Patrick McLaughlin National Library of Medicine National Institutes of Health U.S. Department of Health and Human Services

Drug terminology produced by NLM List of normalized names and unique identifiers for drugs Terminology derived from other drug terminologies 2

3 FDA Structured Product Labels (DailyMed) MeSH NDF-RT SNOMED CT VA National Drug File CMS Formulary Reference File First DataBank Gold Standard Medi-Span Multum Micromedex Anatomical Therapeutic Chemical Classification System Collection of commonly-used public and private drug vocabularies:

ePrescribing Formulary development and maintenance Medication history

Center for Medicare and Medicaid Services (CMS) Formulary Reference File Clinical Quality Measures (CQMs), Meaningful Use Value Sets Office of the National Coordinator (ONC) Standard for medications and medication allergies Required for Electronic Health Record (EHR) certification National Council for Prescription Drug Programs (NCPDP) SCRIPT ePrescribing standard Formulary and Benefit standard Veterans Affairs – Department of Defense (VA-DoD)

* * * * * Sample of NDCs from drug vocabularies:

7 ranitidine 15 mg/mL oral syrup RANITIDINE HCL 15 mg/mL ORAL SYRUP RANITIDINE Ranitidine HCl Syrup 15 MG/ML (75 MG/5ML) Ranitidine Hydrochloride 15 MG/ML Oral Solution Ranitidine Hydrochloride 15mg/1mL Oral solution Ranitidine 15 MG/ML Oral Solution RANITIDINE 15 MG ORAL SYRUP RANITIDINE HYDROCHLORIDE 15 MG ORAL SYRUP RANITIDINE HYDROCHLORIDE 16.8 MG ORAL SYRUP RANITIDINE HYDROCHLORIDE 75 MG ORAL SOLUTION RANITIDINE HYDROCHLORIDE 15 mg in 1 mL ORAL SYRUP RANITIDINE HYDROCHLORIDE 15 MG ORAL SYRUP Ranitidine 15 mg in 1 mL ORAL SOLUTION RANITIDINE 15 MG ORAL SOLUTION RANITIDINE HYDROCHLORIDE 16.8 MG ORAL SOLUTION Sample of drug names from drug vocabularies:

RANITIDINE HYDROCHLORIDE 15 MG ORAL SYRUP RANITIDINE HYDROCHLORIDE 16.8 MG ORAL SYRUP RANITIDINE HYDROCHLORIDE 75 MG ORAL SOLUTION Normalized name: Ranitidine 15 MG/ML Oral Solution 8

Represent drugs from prescribers’ point of view rather than dispensers’ point of view RXCUI (RxNorm concept unique identifier): Normalized name: Ranitidine 15 MG/ML Oral Solution 9

Group synonymous terms (RANITIDINE 15 MG ORAL SOLUTION, Ranitidine 75mg/5mL syrup, RANITIDINE 15 MG ORAL SYRUP) Create unique identifier (RXCUI=705610) Create normalized name * (Ranitidine 15 MG/ML Oral Solution) 10 *Out of scope information does not receive a normalized name. Radiopharmaceuticals, medical devices, and homeopathics are out of scope.

Many levels of description - labeled with term types: 11 TTYIngredientStrengthDose FormBrand Name INRanitidine SCDCRanitidine15 MG/ML SCDFRanitidineOral Solution SCDRanitidine15 MG/MLOral Solution SBDRanitidine15 MG/MLOral Solution[Zantac] SBDFRanitidineOral Solution[Zantac] SBDCRanitidine15 MG/ML[Zantac] BNZantac

SCD – generic drug Ranitidine 15 MG/ML Oral Solution SBD – branded drug Ranitidine 15 MG/ML Oral Solution [Zantac] GPCK – generic pack {30 (Aspirin 325 MG Oral Tablet) / 30 (Pravastatin Sodium 20 MG Oral Tablet) } Pack BPCK – branded pack {30 (Aspirin 325 MG Oral Tablet) / 30 (Pravastatin Sodium 20 MG Oral Tablet [Pravachol]) } Pack [Pravigard 325/20] 12

Relationships connect RXCUIs SCD has_tradename SBD BPCK contains SCD consists_of SCDC has_ingredient IN SBD has_doseform DF RXCUIs have associated attributes NDCs Marketing Category Labeler

RXNCONSO RXCUIs and drug names RXNREL RXCUIs and relationships RXNSAT RXCUIs and attributes

Monthly zip file* Weekly updates for newly added FDA drug labels Current Prescribable Content subset zip file APIs – RxNorm, prescribable subset *Requires a (free) UMLS license to access 15

October Release: Generic drugs19,717 Branded drugs 10,550 Generic packs349 Branded packs399 16

Patrick McLaughlin 27