Epocrates: PDA medical software

The medical information editors generally add most new drugs approved by the FDA for use in humans around the time the drug becomes commercially available. In order to avoid confusion about what is actually available for clinicians to prescribe, we do not add drugs to the database immediately upon FDA approval. After the FDA approves a product, it typically takes several weeks to months (or even in rare circumstances, years) for the manufacturer to actually release the product to the market. During this time, we remain in contact with pharmaceutical manufacturers regarding their expected launch dates for new products, and then time the addition of a new monograph around this. Because new content is pushed out to users weekly, you can expect to see a new monograph in Epocrates Rx either shortly before or after the time of launch.

Unlike many other compendia, the Epocrates Rx database is product-specific. In other words, rather than providing a single generic monograph with a listing of several synonyms for different brand name products, we build a distinct monograph for each brand name product and a monograph for the generic (if available), based on product-specific information such as available formulations, dosing, indications, manufacturer, and pricing, which often differ between specific products.

When brand name products are discontinued or phased out, we typically make the following note in our database in the Dosing fields:

Brand Discontinued in US

We strive to provide the most accurate, product-specific, up-to-date content. Therefore, periodically, these obsolete brand name monographs are removed from the Epocrates database. However, a monograph for the generic equivalent, if still available, will remain in the Epocrates database.

In response to user feedback and to enable ease of use, we have occasionally left some high profile and high use brand name medication names (e.g., Elavil) in the database longer than usual, and restored some others. If you believe that a monograph for a discontinued brand name product should be restored in our system, please let us know.

The Epocrates Rx and Epocrates Online drug database is a proprietary database developed by our editorial team of pharmacists and physicians from academic backgrounds and institutions. To provide our customers with the most accurate, comprehensive, and clinically relevant drug information, these editors review information sources ranging from product labeling (package inserts) and the FDA to standard medical and pharmacotherapy texts, specialty references, clinical guidelines and consensus documents, high-quality review articles, and primary literature. We also maintain a board of clinical practitioners whom the medical editors may consult regarding specific clinical practices or controversies. To learn more about the sources of all of our products, visit our content sources page.

Due to the number of therapeutically equivalent generic products available for each drug that no longer holds patent exclusivity, and the constant approval and removal from the market of these drugs from multiple manufacturers, we are unable to provide FDA equivalency ratings for all products.

When looking up a drug by its generic name, you will be directed to a screen with both the generic and brand names, providing the product is available in both forms in the US and both forms are in the Epocrates drug database. If the product is not available generically in the US or is not yet in Epocrates, selecting the generic name takes you directly to the brand name monograph or a listing of multiple brand names, if more than one is available.

Our class/subclass structure is a combination of both functional and pharmacologic classes. The reasons behind this design include speed of access (limiting the search to only two levels allows more rapid access to the information) and broad appeal to most users (using both pharmacologic and functional terms encompasses the most common thought processes employed when users access information by class).

For example, within the “Gastrointestinal” class, we have subclasses that are functional (e.g., nausea/vomiting) and pharmacologic (e.g., H2 blockers, PPIs). The “Cardiovascular” class is another good example of how combining functional and pharmacologic classes works to facilitate user access. Additionally, you will find that some monographs include information about the pharmacologic class under the mechanism of action statements.

Yes – in our mobile products you can search adverse reactions, brand and generic names, contraindications, indications, manufacturers, notes, and more using the “Find” feature. Here’s how:

1. Tap the ‘Find’ icon (a magnifying glass) at the bottom of the screen. If you do not see this icon, go to “Edit” in your app menu and select “Find”, or use the graffiti shortcut.
2. Tap the triangle to display the drop-down search category menu, and select a category (for example,select “Drugs-Adverse Reactions” to find all the drugs in Epocrates Rx that might cause a particular adverse reaction).
3. In the Find box, Enter the term or portion of the term you wish to find (For example, enter “rhabdo” to search for drugs that can cause rhabdomyolysis).
4. Tap “OK” to display any matches in the database.
5. Tap on a drug name to go to the monograph.

Common Reactions are generally listed in descending order of frequency (if available), with the most common listed first. We include all effects reported in more than 2% of patients and occurring more frequently in the treatment group than the placebo (or control) group. However, this may vary with some products for which such information is not available. Occasionally, similar or related effects are listed together for ease of use.

Serious Reactions are included regardless of incidence and are not listed in order of frequency. These effects are typically grouped by organ system. The decision to include an effect as a Serious Reaction is based on its potential to cause death, result in significant morbidity or dependence/abuse, or require major medical intervention.

