"Where name and image meet"—the argument for "adrenaline"

British Medical Journal, Feb 19, 2000 by Jeffrey K Aronson

As this brief account shows, there is no historical justification for the use of the term epinephrine. Indeed, the evidence clearly shows that it is the wrong name to use.

The etymological argument

Other words use the stems adren(o)- or -enaline rather than epinephr(o)- or -ephrine.

* The gland is the adrenal gland, not the epinephric gland, and the operation to remove it is adrenalectomy. Other derivatives include adrenochrome, adrenocortical, adrenocorticotrop(h)ic, adrenogenital, and adrenolytic; none has a counterpart with the stem epinephro-

* Neurones with adrenaline and noradrenaline as neurotransmitters are called adrenergic and noradrenergic neurones; although the terms epinephrinergic and norepinephrinergic exist, their use is rare. A search of Medline showed that since 1965 they have been used in only 39 papers, whereas adrenergic or noradrenergic have been used 86 101 times

* The receptors on which adrenaline and noradrenaline act are classified internationally as adrenoceptors[31]

* The recommended international non-proprietary name for the noradrenaline derivative isopropylnoradrenaline is isoprenaline; its analogue 1-(3,5-dihydroxyphenyl)-2-isopropylaminoethanol is orciprenaline

* The proposed international non-proprietary name for the [Beta] keto derivative of adrenaline is adrenalone, which is also the United States adopted name; there is no epinephrone.

Conclusion

When the legislation is promulgated, the two dozen or so drugs that the Medicines Control Agency in Britain has identified as having a problematic recommended international non-proprietary name will be labelled with both names.[4 7 8] Dual labelling has already been adopted in the British Pharmacopoeia for 16 of those drugs.[32] There the recommended international nonproprietary name is given first, except, crucially, in the case of adrenaline and noradrenaline, for which the British approved name is given first. Dual labelling will pose some problems for pharmacists,[33] but they are not major ones, and we shall eventually get used to the new names, without (one hopes) serious errors. We shall, if we must, even get used to epinephrine ... eventually. But the dangers in changing the name from adrenaline to epinephrine will far outweigh any other problems during the lengthy changeover period.

Use of the term epinephrine will increase the risk of serious errors in administering adrenaline in the many countries in which the term adrenaline is currently preferred. There is, furthermore, clear historical and etymological evidence that epinephrine is an inappropriate name to use. We should urge the World Health Organisation to change the recommended international non-proprietary name epinephrine to adrenaline (and norepinephrine to noradrenaline). If the existence of Adrenalin as a brand name in some countries militates against this, the European Union should allow adrenaline to be an exception to the rule that all names should be recommended international non-proprietary names. After all, the title of the relevant monograph in the European Pharmacopoeia is--yes--"Adrenaline."