Objectives: This retrospective analysis classifies US adopted naming (USAN) stems based on how the stem is defined. This analysis seeks to identify “commonalities” among stems, discuss medication errors due to drug name issues, identify inconsistencies of the stem-based naming system, and discuss possible solutions to the problem, including education of health care providers. Methods: Stems were tagged by up to four descriptors, invented by the author, according to their definition(s). These descriptors are prototype, therapeutic use, mechanism of action, and composition. Unordered combinations of the four descriptors produced 15 possible subsets. A search of the USAN dictionary was conducted to identify drug names that mis-incorporated a stem. On the basis of the data collected, the authors were able to identify inconsistencies with the naming system. Results: Of the 383 stems on the USAN stem list, 312 (81.46%) were classified into one of the 15 subsets. The six most frequently occupied subsets account for 287 of the 312 stems originally classified (91.99%). These six subsets, in order of decreasing frequency are prototype/use, mechanism of action (MOA), prototype, use/MOA, and prototype/MOA. Conclusion: Misincorporation of a stem into a drug name may result in confusion as to the nature and use of a drug. Proper incorporation of a stem into a drug name is easiest when the stem's definition is simple, that is, fits only one descriptor. Since the ultimate goal of a drug name is to convey simple and useful information to a health care professional, stems should be incorporated correctly. Our data does not give enough information to support how drugs should be named (for example, only with stems that show MOA), but it clearly shows that drugs should not be named with stems that are misincorporated, or that fit many or all of the descriptors, since this leads to confusion and medication errors. Education of health care professionals and consumers is important to address existing drug names with misincorporated stems and to prevent misincorporation of stems from occurring in the future.
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