1. The Coronary Drug Project: Findings leading to discontinuation of the 2.5 mg/day estrogen group, Coro- nary Drug Project Research Group. JAMA 226:652-657, 1973. 2. Cox DR: Regression models and life-table. J R Stat Soc 34:187-202, 1972. 3. Littell AS: Estimation of the T-year survival rate from follow-up studies over a limited period of time. Hum Biol 24:87-116, 1952. 4. The Coronary Drug Project: Initial findings leading to modifications of its research protocol, Coronary Drug Project Research Group. JAMA 214:1303-1313, 1970. 5. Hueper WC, Conway WD: Chemical carcinogenesis and cancers. Springfield, Ill, Charles C Thomas Publisher, 1964, p 40. What's in a Name? What's in a Name? What's in a Name? What's in a Name? To the Editor.\p=m-\ Many new drug names leave me fit to be tied, But I'm simply flummoxed by flumoxonide. Alan Blum, MD Miami In Reply.\p=m-\Since many drugs\p=m-\and hence many nonproprietary and trademark names\p=m-\alreadyexist, any new name must be selected to be free of conflict with established names and to be as distinctive as possible. The United States Adopted Names (USAN) Council was given, as start- ers, a choice between "moxcinonide" and "flumoxonide," which are abbre- viations of "methoxycinonide" or "fluromethoxycinonide"\p=m-\hybrid des- ignations derived from the chemical name of this compound and the appli- cable USAN stem for it. Any new name beginning with me- would not be distinctive because of the large number of drug names having this prefix. As several references describe (232:294, 1975; 237:2413, 1977),1,2 the name for the new compound must include the stem -onide to signal the presence of an acetal (here, acetonide) derivative or, more importantly, to connote a topical steroid. The name "flumoxonide" also indicates the presence of fluorine atoms and thus implies, by the name alone, the expected use of this drug as well as some related therapeutic considera¬ tions. Surely a name that does all that—it is simple and useful as required by the 1962 Drug Amendments—cannot be all that bad, and I hope Dr Blum will agree. Joseph B. Jerome, PhD Secretary, USAN Council Chicago 1. Jerome JB, Alessandri MC: Case studies in nonpro- prietary nomenclature practices. J Am Pharm Assoc NS6:584-587,1966. 2. Jerome JB, Alessandri MC: Drug nomenclature in review. J Am Pharm Assoc NS5:90-94, 1965. In Reply.\p=m-\My quibble over the new drug name "flumoxonide" is probably more piddling than pedantic. The aim was as much to pun as to puncture. I remain a proponent of the use of nonproprietary names, although I occasionally balk at writing "dioctyl sodium sulfosuccinate," and I confess to abbreviating "phenoxymethyl pen- icillin." It is a real challenge to resist the subliminal impulse to prescribe the catchier brand name. Consequent- ly, regardless of the trademark name that the manufacturer chooses for it, I have to smile when I see "flumox- onide," because "flummox" (origin unknown) means "to confuse." Now, "moxcinonide," the other pos- sibility, calls to mind that delicious New England concoction, Moxie, but it still sounds too much like "sya- nide." I would say that "flumethox- onide" would have been a safe, if not especially stirring, compromise. In any event, I am sure that writing a prescription for flumoxonide will al- ways brighten my day. Alan Blum, MD In Reply.\p=m-\The old nonproprietary names are hard to change, but "phe- noxymethyl penicillin" has been "penicillin V" since July 1, 1975, and while we have made several unsec- cessful attempts in the past at chang- ing "dioctyl sodium sulfosuccinate," we are hopeful that the United States Pharmacopeia will accept the USAN Council's current recommendation, "docusate sodium." If other names are troublesome, we will see what can be done. We are pleased if we can be of service and brighten someone's day as well. Joseph B. Jerome, PhD Contact Stomatitis and Lithium Carbonate Tablets To the Editor.\p=m-\Contact stomatitis has been associated with a wide variety of metals, whether these metals are used in dental fillings and prostheses or as therapeutic agents. The metals known to produce a stomatitis include gold, mercury, bis- muth, chromium, nickel, copper, and zinc.1,2 In fact, contact stomatitis has been reported in up to 7.5% of patients treated with gold.3 Report of a Case.\p=m-\A 36-year-old man with a 12-year history of schizo-affective schizophrenia recently complained of a sore mouth and severe burning when attempting to eat warm food or drink warm liquids. During the past four years the patient had been taking therapeutic doses of both chlorpromazine and lithium carbonate. There had been no previous history of any inflammation of the oral mucosa. When these symptoms developed, the tongue and buccal mucosa appeared to have a bright red erythema associated with several scattered erosions of the mucosa. The lithium carbonate treatment was discontinued, and the stomatitis rapidly improved within a week. However, during this time the behavior of the patient deteriorated dramatically, as man¬ ifested by wide mood swings and a great increase in his delusional thought content. The daily dosage of chlorpromazine had been progressively increased to more than double the dosage given with the lithium. There was no improvement. Two weeks after discontinuing the treatment with lithium, it was begun again in the tablet form. Within 48 hours the symptom of sore mouth returned, and the bright red erythema of the stomatitis was pronounced. Angular chilitis also developed. The patient's therapy was switched to the capsule preparation of lithium carbonate at the same daily dosage as the tablet preparation. The patient became asymptomatic of the stomatitis within one week, and all signs of the stomatitis and chilitis disappeared within three weeks. The daily dosage of chlorpromazine was gradually decreased to roughly the original dose. The mental status examination of the patient returned to what it had been prior to the initial stomatitis. Comment—We propose that like other heavy metals, lithium can cause contact stomatitis. This seems to occur only with the tablet prepara¬ tion. Contact stomatitis is infrequent¬ ly encountered, probably because the saliva dilutes and acts rapidly along with the extensive vascularization of the buccal mucosa to remove poten¬ tial allergens. Therefore, the period of contact of an allergen with the buccal mucous membranes would be brief." It may be that when lithium carbonate is used along with a phenothiazine, the anticholinergic side effect results in prolonged exposure of the lithium tablet to the buccal mucosa. Therefore, we recommend the use of the capsule preparation of lithium carbonate if symptoms of a stomatitis develop. Carlos E. Muniz, MD Donald H. Berghman, MD University of Florida Gainesville 1. Burket WB, Catigliano SG: Oral Medicine Diagnosis and Treatment Philadelphia, JB Lippincott Co, 1965, pp 51-54. 2. Goodman LS, Gilman A: The Pharmacological Basis of Therapeutics. New York, Macmillan Co Publishers, 1975, pp 926-937. 3. Dukes MNG (ed): Meyler's Side Effects of Drugs. Amsterdam, Excerpta Medica Foundation, 1975, vol 8, p 509. 4. Fisher AA: Contact stomatitis, glossitis, and cheili- tis. Otolaryngol Clin North Am 7:827-843, 1974. Rural Medicine To the Editor.\p=m-\Overa year ago I decided that I no longer wanted urban medicine, and I opted for rural medi- DownloadedFrom:http://jama.jamanetwork.com/byaUniversityofArizonaHealthSciencesLibraryUseron06/09/2015