Mapping RxNorm to ATC doesn't work for some lipids concepts

1

Hi team-

Question again: I used concept_relationship table with relationship ‘RxNorm-ATC’, ‘Primary lateral’, ‘Primary up’ and ancestor table to create a thorough mapping from RxNorm to ATC. It’s working great in general! However, when we tested it with the lipids RxNorm codes generated by lipid domain experts, we noticed that below RxNorm weren’t able to map to ATC2 lipids modifying agents.

I am wondering do you have any insights on this?

|cetirizine hydrochloride 10 MG Oral Tablet [Zyrtec]|1020026|
|simvastatin 10 MG / sitagliptin 100 MG [Juvisync]|1189806|
|simvastatin 20 MG / sitagliptin 100 MG Oral Tablet|1189808|
|simvastatin 20 MG / sitagliptin 100 MG Oral Tablet [Juvisync]|1189814|
|cholestyramine resin 70 MG / diclofenac sodium 75 MG Oral Capsule|1234639|
|simvastatin 10 MG / sitagliptin 50 MG [Juvisync]|1312411|
|simvastatin 20 MG / sitagliptin 50 MG Oral Tablet|1312416|
|topiramate 25 MG Oral Tablet [Topamax]|152855|
|calcium gluconate 1000 MG Oral Tablet|205082|
|glyburide 3 MG Oral Tablet|310536|
|pentobarbital sodium 100 MG Oral Tablet|312294|
|sodium fluoride 1 MG Oral Tablet|313038|
|sodium fluoride 1 MG|315946|
|sodium chloride 600 MG|317502|
|sodium salicylate 500 MG|335600|
|calcium gluconate 5 MG|336072|
|calcium carbonate 180 MG|336472|
|calcium orotate 400 MG Oral Tablet|427548|
|sodium benzoate 500 MG Oral Tablet|427555|
|cholestyramine resin 70 MG|438944|
|cholestyramine resin / diclofenac Oral Capsule|438945|
|sodium fluoride 25 MG|451714|
|sodium phosphate, dibasic 60 MG|451759|
|sodium fluoride 2 MG/ML Oral Solution|544438|
|hydrocodone|5489|
|amitriptyline hydrochloride 25 MG Oral Tablet [Elavil]|856836|
|calcium pantothenate 100 MG Oral Tablet|994796|

thanks,
Ivonne

2

@Ivonne_Xu:

Couple answers (or definite challenge to your domain experts. :slight_smile: )

  1. Cetirizine (Zyrtec) is not listed under ATC2 C10 “LIPID MODIFYING AGENTS”, but under ATC2 R06 “ANTIHISTAMINES FOR SYSTEMIC USE”. No connection to lipid medications.
  2. Simvastatin/sitagliptin combos are not listed under ATC2 C10 “LIPID MODIFYING AGENTS”, but under ATC2 A10 “DRUGS USED IN DIABETES”. This is the only one where you could argue with ATC that it is also a lipid modifier.
  3. Topiramate is not listed under ATC2 C10 “LIPID MODIFYING AGENTS”, but under ATC2 N03 “ANTIEPILEPTICS”. Not sure why they think it is lipid lowering. The only association I can see is that it causes weight loss, and could be used for that.
  4. Calcium gluconate is not listed under ATC2 C10 “LIPID MODIFYING AGENTS”, but under ATC2 A12 “MINERAL SUPPLEMENTS”. Why that should be lipid lowering beats me.
  5. Glyburide (known as glibenclamide in Europe) is not listed under ATC2 C10 “LIPID MODIFYING AGENTS”, but under ATC2 A10 “DRUGS USED IN DIABETES”. It has nothing to do with the lipids.
  6. Pentobarbital is not listed under ATC2 C10 “LIPID MODIFYING AGENTS”, but under ATC2 N05 “PSYCHOLEPTICS”. Seriously? Pentobarbital? It’s not even sold in the US anymore. It’s nasty. A drug from the 60ies, today only used for assisted suicide and execution of the death penalty. Nothing to do with lipids.
  7. All the other calcium and sodium salts are all not lipid modifying drugs by any stretch of the imagination.
  8. Hydrocodone is not listed under ATC2 C10 “LIPID MODIFYING AGENTS”, but under ATC2 R05 “COUGH AND COLD PREPARATIONS”. It’s an opioid used to supress cough (but doesn’t give you the high). Lipids? Beats me.
  9. Amitriptyline is not listed under ATC2 C10 “LIPID MODIFYING AGENTS”, but under ATC2 N06 “PSYCHOANALEPTICS”. It’s an antidepressant. It can cause weight gain. I don’t know if it does it through the lipid metabolism, but certainly the effect is in the wrong direction.
  10. Pantothenic acid is vitamin B5. Not even going there.

Good luck with your response.

3

Ha! I forgot that one. It actually is a lipid modifier, and it is listed under C02 “LIPID MODIFYING AGENTS” (but spelled colestyramine in Europe). However, in combination with diclofenac they consider the latter the main ingredient, which makes the combo ATC5 M01AB55 “diclofenac, combinations”, listed under ATC2 M01 “ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS”. But actually that combination makes no sense, and there is no NDC listed for it. No idea why RxNorm even has it.

Bottom line: ATC works fairly well, and you can trust it. Not sure about those friends of yours. :slight_smile: