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Where can I find alternative drugs in Epocrates Rx drug monographs? The Alternatives section of an Epocrates Rx drug monograph includes a list of other drugs in the same subclass(es) as the current drug monograph. - Some drug monographs may be linked to multiple subclasses based on therapeutic uses and/or pharmacologic properties.
- Tapping on a subclass title in this section allows you to view a list of product-specific monographs also assigned to this same subclass.
Sometimes, a drug search in Epocrates on a mobile device may land on the “drug card” rather than the full Epocrates drug monograph. - In this situation, tapping on the Subclass (Alternatives) section gives the option to view all drugs in the subclass(es) corresponding to where this particular drug is assigned.
- Here's an example of how to use the Subclass (Alternatives) section in Epocrates through the "drug card":
1. Launch the Epocrates app on your mobile device.
2. Type "cephalexin" into the search bar at the top of the main screen and press Search.
3. You’ll land on the search results screen, which includes the "drug card" for cephalexin. Tap on the Subclasses (Alternatives) section that includes the subclass: "Cephalosporins, 1st generation."
4. You’ll be presented with a list of other drugs in the "Cephalosporins, 1st generation" subclass. If you have a specific formulary selected, notice that the formulary code for each drug is included on the right-hand side of the screen.
5. For some drugs, multiple subclasses may be listed in the Subclasses (Alternatives) section and may be selected each in turn to view the complete list of drugs assigned to that subclass.
Where can I find alternative drugs in Epocrates OTC monographs? The Alternatives section of an Epocrates OTC monograph includes various links to similar products to allow for easy and fast alternative product selection. - First are listed other OTC products with the same active ingredients, but which may be available in other formulations that are more appropriate for a given patient, if available.
- Below these first OTC products are links to search for other products (Rx and OTC) in the same subclass and in related subclasses. The related subclass links often allow you to quickly exclude an ingredient that is inappropriate, unsafe, or otherwise undesired for a given patient, or conversely, to add another needed ingredient.
Where can I find the indications/uses for a drug in Epocrates? Prescription (Rx) drugs - FDA-approved indications and off-label uses for prescription (Rx) drugs can be found under the Adult and Peds Dosing sections in Epocrates drug monographs.
- Each bold header is an indication or use for the product, with appropriate dosing found under each.
- An asterisk (*) before the bold statement of use denotes that it is "off-label."
Over-the-counter (OTC) drug monographs - Over-the-counter (OTC) drug monographs in Epocrates include “Uses” and “Doses” sections. This structure differs from Rx drug monographs, which include the indications and uses in the Adult and Peds Dosing sections.
- Unlike most Rx drug products, OTC drugs commonly have several active ingredients, each intended for a different purpose (eg, a combination product containing an analgesic/antipyretic for pain/fever, an antihistamine for sneezing, a decongestant for nasal congestion, and an expectorant for chest congestion).
Where can I find the “schedule” of a controlled substance in Epocrates? The Manufacturer/Pricing section of each Epocrates drug monograph identifies the legal status of the product (eg, OTC, Rx, or controlled substance) and gives the DEA schedule, when relevant.
Where can I find incidence rates for adverse drug reactions? We’ve extensively researched 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’ve chosen to list only the common adverse reactions in Epocrates, in general descending order of frequency.
Here's a bit more about our thinking:
- Adverse effect incidence rates derived from clinical trials can’t be accurately used to predict the frequency of adverse experiences in the course of usual medical practice, where patient characteristics and other factors may differ from those occurring during clinical studies.
- Similarly, the cited adverse-effect incidence rates from one study can’t be directly compared with figures obtained from other studies involving different treatments, uses, or investigators.
- If resources for adverse drug effect information improve, we’ll consider adding adverse-reaction incidence rates to future versions of Epocrates.
Where can I find intravenous (IV) administration information? At present, Epocrates doesn’t include IV administration information. - We encourage use of the Notes section of a drug monograph to record IV administration information for frequently ordered and administered drugs.
- We developed the Notes functionality so that individual users could customize Epocrates drug monographs for their own needs and practice settings.
- We’ll continue to explore the feasibility of adding such information.
