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Anatomical Therapeutic Chemical Classification System

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TheAnatomical Therapeutic Chemical (ATC) Classification Systemis adrug classificationsystem that classifies theactive ingredientsofdrugsaccording to theorganorsystemon which they act and theirtherapeutic,pharmacologicalandchemicalproperties. Its purpose is an aid tomonitor drug useand forresearchto improve quality medication use. It does not implydrug recommendationorefficacy.[1]It is controlled by theWorld Health OrganizationCollaborating Centre for Drug Statistics Methodology (WHOCC), and was first published in 1976.[2][3][4]

Coding system

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Thispharmaceutical coding systemdivides drugs into different groups according to the organ or system on which they act, theirtherapeuticintent or nature, and the drug'schemical characteristics.Different brands share the same code if they have the same active substance and indications. Each bottom-level ATC code stands for a pharmaceutically used substance, or a combination of substances, in a single indication (or use). This means that one drug can have more than one code, for exampleacetylsalicylic acid(aspirin) hasA01AD05(WHO) as a drug for localoraltreatment,B01AC06(WHO) as aplatelet inhibitor,andN02BA01(WHO) as ananalgesicandantipyretic;as well as one code can represent more than one active ingredient, for exampleC09BB04(WHO) is the combination of perindopril with amlodipine, two active ingredients that have their own codes (C09AA04(WHO) andC08CA01(WHO) respectively) when prescribed alone.

The ATC classification system is a strict hierarchy,[5]meaning that each code necessarily has one and only one parent code, except for the 14 codes at the topmost level which have no parents. The codes are semantic identifiers,[5]meaning they depict information by themselves beyond serving as identifiers (namely, the codes depict themselves the complete lineage of parenthood). As of 7 May 2020, there are 6,331 codes in ATC; the table below gives the count per level.[6]

ATC level Codes Different names/pharmaceuticals
Level 1 14 14
Level 2 94 94
Level 3 267 262
Level 4 889 819
Level 5 5067 4363

History

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The ATC system is based on the earlier Anatomical Classification System, which is intended as a tool for the pharmaceutical industry to classify pharmaceutical products (as opposed to their active ingredients).[7]This system, confusingly also called ATC, was initiated in 1971 by theEuropean Pharmaceutical Market Research Association(EphMRA) and is being maintained by the EphMRA and Intellus. Its codes are organised into four levels.[8]The WHO's system, having five levels, is an extension and modification of the EphMRA's. It was first published in 1976.[2]

Classification

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In this system, drugs are classified into groups at five different levels:[9]

First level

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The first level of the code indicates the anatomical main group and consists of one letter. There are 14 main groups:[10]

Code Contents
A Alimentary tractandmetabolism
B Bloodandblood forming organs
C Cardiovascular system
D Dermatologicals
G Genito-urinary systemandsex hormones
H Systemichormonalpreparations, excluding sex hormones and insulins
J Antiinfectivesfor systemic use
L Antineoplasticandimmunomodulatingagents
M Musculo-skeletal system
N Nervous system
P Antiparasiticproducts,insecticidesandrepellents
R Respiratory system
S Sensory organs
V Various

Example:CCardiovascular system

Second level

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The second level of the code indicates the therapeutic subgroup and consists of two digits.[11]

Example:C03Diuretics

Third level

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The third level of the code indicates the therapeutic/pharmacological subgroup and consists of one letter.

Example:C03CHigh-ceiling diuretics

Fourth level

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The fourth level of the code indicates the chemical/therapeutic/pharmacological subgroup and consists of one letter.

Example:C03CASulfonamides

Fifth level

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The fifth level of the code indicates the chemical substance and consists of two digits.

Example:C03CA01furosemide

Other ATC classification systems

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ATCvet

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TheAnatomical Therapeutic Chemical Classification System for veterinary medicinal products(ATCvet) is used to classifyveterinarydrugs. ATCvet codes can be created by placing the letter Q in front of the ATC code of most human medications. For example, furosemide for veterinary use has the codeQC03CA01.

Some codes are used exclusively for veterinary drugs, such asQIImmunologicals,QJ51Antibacterials for intramammary useorQN05AX90amperozide.[12]

Herbal ATC (HATC)

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The Herbal ATC system (HATC) is an ATC classification ofherbal substances;it differs from the regular ATC system by using 4 digits instead of 2 at the 5th level group.[13]

The herbal classification is not adopted by WHO. TheUppsala Monitoring Centreis responsible for the Herbal ATC classification, and it is part of theWHODrug Globalportfolio available bysubscription.[14]

Defined daily dose

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Main article:Defined daily dose

The ATC system also includes defined daily doses (DDDs) for many drugs. This is a measurement of drug consumption based on the usual daily dose for a given drug. According to the definition, "[t]he DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults."[15]

