Evaluation of online drug references for identifying over-the-counter solid oral dosage forms.

OBJECTIVE: To evaluate six drug references for their usefulness in identifying over-the-counter (OTC) solid oral dosage forms (SODFs). DESIGN: Retrospective evaluation of a convenience sample of requests for product identification. SETTING: Drug information center that accepts information requests from health care providers and law enforcement officials throughout the state in which it is located. PARTICIPANTS: Researchers. INTERVENTIONS: Using a convenience sample of 68 nonprescription drugs and 41 dietary supplements obtained from the drug information center's question and answer database, researchers sought to identify the SODFs using six drug-identification online databases. MAIN OUTCOME MEASURE: Likelihood of identifying a SODF with a given reference, reported as the percentage identified and the corresponding 95% confidence interval. RESULTS: Overall, 88.2% of nonprescription drugs could be identified using all six references. The highest percentage of nonprescription drugs (77.9%) were identified using Identidex, followed by Ident-A-Drug (67.6%), Drug Identifier (45.6%), RxList (39.7%), Lexi-Drug ID (33.8%), and Clinical Pharmacology (17.6%). Using Ident-A-Drug and RxList together led to the identification of two fewer nonprescription drugs than did Identidex at approximately 5% of the cost. Only 15 (37.5%) of the dietary supplements had an identifying imprint on the dosage form, and 7 (46.6%) of the imprinted products were identified. But overall, only 17.1% (7 of 41) of dietary supplements could be identified, as none of the products without imprints could be positively identified. CONCLUSION: Using these six online references, nonprescription drugs could be identified more frequently than could dietary supplements. The lack of imprints on many dietary supplements is an impediment to identification of these products.

Evaluation of electronic databases used to identify solid oral dosage forms.

The ability of electronic drug identification databases to identify solid oral dosage forms by their imprint codes was studied. The following seven commercially available electronic drug identification databases were selected to identify 500 solid oral dosage forms by their imprint codes: Clinical Pharmacology (Gold Standard Media, Tampa, FL), eFacts (Facts and Comparison, St. Louis, MO), Ident-A-Drug (Therapeutic Research, Stockton, CA), Identidex (Micromedex, Greenwood Village, CO), Clinical Reference Library (Lexi-Comp, Hudson, OH), Physicians' Desk Reference (PDR) Electronic Library (Medical Economics, Montvale, NJ), and RxList (RxList LLC, San Francisco, CA), Chi-square test was used to compare the percentages of medications identified by each of the seven electronic references. The ability of the databases to identify medication by specific characteristics, such as brand name versus generic, prescription versus nonprescription, commercially available for more than one year versus less than one year, colored versus white drug products, and controlled versus noncontrolled substances was evaluated. A logistic regression model was used to determine the probability of a drug product being identified by one of the electronic references based on these characteristics. All seven electronic databases combined identified 95.6% of the unknown medications by imprint code, color, shape, and scoring. Ident-A-Drug and Identidex identified the most drugs. The PDR Electronic Library and Facts and Comparisons Identified the least number of drugs. Solid oral dosage forms more likely to be identified were those that were on the market for more than a year, brand-name products, and prescription medications. Generic products on the market for less than a year and nonprescription products were particularly difficult to identify. A combination of electronic drug identification databases provides the best method of drug identification in an institutional setting.

Intraspinal use of morphine.

OBJECTIVE: To compare the different sterility standards and the cost issues involved when choosing an opioid product for intraspinal administration. DATA SOURCES: Literature accessed through MEDLINE and other Internet search engines (September 2002-April 2003) was evaluated. Key search terms included epidural/intrathecal, opioids, sterility, and compounding. DATA SYNTHESIS: Intraspinal use is prevalent in the area of pain management. Product selection is of utmost importance when administering through the intraspinal route. An evaluation of guidelines on sterility and a cost comparison were conducted. CONCLUSIONS: The preservative-free commercially available products that are indicated for intrathecal/epidural use are the best alternative due to proper outside testing and stringent quality assurance. The generic morphine preservative-free product may also be considered if proper steps are taken to ensure that the final product is diluted properly.