Where can I find drug allergy information in Epocrates? Epocrates drug monographs include the contraindication “hypersens. to drug/class/compon.,” a phrase meant to globally convey that hypersensitivity to the drug, drug class, or the inactive ingredients is a contraindication for use. Epocrates drug monographs also include some specific clinically relevant allergens and cross-allergen risks in the Contraindications/Cautions section.
For instance, the Epocrates drug monograph for furosemide includes a caution for patients who are hypersensitive to sulfonamides; the Epocrates drug monograph for penicillin V potassium includes various contraindications and cautions regarding other beta-lactams; and the Epocrates drug monograph for testosterone cypionate includes a contraindication in patients who are hypersensitive to cottonseed oil.
Currently, Epocrates doesn't contain a feature that enables cross-checking of drugs and patient allergies.
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How do I contact Epocrates Support team about billing, my profile, technical issues, etc? Please use this page to contact the Epocrates Customer Support team with any questions you may have, to renew your subscription, and/or to log-in to manage your account.
For answers to your questions by email, please contact us at: support@epocrates.com.
How do I use the weight-based dosing calculator to calculate individual dose amounts? The weight-based dosing calculator included in Epocrates can calculate both individual dose amounts based on dose and patient weight (eg, mcg/kg, mg/kg, etc) and total daily dose amounts divided between multiple daily doses (eg, mcg/kg/day, mg/kg/day, etc). In addition, doses can be calculated in terms of dose mass (eg, mcg, mg, g) for tablets/capsules or dose volume (eg, mL) for liquids.
Epocrates has incorporated functionality in its mobile app that allows the general weight-based dosing calculator to be launched from any Epocrates drug monograph that contains weight-based dosing.
However, the calculator isn’t specific to any given drug: Units pre-populated into any input field and all units available for any given field don’t necessarily pertain to the drug from which the calculator was launched. As a result, units need to be manually changed for any given drug or dose calculation. Unnecessary fields are inactive until you select criteria that activate them.
- Calculating individual dose amounts
If the dose expression is "10 mg/kg PO q8h," simply calculate the individual dose amount that will be given at each interval. Only the dose and patient weight need to be entered. Enter "10" in the Dose Amt field. Select the units "mg/kg." Enter the patient weight in the Weight field. Select the appropriate patient weight units (ie, lb or kg). Finally, tap "View Results” on iPhone/iPad or “Calculate” on Android; the calculator will then display the amount of each individual dose, based on the patient's weight.
How do I use the weight-based dosing calculator to calculate daily dose amounts divided between multiple daily doses? The weight-based dosing calculator included in Epocrates can calculate both individual dose amounts based on dose and patient weight (eg, mcg/kg, mg/kg, etc) and total daily dose amounts divided between multiple daily doses (eg, mcg/kg/day, mg/kg/day, etc). In addition, doses can be calculated in terms of dose mass (eg, mcg, mg, g) for tablets/capsules or dose volume (eg, mL) for liquids.
Epocrates has incorporated functionality in its mobile app that allows the general weight-based dosing calculator to be launched from any Epocrates drug monograph that contains weight-based dosing.
However, the calculator isn’t specific to any given drug: Units pre-populated into any input field and all units available for any given field don’t necessarily pertain to the drug from which the calculator was launched. As a result, units need to be manually changed for any given drug or dose calculation. Unnecessary fields are inactive until you select criteria that activate them.
- Calculating daily dose amounts divided between multiple daily doses
If the dose expression is "20 mg/kg/day PO divided q6-8h", first calculate the total daily dose and then divide between the doses that will be given at the specified intervals. Dose, patient weight, and dosing frequency must all be entered. Enter "20" in the Dose Amt field. Select the units "mg/kg/day." NOTE: To activate the Freq q field, select a dose unit that includes "/day." Enter the patient weight in the Weight field. Select the appropriate weight units (ie, lb or kg). Enter the desired dosing frequency and units (in this case, q6 hr or q8 hr) in the Freq q field. Finally, tap "View Results” on iPhone/iPad or “Calculate” on Android; the calculator will then display the amount of each dose, based on patient weight and desired dosing frequency.