We have looked extensively into the possibility of including incidence rates with adverse reactions. However, because data on the incidence of adverse drug effects can be variable, inconsistent, and potentially misleading, we have chosen to only list common adverse reactions in general descending order of frequency. Serious adverse reactions are usually listed by organ system. If resources for adverse drug effect information improve, we will consider adding adverse reaction incidence rates in the future.

The Epocrates drug database is quite comprehensive in the area of drug interactions. In fact, a recent independent study found Epocrates handheld products to be the most reliable in detecting clinically relevant interactions without the distraction of detecting those of no clinical significance. [Ann Pharmacother 2006;40:850-5.]

Because any given drug class may contain some drugs exhibiting interactions that other drugs within that class do not, we have developed our drug interaction content at the drug-to-drug level, rather than making generalizations about classes of drugs. Consequently, the MultiCheck feature recognizes individually selected drugs for analysis of drug interaction potential. This is also reflected in the “Drug Interactions” section of individual drug monographs. These features include identified and theoretical interactions that are both pharmacokinetic and pharmacodynamic in nature, with the exception of those based primarily on the intended therapeutic effects (e.g., using multiple antihypertensive agents in combination).

Our medical information editors go far beyond the product labeling (package insert) when researching drug interactions, often extrapolating broad statements involving mechanisms such as CYP450, P-glycoprotein, and other effects and extending them to carefully researched lists that are maintained to help us track metabolic and clinical effects. We also use multiple specialty references, consult experts, and do extensive investigation with manufacturers, the FDA, and primary literature.

Because Epocrates is focused on providing only clinically relevant information, drug interactions may be included that are not identified in the product labeling and may be excluded even though they do appear in the product labeling. For example, drugs that exhibit clinically relevant additive or synergistic adverse effects or opposing therapeutic effects are commonly identified within our content and features, even if not listed in the product labeling. Conversely, when drug interactions result in pharmacokinetic changes that do not demonstrate clinical significance, these interactions are not included in Epocrates Rx, even if listed in the product labeling.

At present, Epocrates does not include intravenous (IV) administration information. As time and resources allow, we are continuing to explore this matter further.

In the meantime, we encourage you to use the “Notes” section of a drug monograph to record IV administration information for the drugs you administer frequently. We developed the Notes functionality so that individual users could customize Epocrates Rx for their own needs and practice settings.

The pricing information in Epocrates Rx and Epocrates Online includes retail prices provided by our partner, drugstore.com. We regret that we are unable to provide pricing for products that are not sold via drugstore.com's website because this information is not included in the drugstore.com data. Such products include controlled substances, most parenteral products, newly approved or marketed, and restricted access products.

Between monthly pricing installments or for drugs that are not covered by the drugstore.com updates, it may be necessary to contact your local retail or hospital pharmacy for pricing. Be sure to AutoUpdate (sync) frequently in order to have access to the most current information available from Epocrates.

Our medical information editors take all content addition, update, and correction requests very seriously, and carefully investigate all concerns regarding such. Due consideration is given to each individual request. We always appreciate diligent, clinically focused scrutiny, as we are constantly working to update our applications and content.

Our users rely on Epocrates Rx to provide them the most relevant, unbiased information on the drugs they prescribe, presented in the most concise manner possible. Our processes for researching and developing our drug information content were established to meet the demands of the more than 500,000 healthcare professionals constituting our large user base, who consistently rate accuracy, clinical relevance, utility, and conciseness amongst the most valuable aspects of our references. In this context, it is neither our goal to include every product available, nor to exactly reproduce product labeling; our drug monographs do not contain all information provided in the prescribing information and often provide information beyond that contained in the prescribing information.

In order to expedite content addition, update, and correction requests from pharmaceutical manufacturers, the Epocrates clinical team requests all such inquiries:

1. Are sent directly to clinical@epocrates.com,
2. Are addressed directly from a clinical representative within the pharmaceutical manufacturer’s medical information department or equivalent business unit, and
3. At a minimum contain specific information, as indicated below.

New Monograph Requests

• name of product
• date of FDA approval
• date of product launch to the market
• name and contact information of clinical representative
• current FDA-approved product labeling (prescribing information)
• supportive scientific literature, as desired

Product Labeling Updates

• name of product
• name and contact information of clinical representative
• description of all changes made from previous product labeling
• current FDA-approved product labeling (prescribing information)
• supportive scientific literature, as desired

Content Correction Requests

• name of product
• name and contact information of clinical representative
• description of specific changes requested and clinical rationale for each
• current FDA-approved product labeling (prescribing information)
• supportive scientific literature

After submitting correspondence, inquirers can expect to receive an automated e-mail confirming receipt of the submission. (Absence of this may indicate a lost transmission.) Our medical information editors address each request personally and strive to provide a personal written response to all requests within ten business days.