-blogs.bmj.com\/bmj\/files\/2018\/01\/aronson_adrenaline_2-300x200.png 300w\" sizes=\"auto, (max-width: 353px) 100vw, 353px\" \/><\/span><\/p>\n<p>J J Abel (1857-1938) and the opening of the paper in which he proposed the name \u201cepinephrine\u201d<\/p>\n<p><span style=\"font-weight: 400\">Josef Hyrtl (1810\u20131894), born in Hungary, studied medicine in Vienna from 1831, became prosector in anatomy in 1833, graduated with a thesis titled <\/span><i><span style=\"font-weight: 400\">Antiquitates anatomic\u00e6 rariores<\/span><\/i><span style=\"font-weight: 400\">, and became professor of anatomy at the University of Prague in 1837, at the age of 26. He was appointed to the chair of anatomy at Vienna in 1845, and in 1850 published his <\/span><i><span style=\"font-weight: 400\">Handbook of Topographic Anatomy<\/span><\/i><span style=\"font-weight: 400\">, the first textbook of applied anatomy. He was famed as a teacher, and in 1865, the 500th anniversary of the foundation of the university of Vienna, was made rector. Perhaps his best known work was a monograph proposing the reform of anatomical terminology, <\/span><a href=\"https:\/\/www.biodiversitylibrary.org\/item\/69009#page\/7\/mode\/1up\"><i><span style=\"font-weight: 400\">Onomatologia Anatomica<\/span><\/i><\/a><span style=\"font-weight: 400\"> (Wien: Wilhelm Braumuller, 1880), subtitled <\/span><i><span style=\"font-weight: 400\">Geschichte und Kritik der anatomischen Sprache der Gegenwart<\/span><\/i><span style=\"font-weight: 400\"> (<\/span><i><span style=\"font-weight: 400\">History and Critique of Current Anatomical Terminology<\/span><\/i><span style=\"font-weight: 400\">).<\/span><\/p>\n<p><span style=\"color: #666666;font-size: small\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Abel&#8217;s epinephrin did not behave physiologically like adrenaline does, and was in fact an inactive benzoylated derivative. In 1901, after having visited Abel, Jokichi Takamine prepared a pure extract of the active principle from the adrenal gland and patented it. Parke, Davis &amp; Co marketed his extract and used the proprietary name Adrenalin. Epinephrine became the generic name in America, on the incorrect assumption that Abel&#8217;s extract was the same as Takamine&#8217;s. \u201cEpinephrine\u201d later became the rINN. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The first instance of \u201cepinephrine\u201d in the online <\/span><i><span style=\"font-weight: 400\">OED<\/span><\/i><span style=\"font-weight: 400\"> is from 1899, but the citation is to a brief abstract in the \u201cJrnl Chem Soc\u201d, an annotation by \u201cW. D. H.\u201d of Abel\u2019s paper in \u201cProc Amer Physiol Soc 1898\u201d titled \u201cOn epinephrin, the active constituent of the suprarenal capsule and its compounds\u201d (pictures). The earliest recorded instance of \u201cadrenaline\u201d is from 1893.<\/span><\/p>\n<p><span style=\"font-weight: 400\">J J Abel coined the name \u201cepinephrine\u201d, but in the UK we continue to call it adrenaline.<\/span><\/p>\n<p><a href=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-32935\" src=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg\" alt=\"jeffrey_aronson\" width=\"96\" height=\"118\" \/><\/a><em><strong>Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Most therapeutic medicines have at least three different names. The chemical name, whose form generally follows the rules issued by the International Union of Pure and Applied Chemistry (IUPAC). For example, (R)\u00ad1\u00ad(3,4\u00addihydroxyphenyl)\u00ad2\u00admethylaminoethanol; the chemical name is an unambiguous description of a drug&#8217;s structure, but it is usually cumbersome and irrelevant to practical prescribing, although there [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2018\/01\/26\/jeffrey-aronson-when-i-use-a-word-adrenaline-and-epinephrine\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-41231","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jeff-aronsons-words"],"jetpack_featured_media_url":"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/41231","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=41231"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/41231\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/38359"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=41231"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=41231"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=41231"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}