How do I use the weight-based dosing calculator to calculate doses for liquid forms? The weight-based dosing calculator included in Epocrates can calculate both individual dose amounts based on dose and patient weight (eg, mcg/kg, mg/kg, etc) and total daily dose amounts divided between multiple daily doses (eg, mcg/kg/day, mg/kg/day, etc). In addition, doses can be calculated in terms of dose mass (eg, mcg, mg, g) for tablets/capsules or dose volume (eg, mL) for liquids.
Epocrates has incorporated functionality in its mobile app that allows the general weight-based dosing calculator to be launched from any Epocrates drug monograph that contains weight-based dosing.
However, the calculator isn’t specific to any given drug: Units pre-populated into any input field and all units available for any given field don’t necessarily pertain to the drug from which the calculator was launched. As a result, units need to be manually changed for any given drug or dose calculation. Unnecessary fields are inactive until you select criteria that activate them.
- Calculating doses for liquid forms
If the final dose needs to be expressed in terms of volume of a liquid form, proceed as above, with a couple of additional steps. After entering the required information noted above (dose amount, patient weight, +/- dosing frequency), enter the concentration of the liquid formulation in the Strength fields. For instance, if the drug comes as a 250 mg/5 mL suspension, enter 250 mg on the first line and 5 mL on the second. On iPhone/iPad, this information may be entered directly into the Strength fields. On Android, tap on the box to the right of “Form” and select “liquid” to activate the Strength fields. Finally, tap "View Results” on iPhone/iPad or “Calculate” on Android; the calculator will then display the amount of each dose in terms of volume (mL).
How do I add/update formulary plans on IOS devices (iPhone/iPad)? You can access over 6,500 formulary plans directly from the Epocrates mobile app or Epocrates Online. For your convenience, your 30 most recently viewed formulary plans are stored for quick access in the Recent Formularies list on mobile or the Formulary drop-down list on Epocrates Online.
To access a plan not included on your recently viewed list, simply add it as a new formulary.
- IOS Devices (iPhone/iPad):
To add new plans, use the “Add New Formulary” button, which can be found in three locations in the app:
(1) Formulary Tile
Go to the Formulary tile and tap the “Add New Formulary” button at the bottom of the screen.
(2) Formulary Bar
When performing a search or browsing drugs by subclass, you can find the “Add New Formulary” button by tapping the Formulary bar displayed at the bottom of the screen.
(3) Drug Monograph
When viewing the sections of a drug monograph, tap the Formulary section to view the Formulary details for this drug and the selected plan. Next, tap the “Add New Formulary” button at the bottom of the screen.
After tapping the “Add New Formulary” button, find the desired plan(s) using the search bar and/or filters for state and formulary type. Choose the desired plan(s) by tapping on the name(s). A check mark will appear to the left of the chosen plan(s). Tap the “Add Formulary” button at the bottom of the screen to finalize the addition(s). The new plan(s) will now be included in your Recent Formularies list. If adding one new plan, it automatically becomes your selected formulary. If adding multiple plans at once, you must select the specific plan that you’d like to view from the Recent Formularies list.
To change the selected formulary, access the Recent Formularies list through the Formulary tile or the Formulary bar, then tap the name of the desired plan. A check mark will appear to the left of the selected plan. In the Formulary section of a drug monograph, your recently viewed formulary plans appear below the coverage details under the heading “Other Formularies.” Tap on the desired plan. The name of the newly selected plan will appear at the top of the Formulary section.
How do I add/update formulary plans on Android devices? You can access over 6,500 formulary plans directly from the Epocrates mobile app or Epocrates Online. For your convenience, your 30 most recently viewed formulary plans are stored for quick access in the Recent Formularies list on mobile or the Formulary drop-down list on Epocrates Online.
To access a plan not included on your recently viewed list, simply add it as a new formulary.
- Android Devices:
To add new plans, use the “+” button, which can be found in three locations in the app.
(1) Formulary Tile
Go to the Formulary tile and tap the “+” button at the bottom of the screen.
(2) Formulary Bar
When performing a search, the name of the selected formulary plan will be displayed in the Formulary bar at the bottom of the screen. Tap the Formulary bar, then the “+” button.
