Re: ATC/DDD -what we learnt at WHO TBS

[Guest guest]

Hello NetRUMians and Madam,

Wish you all and your family very happy new year

New year is starting with the feast of knowledge about ATC/DDD, which is a newer concept, getting elaborated by madam. So a grand welcome to year 2008 by NetRUM.

Regards,

Dr Smita Mali,

GMC, Nagpur.

From: kunda gharpure <gharpurekunda@...>Subject: ATC/DDD -what we learnt at WHO TBSnetrum Date: Monday, 31 December, 2007, 5:13 PM

Hello all

First , I wish you all a very happy new year.

My topic for the discussion is ATC/DDD- what we learnt at Geneva. You will wonder how this topic can be used for discussion, since no one is expected to know what we learnt at Geneva. But I plan to go ahead post by post, telling you what we learnt, and will be inviting your comments, suggestions, and experiences on the topic. So lets gear up for a new topic commencing from tomorrow.

kunda

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[Guest guest]

Hi all members, It is obvious that DDD of any particular drug will vary according to severity of the disease condition, also DDD will be different for each dosage forms of the medicine. Now I would like to know that whether the DDD varies according to the chemical composition of the drug or chemical composition is not taken into account while calculatingthe DDD of the drug, because different chemical forms of the drug will have different bioavailability. And it is not taken into account then that will be the limitation of this classification. Regards. Dr. Mangesh Bankaro.co.in> wrote: Hello all First , I wish you all a very happy new year. My topic for the discussion is ATC/DDD- what we learnt at Geneva. You will wonder how this topic can be used for discussion, since no one is expected to know what we learnt at Geneva. But I plan to go ahead post by post, telling you what we learnt, and will be inviting your comments, suggestions, and experiences on the topic. So lets gear up for a new topic commencing from tomorrow. kunda Save all your chat conversations. Find them online.

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[Guest guest]

Hi, Please go through a part of the article: Use of the World Health Organisation Anatomical Therapeutic Chemical/Defined Daily Dose Methodology in Canada*, The Drug Information Journal, 2004 by Sketris, Ingrid S, Metge, Colleen J, Ross, L, MacCara, E, Et al << Page 1 Continued from page 6. Previous | Next For international studies, it is necessary to convert figures to a common currency, and if the study is over a period of time, adjustments should be made for inflation or a base year used for comparison. In addition, national and international drug prices often vary by institution, region, and country, and are dependent on market factors, purchase arrangements, and regulatory policies. ADVANTAGES AND LIMITATIONS OF USING THE WHO ATC/DDD METHODOLOGY There are advantages and limitations to consider when using the WHO ATC/DDD system. Tables 4 and 5 illustrate the advantages of and limitations to, respectively, using the ATC/DDD methodology. The major advantages of the ATC classification system are that it allows for the aggregation of data into meaningful therapeutic classes, and unique identification of the medical substance by the fifth

level ATC code. Fixed combination drugs are assigned an ATC code based on specific rules for assignment and may be located in the index separate from one or more of the ATC assignments to the individual active drug components. Also, the index descriptions for combinations do not identify all of the active drug ingredients found in a combination drug preparation and on rare occasions, drug salts or moieties are not identified uniquely by the ATC and may result in more than one DDD assignment per ATC code. For example, erythromycin when classified as an antibacterial has an ATC code of J01F A01; the DDD for oral or parenteral erythromycin is l g whereas the oral salt (erythromycin elhylsuccinate) has a DDD of 2 g because it is less bioavailable (6,7). A new edition of the ATC/DDD index is published by the WHO Collaborating Centre for Drug Statistics Methodology every January (8). After a DDD is assigned to a new drug, il is sessed after three

years for its accuracy as there are more data on prescribed daily doses available three years after introduction rather than at the time of marketing. "After the first three-year period, the DDD normally remains unchanged for at least five years unless the WHO working group decides to make a total revision of all DDDs assigned in an ATC group" (6). The main reasons that a DDD would change are linked to its derivation; that is, if the recommended or prescribed daily doses change or if the main indication has changed (6). Because DDDs can change over Lime, it is important Io cite the edition of the ATC/DDD index used and to present all data in terms of the most recent DDD if conducting an historical consumption study (30). It is important to understand, however, that the calculation of drug use applying the latest DDD value may alter the presentation of drug use in past years. Additional information such as national dosages and shifts in dose recommendations over

