Liprolog vs Liprolog mix and Humalog vs Humalog mix

[ttsv]

Hi there, According to this link from EMA Liprolog is a drug with single ingredient lispro. It is also mentioned that whenever there is the ingredient protamine added to the the initial one ... the name of the drug become Liprolog mix 25 or 50 depending on the proportions.

The following SQL snippet select * from concept where concept_name ilike '%Liprolog%' and concept_name ilike '%protamine%' and domain_id = 'Drug'

Will return 69 records that are with the brand name Liprolog and contain protamine. Below is the list with concept_ids.

40844713, 40844716, 40875919, 40891260, 40953441, 41000522, 41050265, 41062759, 41062760, 41112967, 41125573, 41125574, 41157069, 41157072, 41188170, 41188172, 41219373, 41237984, 41250400, 41250401, 41250402, 41312557, 41346762, 41346834, 41347071, 41347072, 41347412, 41347636, 41347791, 41348247, 41348476, 41348477, 41348815, 41349198, 41349199, 41349200, 41349201, 41349299, 41349459, 41349460, 41349550, 41349551, 41349784, 41350029, 41350175, 41350414, 41350415, 41350416, 44166028, 44173537, 44175888, 44180990, 44180991, 44188538, 44188539, 44188540, 44190873, 44190874, 44190906, 44190946, 44190977, 44191042, 44191145, 44191231, 44191288, 44191289, 44191383, 44191442, 44191473

The same problem is observed with the brand Humalog and Humalog mix. Below are the effected concept_ids:

44572665, 44676047, 44642115, 44028424, 44047473, 44063361, 44095746, 36055899, 36055900, 36055901, 36055902, 36063899, 36063900, 36063901

Best Tsonko

[cgreich]

@ttsv:

The same problem

What's the problem?

[ttsv]

Hi @cgreich,

Thank you for reaching back! The conceptid provided above are for drugs with 2 ingredients - lispro and protamine_ and in their concept name they are identified with brand names as Liprolog and Humalog which is wrong. Their brand names should be LIprolog mix25, or Liprolog mix50, Humalog mix 25 or Humalog mix50 - depending on the proportions of lispro/protamine as it is described in the attached link from EMA in the previous post. Liprolog and Humalog are drugs with only 1 ingredient - lispro.

Please let me know if I can provide more information!

Best ttsv

[dimshitc]

@ttsv thanks for a clarification. @cgreich this problem originates from the improper Brand Names clean up, in a source (in GRR) all are Liprolog Mix, but in RxNorm Extension they turn into Liprolog.

[Alexdavv]

@dimshitc We already discussed a similar issue with detemir ingredient being combined with Humulin, Insuman, and Actrapid brand names. The good news is that only GGR vocabulary was affected. The bad news is wrong RxNorm Extension attribute combinations that confuse people and require a clean-up procedure after the source drug vocabulary mapping fix.

[cgreich]

We probably need to define what constitutes a Brand Name. And whether the addition of suffixes like "Mix" creates a new brand name.

[ttsv]

Perhaps not needed but here is how I see it:

Correct me if I am wrong but a 'Brand Name' is something that a patient asks for when is purchasing a drug in a pharmacy. If that assumption is correct then ingredient content and a brand name should have 1:1 relationship. Even if the ingredients are the same as it is in 'XXXX MIX' different concentration creates different profile (long, intermediate, fast acting), hence 70/30, 50/50, etc. additions after the 'mix' in the brand name. If the patient needs a single ingredient Humalog and ask for it as just (Humalog) or any other single ingredient insulin but is provided with a 'mix' version of the drug that would create some confusion and perhaps "inconvenience" to the patient.

Please let me know if my assumption is wrong. If so, how can I find the codes for the brand names/drugs as described above were the ingredient - brand name relationship is unique.

I also would like to point that the examples described above are just the tip of the iceberg. I am trying to make sense with the records for drugs called Humulin, Insuman and Mixtard right now, and let me tell you it is a huge mess. I do not know if you would like to have the examples of inconsistencies I found so you would know were to concentrate efforts if/when you decide/have the resource to do the RxNorm Extension clean up ... or I should not waste everyone's time.

Best ttsv