When browsing drugs by subclass, the Formulary bar will appear at the top of the screen. Tap on the “Change” button to the right of the Formulary bar, then the “+” button.
(3) Drug Monograph
When viewing the list of sections for an individual drug monograph, the current formulary plan name is found directly below the drug name. Tap the current formulary name to go to the Formulary section of the monograph. Next, tap the “Change” button, then the “+” button.
After tapping the “+” button, find the desired plan(s) using the search bar and/or filters for state and formulary type. Choose the desired plan(s) by tapping on the name(s). A check mark will appear to the left of the chosen plan(s). Tap the Add Formulary button at the bottom of the screen to finalize the addition(s). The new plan(s) will now be included in your Recent Formularies list. If adding one new plan, it automatically becomes your selected formulary. If adding multiple plans at once, you must select the specific plan that you’d like to view from the Recent Formularies list.
To change the selected formulary, access the Recent Formularies list through the Formulary tile or the Formulary bar, then tap the name of the desired plan. Alternatively, you can change your formulary from the Formulary section of a drug monograph by simply tapping the “Change” button, then selecting a formulary from the Recent Formularies list.
How do I add/update formulary plans on Epocrates Online? You can access over 6,500 formulary plans directly from the Epocrates mobile app or Epocrates Online. For your convenience, your 30 most recently viewed formulary plans are stored for quick access in the Recent Formularies list on mobile or the Formulary drop-down list on Epocrates Online.
To access a plan not included on your recently viewed list, simply add it as a new formulary.
- Epocrates Online:
Go to the Drugs tab and open the Formulary drop-down list located directly below Drug Lookup. To select a plan from this list, simply click on the plan name. To add one or more plans not included in this list, click on the blue text button labeled “Add New Formulary.” Find the desired plan(s) using the search bar and/or filters for state and formulary type. Choose the desired plan(s) by clicking on the name(s). A check mark will appear to the left of the chosen plan(s). Click the “Add Formulary” button at the bottom of the pop-up box to finalize the addition(s).
Now when you open the Formulary drop-down list, the new plan(s) appear in this list. If you added one new plan, this plan automatically becomes your selected formulary. If adding multiple plans at once, you must open the Formulary drop-down list to select the specific plan that you’d like to view.
How do I submit a clinical request if I'm a pharmaceutical manufacturer? Our medical information editors carefully investigate all content requests and concerns submitted for our review. We always appreciate diligent, clinically focused scrutiny, as we’re constantly working to update our applications and content.
More than 1,000,000 healthcare professionals consistently rate accuracy, clinical relevance, utility, and conciseness among the most valuable aspects of our references. In this context, it’s not always relevant to include every product available, nor to exactly reproduce product labeling; instead, our drug monographs provide essential, evidence-based information beyond that contained in the prescribing information.
- All Requests: To best expedite content addition, update, and correction requests from pharmaceutical manufacturers, the Epocrates Medical Information Team requests that all such inquiries:
- Be sent directly to clinical@epocrates.com
- Be addressed directly from a clinical representative within the pharmaceutical manufacturer’s medical information department or equivalent business unit, and
- At a minimum, contain specific information, as indicated below.
If you write to us, you can expect to receive an automated email confirming receipt of your submission. Please resubmit if you don't receive such an email.
- New Monograph Requests: Please include the following additional info:
- 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: Please include the following additional info:
- 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: Please include the following additional info:
- 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
How do I cite Epocrates in my publication? Epocrates applications may be cited as databases. For a detailed explanation on this topic, please go to this link. The citation format included on this page has been extrapolated from the National Library of Medicine (NLM) Style Guide for Authors, Editors, and Publishers and the International Committee of Medical Journal Editors (ICMJE) Uniform Requirements for Manuscripts Submitted to Biomedical Journals. If you’re required to use a different citation format, the same information can be rearranged, as needed.