time will facilitate proper interpretation of the data (30). LOGISTICAL CONSIDERATIONS OF USING THE ATC/DDD METHODOLOGY IN CANADA In most Canadian pharmacy administrative claims databases, each record contains a Drug Identification Number (DIN) assigned by Health Canada upon approval for use. This DIN uniquely identifies the drug product by brand/trade name, manufacturer, name and strength of active (drug) ingredients, route of administration, and pharmaceutical dosage form (31). These DINs are sequentially assigned and have no particular meaning. In order to classify or compare the use of drugs, DINs must be combined with other types of classification systems such as the American Hospital Formulary System (AHFS) or the WHO ATC classification. Previous - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 -

12 - 13 - Next -ANUPAMA mangesh bankar <drmangesh_bankar@...> wrote: Hi all members, It is obvious that DDD of any particular drug will vary according to severity of the disease condition, also DDD will be different for each dosage forms of the medicine. Now I would like to know that whether the DDD varies according to the

chemical composition of the drug or chemical composition is not taken into account while calculatingthe DDD of the drug, because different chemical forms of the drug will have different bioavailability. And it is not taken into account then that will be the limitation of this classification. Regards. Dr. Mangesh Bankaro.co.in> wrote: Hello all First , I wish you all a very happy new year. My topic for the discussion is ATC/DDD- what we learnt at Geneva. You will wonder how this topic can be used for discussion, since no one is expected to know what we learnt at Geneva. But I plan to go ahead post by post, telling you what we learnt, and will be inviting your comments, suggestions, and experiences on the topic. So lets

gear up for a new topic commencing from tomorrow. kunda Save all your chat conversations. Find them online. Save all your chat conversations. Find them online.

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[Guest guest]

Hello Mangesh

when you say different chemical form if you mean different salt of the same active ingredient, then they are not assigned different DDD.. There are some exceptions which are mentioned in the ATC guidelines in each section.whereas different formulation ie dosage form will surely differ in bioavailability and they are therefore given different DDDs.

As mentioned earlier the DDD does not truly represent the prescribed daily dose(PDD) . It is only tool for comparison. for eg. Inch is a unit of length. It does not mean that every object should be of one inch. similarly the PDD can be half of DDD or 1.2 times DDD . hope I am able to convey myself clearly.

kunda

- On Thu, 3/1/08, mangesh bankar <drmangesh_bankar@...> wrote:

From: mangesh bankar <drmangesh_bankar@...>Subject: Re: ATC/DDD -what we learnt at WHO TBSnetrum Date: Thursday, 3 January, 2008, 3:28 PM

Hi all members,

It is obvious that DDD of any particular drug will vary according to severity of the disease condition, also DDD will be different for each dosage forms of the medicine. Now I would like to know that whether the DDD varies according to the chemical composition of the drug or chemical composition is not taken into account while calculatingthe DDD of the drug, because different chemical forms of the drug will have different bioavailability. And it is not taken into account then that will be the limitation of this classification.

Regards.

Dr. Mangesh Bankaro.co.in> wrote:

Hello all

First , I wish you all a very happy new year.

My topic for the discussion is ATC/DDD- what we learnt at Geneva. You will wonder how this topic can be used for discussion, since no one is expected to know what we learnt at Geneva. But I plan to go ahead post by post, telling you what we learnt, and will be inviting your comments, suggestions, and experiences on the topic. So lets gear up for a new topic commencing from tomorrow.

kunda

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[Guest guest]

hello madam, According to me, Different ATC codes should be assigned to different formulations and strengths of same drug having seperate indications. regards Dr. sarangDR.SARANG DESHMUKHJR-1 PHARMACOLOGYROOM NO.40NEW PG HOSTELGMCNAGPUR-440003

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[Guest guest]

Hello all, Here is one PDF file " CHLORPROMAZINE EQUIVALENTS VERSUS DEFINED DAILY DOSES: HOW TO COMPARE ANTIPSYCHOTIC DRUG DOSES?" This will create more clear picture about DDD and its importance. Regards Dr. sarang DR.SARANG DESHMUKHJR-1 PHARMACOLOGYROOM NO.40NEW PG HOSTELGMCNAGPUR-440003

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