Adaptations and updates

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National issues of the ATC classification, such as theGermanAnatomisch-therapeutisch-chemische Klassifikation mit Tagesdosen,may include additional codes and DDDs not present in the WHO version.[16]

ATC follows guidelines[17]in creating new codes for newly approved drugs. An application is submitted to WHO for ATC classification and DDD assignment. A preliminary or temporary code is assigned and published on the website and in theWHO Drug Informationfor comment or objection. New ATC/DDD codes are discussed at the semi-annual Working Group meeting. If accepted it becomes a final decision and published semi-annually on the website andWHO Drug Informationand implemented in the annual print/on-line ACT/DDD Index on January 1.[18]

Changes to existing ATC/DDD follow a similar process to become temporary codes and if accepted become a final decision as ATC/DDD alterations. ATC and DDD alterations are only valid and implemented in the coming annual updates; the original codes must continue until the end of the year.[19][20]An updated version of the complete on-line/print ATC index with DDDs is published annually on January 1.[21]

See also

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References

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  1. ^"Purpose of the ATC/DDD system".WHO Collaborating Centre for Drug Statistics Methodology.Archivedfrom the original on 14 January 2010.Retrieved6 July2021.
  2. ^ab"ATC/DDD Methodology: History".WHO Collaborating Centre for Drug Statistics Methodology.Archivedfrom the original on 2010-03-14.Retrieved2009-12-26.
  3. ^"ATC alterations from 2005-2019".WHOCC.28 November 2019.Archivedfrom the original on 27 July 2013.Retrieved27 December2019.
  4. ^"DDD alterations from 2005-2019".WHOCC.28 November 2018.Archivedfrom the original on 2 May 2013.Retrieved27 December2019.
  5. ^abCimino, James (Nov 1998)."Desiderata for Controlled Medical Vocabularies in the Twenty-First Century".Methods of Information in Medicine.37(4–5): 394–403.doi:10.1055/s-0038-1634558.PMC3415631.PMID9865037.
  6. ^Kury, Fabrício."Scrape Anatomical-Therapeutic-Chemical (ATC) classes from the WHO Collaborating Centre for Drug Statistics Methodology website".GitHub.Archivedfrom the original on 30 September 2020.Retrieved7 May2020.
  7. ^"Comparison of the WHO ATC Classification & EphMRA/Intellus Anatomical Classification"(PDF).EphMRA. Archived fromthe original(PDF)on 6 August 2015.Retrieved7 January2017.
  8. ^"EphMRA Anatomical Classification Guidelines 2018"(PDF).Archived fromthe original(PDF)on 2016-04-23.Retrieved2017-01-07.
  9. ^"ATC: Structure and principles".WHO Collaborating Centre for Drug Statistics Methodology.Archivedfrom the original on 2010-01-14.Retrieved2009-12-26.
  10. ^"ATC/DDD Index".WHO Collaborating Centre for Drug Statistics Methodology.Archivedfrom the original on 2012-09-23.Retrieved2009-12-26.
  11. ^"ATC search result for '0'".sdrugs.com.Archivedfrom the original on 2017-12-23.Retrieved2023-10-20.
  12. ^"ATCvet".WHO Collaborating Centre for Drug Statistics Methodology. Archived fromthe originalon 2015-04-13.Retrieved2015-02-15.
  13. ^"The Herbal Anatomical Therapeutic Chemical Classification System".Uppsala Monitoring Centre.Archivedfrom the original on 9 July 2021.Retrieved7 July2021.
  14. ^"WHODrug portfolio".Uppsala Monitoring Centre.Archivedfrom the original on 9 July 2021.Retrieved6 July2021.
  15. ^"DDD: Definition and general considerations".WHO Collaborating Centre for Drug Statistics Methodology.Archivedfrom the original on 2012-07-02.Retrieved2009-12-26.
  16. ^"ATC-Klassifikation mit DDD: Gesetzlicher Hintergrund"(in German). Deutsches Institut für Medizinische Dokumentation und Information. Archived fromthe originalon 2016-03-03.Retrieved2010-02-14.
  17. ^"Guidelines for ATC classification and DDD assignment".WHO Collaborating Centre for Drug Statistics Methodology. 2020-12-16.Archivedfrom the original on 2021-06-18.Retrieved2021-06-15.
  18. ^"New ATC 5th levels".WHO Collaborating Centre for Drug Statistics Methodology. 2021-05-04.Archivedfrom the original on 2021-11-28.Retrieved2021-06-18.
  19. ^"ATC 53rd Executive Summary".World Health Organization (WHO).31 May 2023.Retrieved5 July2024.
  20. ^"ATC 54th Executive Summary".World Health Organization (WHO).11 January 2024.Retrieved5 July2024.
  21. ^"ATC Index with DDDs".WHO Collaborating Centre for Drug Statistics Methodology. 2020-12-16.Archivedfrom the original on 2020-05-23.Retrieved2020-06-15.
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