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Editorial Policies: The Why Behind Our Drug Info
When does Epocrates add new drug products? Our medical information editors add new drugs approved by the FDA around the time the drug becomes commercially available to prescribe in the US. After the FDA approves a product, it may take several weeks to months for the manufacturer to actually release the product on the US market. During this time, we’re in close contact with pharmaceutical manufacturers as to the expected date of availability. We then time new monograph publishing to coincide with this date so that clinicians have the most accurate real-market information. Because content is published weekly, you can expect to see a new monograph in Epocrates either shortly before or after the time that drug is available for prescribing.
From what sources does Epocrates develop its clinical drug content? The Epocrates proprietary drug database is developed by our in-house team of pharmacist and physician medical information editors to provide clinicians with the most accurate, comprehensive, and clinically relevant drug information for use at the point of care:
- Our editors review a variety of resources when creating and updating Epocrates drug monographs, such as FDA-approved product labeling (prescribing information), FDA review documents, pharmacotherapy texts, specialty references, clinical practice guidelines, consensus documents, high-quality review articles, and the primary literature.
- Our editors also consult, as needed, with a board of clinical practitioners about specific clinical practices.
- To learn more, visit our content sources page.
Why are there brand-name Epocrates drug monographs listed when I search for a generic drug name? Mobile devices (iPhone/iPad/Android)
- When only the brand-name drug is available in the US, but the generic is not, Epocrates includes only the brand-name monograph. Searching by the generic name displays a list with the brand-name monograph as well as any applicable monographs that contain the generic active ingredient.
- When two or more brand-name drugs are available in the US, but the generic product is not, Epocrates includes only the brand-name monographs. Searching by the generic name displays a list of the brand-name monographs as well as any applicable monographs that contain the generic active ingredient.
- When both generic- and brand-name drugs are available in the US, Epocrates includes the generic and brand-name monographs separately. Searching by the generic name will direct you to a screen called the “drug card.” The drug card provides a list of sections from the generic drug monograph followed by links to the brand-name monographs and other content associated with the generic drug name.
- Here’s an example: Epocrates includes a unique monograph for each brand-name albuterol inhaled product (ie, ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin HFA), as well as a generic albuterol inhaled monograph, which includes only those strengths and forms available on the US market as generic products. We present separate monographs for all albuterol inhaled products due to variations in clinical content between available formulations. Thus, typing “albuterol inhaled” in the main Epocrates search bar will open the generic albuterol inhaled “drug card.” This drug card lists several sections of the albuterol inhaled monograph. Scroll down on this screen to view a list of brand-name and other generic monographs that include the active ingredient albuterol inhaled. Tap "View all results" to see the complete list of monographs.
Epocrates Online:
- When only a brand-name drug is available in the US, but a generic is not, Epocrates includes only a brand-name monograph. Searching by the generic name will open to the brand-name monograph.
- When two or more brand-name drugs are available, but a generic product is not, Epocrates includes only the brand-name monographs. Searching by the generic name will display a list of brand-name monograph links to select from.
- When both generic- and brand-name drugs are available, searching by generic name will display a list of generic and brand-name monograph links to select from.
- Here’s an example: Epocrates includes a unique monograph for each brand-name albuterol inhaled product (ie, ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin HFA), as well as a generic albuterol inhaled monograph, which includes only those strengths and forms available on the US market as generic products. We present separate monographs for all albuterol inhaled products due to variations in clinical content between available formulations. Thus, typing “albuterol inhaled” in the main Epocrates search bar will yield search results that include all brand name and generic monographs.
What does Epocrates do when brand-name drug products are removed from the market? Often, clinicians are unaware that a brand product has actually been off the market because clinicians continue to prescribe the drug by the brand name. Pharmacists will generally just switch the order to the available generic without providing feedback to the prescriber that the brand-name product is no longer available, thus perpetuating the myth that the brand-name product is still available.
The Epocrates drug database differs from that of many other compendia in that it is actually product-specific:
- 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 the generic (if available), based on product-specific information, such as available formulations, dosing, indications, manufacturer, and pricing, which often differ between specific products containing the same active ingredient.
