Friday, August 21, 2020

Zomax Was an Anguished Analgesic

 "Now I know how Zomax works. My stomach aches so bad 
I don't even notice my fractured femur!" (GI  distress was a 
common side effect of Zomax.)

Pharmaceutical representatives also known as drug salesmen had free run of the hospital in the early 1980s and offered endless supplies of assorted trinkets and free lunches to all who would listen to their huckstering. A revolution in pain relief by an innovative new analgesic supposedly as strong as a narcotic, but non-addicting , Zomax, manufactured by McNeil labs was the hot new product in 1980 and the sales folks were chomping on the bit. Alas, a non addicting drug as strong as morphine was too good to be true.

Zomax  marketing was unique in that ordinary nurses were targeted by the vulture like drug salesmen. I suspect McNeil was emboldened by their success in marketing the anesthetic, Sublimaze, to nurse anesthetists. The American Association of Nurse Anesthetists even increased their case load requirement for anesthesia  students using Sublimaze after McNeil greased the skids for their product. 

Like Pavlov's dogs, every nurse was conditioned to always have a pen, scissors, and a watch. There was even an organization to recruit unsuspecting, innocent youngsters to the brutal field of  nursing known as Penwaciez which was named for the 3 things a nurse must always have in her possession: a watch, pen, and scissors.

 McNeil had this holy nursing equipment  triumvirate covered with a cheap Chinese made nurse's watch with a huge Zomax insignia on the dial. It did work well until the non-replaceable batteries bought the farm and  even had a nice white band. Most nurses were easily suckered into the corporate marketing gamesmanship because it was rare for anyone to give nurses  much of anything. Physicians were the traditional recipients of pharmaceutical company swag. Fancy golf club cover ups and writing instruments were popular. 

Zomax pens were  soon ubiquitous at every nurses station and were really nice upgrade  from the  cheap Bic stick pens we were raised on. Zomax emblazoned scissors were functional and were one of the first bandage scissors with blue plastic covered handles. We liked them a lot even though "Zomax" was emblazoned on any place available..

With nurses being the boots on the ground for Zomax marketing, McNeil came up with a battleground themed sales campaign code  named "Operation 111." The  notation represented the 111 million dollars the pharmaceutical company planned to gain in sales when the drug was introduced. A salesman summed the scheme nicely, "We're calling it operation 111. Now if that sounds like a war, well in our world of sales that's what it is." Sales memos were complete with a crossed rifle insignia as well as tanks and fighter planes. Fighting and battle themed analogies are all to common in health care, but the human body was never meant to be a battleground.

Nurses were bombarded with the mantra that 100mg. of Zomax was the analgesic equal to 10mg of morphine and there was no risk of addiction or tolerance. The centerpiece of a sales meeting with medical folks frequently featured  a small ornate punch bowl filled with single Zomax pills wrapped in colorful foil which glowed incandescent in the room light as a beacon in the fight (oops another war analogy) against the formidable foe of pain. We were invited to help ourselves to experience this breakthrough analgesic. I took one for low back pain and my stomach felt like a threshing machine left out in the pasture way too long. One dose was more than enough for me and I had a tough time figuring out which was worse my stomach distress or my back ache. 

Zomax pills were manufactured in the shape of a cute little house or cottage. The soothing green tint and image of a happy pain free home, sweet home were definitely alluring. As the big name pharmaceutical  houses began to loose patents to generic manufacturers  on their lucrative name brand  drugs the age of distinctive pill making was hatched. The most unusual of the bunch was a molded hollow scripted Valium pill. Roche had really out done itself with this design. The hollow fancy scripted "V" appeared to float in the center of the pill.

Despite the fact that most nurses were unimpressed with Zomax's efficacy, it did produce 15 million prescriptions in the first 2 years on the market. Trouble was on the horizon. In March 1983, McNeil announced the drug was being pulled from the market as a result of 5 deaths following Zomax ingestion.

It was discovered that one of the metabolites of Zomax caused an anaphylactic reaction in a small subset of users. Over time, especially with intermittent use, antibodies  accumulated  and caused the adverse reaction. For the time being the dream of a non-addicting analgesic was dead.


  1. Viox was another NSAID with a checkered past.

    1. I vividly remember those elegant commercials with figure skater Dorothy Hammil.

  2. I had a specialist try to put me on a drug for a medical problem that caused severe hoarsening of the voice - and I was a trained singer! Horrified I went for a second opinion and was told the first specialist was definitely on the payroll for a drug trial and never to take the med. Terrifying the way doctors were paid by drug companies to participate in drug trials back then..

    You take care over there, Sue.

    1. I wonder if things have changed. The hospitals and physicians offices here have banned drug salespeople so that has been an improvement. If a drug is really effective like penicillin, I doubt salespeople are needed.