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E-drug: Adrenalin - epinephrine (cont'd)
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I have been permitted by Jeff Aronson to forward his answers to me
to E-drug (my comments to him with ">").
Stein Lyftingsmo
Hospital pharmacy of Elverum
Norway
e-mail: sjappe@apotek.no
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I believe the alternative to EU changing to Epinephrine is US
changing to Adrenaline. I would prefer the latter very strongly.
Dear Stein,
Many thanks for noticing my article and commenting.
The important question to ask first is, not what they use in the US,
but what the rINN should be. [As I point out in my article, it is wrong
to equate rINNs with the names that are used in the US--they don't
always correspond; this is an important point that people don't always
understand.] The rINN is currently epinephrine, and I do think that the
rINN should be adrenaline rather than epinephrine. Then the EU could
use the name adrenaline without difficulty.
However, if the WHO will not change the rINN from epinephrine to
adrenaline, then I think that the EU should make adrenaline an
exception to its rule that the rINN must be used.
Even if the rINN was changed to adrenaline, the US could still decide
not to use it. Indeed, there may be a barrier to their using it (as I
hinted at the end of my article), since the brand-name Adrenalin is still
used by Parke-Davis in the US (and perhaps elsewhere for all I know).
[Incidentally, paracetamol is the rINN, but in the US they use
acetaminophen.] The fact that there is still this confusing brand-name
in use,m i.e. Adrenalin, may in fact prevent the WHO from changing
the rINN from epinephrine to adrenaline.
Regards,
Jeff Aronson
I agree that the important thing is to get WHO to decide to
chose adrenaline as the INN-name. But what is the purpose with
a standard if it is not used? So I still think it is relevant
to ask whether US or EU should change.
I certainly think that the the whole world, including the US, should use
rINNs, but that is too big a fight to fight at the moment. For example,
I just can't see the US starting to use "paracetamol" (rINN) instead of
"acetaminophen" (USAN)--there is too big a commercial interest for
them to do that. As far as the EU is concerned we should start to use
rINNs, except adrenaline, which we should concentrate on fighting
about. We should certainly ask the WHO to change the rINN from
"epinephrine" to "adrenaline". If they do that then we can use
"adrenaline" and won't have to care about what they do in the US
(because again they are unlikely to change from epinephrine, even if
the rINN is adrenaline). If WHO won't do that (and I suspect that they
won't budge), then the best we can do is to ask the EU to make this
one exception. This is the art of the possible. I don't think that we
should get hung up about what the US will or will not do.
Jeffrey K Aronson
Department of Clinical Pharmacology
University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE
e-mail: jeffrey.aronson@clinpharm.ox.ac.uk
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