- When a brand-name product is discontinued or phased out by its manufacturer, we typically make the following note in the Dosing sections of the Epocrates drug monograph: Brand Discontinued in US [see generic]
- Periodically, some of these obsolete brand-name monographs (generally those with less recognized names) are removed from Epocrates to optimize app space on handheld devices and because removing obsolete information makes sense given our focus on providing accurate, product-specific, up-to-date content. However, in response to user feedback, we’ve also kept many high-profile and high-use brand-name medications in Epocrates longer than usual and restored others, even those that are truly discontinued.
- When viewing a brand-name monograph for which a generic and/or other brand products are available, simply click/tap on the generic name at the top of the monograph to quickly navigate to these alternatives.
Why doesn't Epocrates include incidence rates for adverse drug reactions? We’ve extensively researched 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’ve chosen to list only the common adverse reactions in Epocrates, in general descending order of frequency. Here's a bit more about our thinking:
- Adverse effect incidence rates derived from clinical trials can’t be accurately used to predict the frequency of adverse experiences in the course of usual medical practice, where patient characteristics and other factors may differ from those occurring during clinical studies.
- Similarly, the cited adverse-effect incidence rates from one study can’t be directly compared with figures obtained from other studies involving different treatments, uses, or investigators.
- If resources for adverse drug effect information improve, we’ll consider adding adverse-reaction incidence rates to future versions of Epocrates.
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Drug Content: What's In Each Drug Section
Dosing/Uses and Formulations In the Dosing sections of Epocrates drug monographs, under renal dosing, what does "no supplement" mean? - The notation "no supplement" after hemodialysis (HD) or peritoneal dialysis (PD) means that a supplemental dose isn’t required following the dialysis session or period. If a supplement dose is necessary after dialysis, this will be noted. For instance, "HD: give 50% usual dose as supplement after dialysis if next maint. dose not due right after dialysis" means to give half of the normal dose as a supplement after hemodialysis. This implies that this drug is at least partially dialyzable, making replacement necessary after a dialysis session. Situations requiring maintenance dose changes will generally be dictated by renal function and presented in the renal dosing section.
For products that are systemically absorbed to a clinically significant extent, dosing for patients with renal and hepatic dysfunction (when applicable) is provided in the Adult and Peds Dosing sections below the listing of approved indications and off-label uses. Renal dosing (when available) may also include dose adjustments and supplement dose information for patients receiving HD or PD.
In patients undergoing HD or PD, both renal function and dialysis play a role in proper drug dosing. In these patients, renal function usually still guides the maintenance dosing; however, the process of dialysis may necessitate post-dialysis supplemental doses, depending on the extent the drug is dialyzed. Drugs administered to patients who have significant renal dysfunction and are also undergoing HD or PD may require one of the following regimen changes:
(1) adjustment to the maintenance dose and supplemental doses
(2) adjustment to the maintenance dose, but no supplemental doses
(3) no adjustment to the maintenance dose, but supplemental doses
(4) no adjustment to the maintenance dose and no supplemental doses
What's in the Dosage Forms field of Epocrates drug monographs? - Available dosage strengths and formulations are listed at the top of each Adult and Peds Dosing section of Epocrates drug monographs in the Dosage Forms field. This field includes a list of dosage forms, each followed by the available strengths with the appropriate units. Tablets, capsules, and various immediate- and extended-release forms are listed as distinct dosage forms and strengths. Injectable product monographs--those available in multiple forms and intended for non-intravenous administration--also contain information about the available strengths with appropriate units for each form (eg, vials, pre-filled syringes, pens, etc).
What's in the Formulations section of Epocrates OTC monographs? - The Formulations section of Epocrates OTC monographs includes available formulations for the drug and the amount of each active ingredient in each formulation. For soft oral formulations (eg, oral liquids, chewables, dissolvables, etc), flavors and the presence or absence of inactive ingredients of note (alcohol, dye, phenylalanine, saccharin, sucralose, and sugar) are also listed.
From where is Epocrates' Black Box Warnings content derived? - The Black Box Warnings section of Epocrates drug monographs includes content adapted from boxed warnings appearing in the US prescribing information. Epocrates may add content to this section before it’s published in the US prescribing information if the FDA has released proposed language for new required boxed warnings.
