[e-drug] Re: EDL - ATC (cont'd) - revised

[Kirsten Myhr <myhr@online.no>]

E-drug: Re: EDL - ATC (cont'd) - revised
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Dear friends,

I was so eager to give Marcus a reply that my head had not been thinking 
long enough on examples. And before i had managed to correct it, the 
moderator had already posted it! Then Stein gave a reply similar to what I 
had proposed, but I would still like to post my revised reply which you 
find below. And if any of you save these messages, please delete my 17 July 
posting from your file!

To Mary Couper I would like to say that there will be a letter, if not by 
all or some of the participants in the discussion, then definitely by me! 
But of course I will try to get others 'on board'.

Amongst the few I can recall are some drugs for asthma that are both for 
inhalation and for systemic use, e.g. salbutamol R03AC02 and R03CC02, 
metronidazole, adrenaline and acetylsalicylic acid. The salbutamol products 
are in the same main group, respiratory system, and subgroup, 
antiasthmatics, but because a distinction is made on the third level 
between products for inhalation and systemic use, this situation occurs. In 
which case the dosage forms are very different and the national body that 
assigns and maintains the classification will be able to distinguish and 
give the products on the market the right code. Metronidazole has three 
codes, G01AF01 where you find the vaginal tablets, J01XD01 where you find 
the infusion and P01B01 where you find the tablets, mixture and 
suppositories. Of course some of these may also be used for anaerobic 
infections, but the use for parasitic diseases has been regarded as the 
main indication. Adrenaline has two codes, C01CA2 for cardiac use and 
S01EA01 as eyedrops. Two different dosage forms, injection and eyedrops. 
Acetylsalicylic acid has two codes, B01AC06 and N02BA01. The first was 
created when the use as prophylaxis in cardiovascular disease took off. The 
low strengths of 75 and 160 mg are classified here, the other strengths as 
analgesics. In this instance the substance is in the same dosage form, but 
in different strengths and with different DDDs. It is probably the only 
exception to the rule that different dosage forms are in in different 
groups and to use the code for the main indication only.

In my opinion, and supported by Stein, this cannot create any confusion, at 
least it is not doing so for experienced users such as the Nordic 
countries, Australia and several other countries in the extended Europe. I 
have worked with the ATC-system since the beginning in early 70s and I have 
never heard of or experienced such a problem. Of course it would be an 
advantage if we could avoid it, but I have seen no better system so far and 
people all over the world have spent a good 20 years trying to create a 
better one because they are dissatisfied with what they have. However, I 
need to emphasise the importance of a competent national body to maintain 
the list.

If there is anything to add, Marit (Ronning) will do so when she is back 
from holiday mid August.

Kind regards

Kirsten

Kirsten Myhr
Head of Eastern Region Drug Information Centre

RELIS Ost
Ulleval University Hospital
0407 Oslo, Norway
Tel.: +47 23 01 64 11(o)   Fax: +47 23 01 64 10
+47 22 56 05 85 (h)   mobile: +47 416 38 747
myhr@online.no
www.relis.no

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