What’s in the Formulary section of Epocrates drug monographs? - The Formulary section of an Epocrates drug monograph includes coverage information for that drug based on the selected formulary plan. The name of the selected plan appears at the top of the Formulary section followed by coverage information for each formulation. Detailed notes on prior authorizations, step therapy, quantity limits, and other relevant information are also included, when applicable. To view the definition of a formulary status code appearing to the right of a drug formulation, simply click/tap on the code.
What's in the Alternatives section of Epocrates Rx drug monographs? - The Alternatives section of an Epocrates Rx drug monograph includes a list of other drugs in the same subclass(es) as the current drug monograph. Some drug monographs may be linked to multiple subclasses based on therapeutic uses and/or pharmacologic properties. Tapping on a subclass title in this section allows you to view a list of product-specific monographs also assigned to this same subclass.
Sometimes, a drug search in Epocrates on a mobile device may land on the “drug card” rather than the full Epocrates drug monograph. In this situation, tapping on the Subclass (Alternatives) section gives the option to view all drugs in the subclass(es) corresponding to where this particular drug is assigned.
Here’s an example of how to use the Subclass (Alternatives) section in Epocrates through the "drug card":
1. Launch the Epocrates app on your mobile device.
2. Type "cephalexin" into the search bar at the top of the main screen and press Search.
3. You’ll land on the search results screen, which includes the "drug card" for cephalexin. Tap on the Subclasses (Alternatives) section that includes the subclass: "Cephalosporins, 1st generation."
4. You’ll be presented with a list of other drugs in the "Cephalosporins, 1st generation" subclass. If you have a specific formulary selected, notice that the formulary code for each drug is included on the right-hand side of the screen.
5. For some drugs, multiple subclasses may be listed in the Subclasses (Alternatives) section and may be selected each in turn to view the complete list of drugs assigned to that subclass.
What's in the Alternatives section of Epocrates OTC monographs? - The Alternatives section of an Epocrates OTC monograph includes various links to similar products to allow for easy and fast alternative product selection. First are listed other OTC products with the same active ingredients, but which may be available in other formulations that are more appropriate for a given patient, if available. Below these first OTC products are links to search for other products (Rx and OTC) in the same subclass and in related subclasses. The related subclass links often allow you to quickly exclude an ingredient that is inappropriate, unsafe, or otherwise undesired for a given patient, or conversely, to add another needed ingredient.
Contraindications/Cautions What's in the Contraindications/Cautions section of Epocrates drug monographs? - The Contraindications/Cautions section of Epocrates drug monographs includes diseases, conditions, and other circumstances in which the drug should not generally be used or should be used with caution.
Epocrates doesn’t limit contraindications and cautions to only those conditions appearing in the Contraindications or Warnings and Precautions sections of a drug’s prescribing information. The Contraindications/Cautions section of each monograph includes all conditions in which the drug is not recommended or should be used with caution, regardless of source or section in which it might appear in the prescribing information.
Epocrates also doesn’t differentiate between relative and absolute contraindications and commonly interprets such phrases as "should not be used" or "is not recommended" appearing in prescribing information as contraindication language, even when such information isn’t explicitly included in the Contraindications section of the label.
Contraindications are listed first, followed by cautions, which always begin with the term "caution." Otherwise, the order of items listed within the contraindications and cautions isn’t necessarily an indication of severity or clinical relevance.
For most oral combination over-the-counter (OTC) products, the individual ingredient(s) responsible for the contraindication or caution are identified.
What's in the Adverse Reactions section of Epocrates drug monographs? - Epocrates’ standard for inclusion in the Common Reactions section is to include all adverse drug reactions (ADRs) and lab abnormalities reported in at least 2% of patients at any recommended dose for any indication and occurring more frequently in the treatment group than the placebo group.
- Common Reactions also include any ADR referred to as “frequent,” “common,” or “most common” in the product labeling or primary literature.
- However, the greater than or equal to 2% standard may vary for products in which such information isn’t available, reported differently (eg, listed as >1% or >5% in the product labeling), or studied versus an active control. We’ve found that the 2% cut-off allows for reasonable comprehensiveness and optimal usability, especially given that our users have told us that they prefer not to see a "laundry list" of every adverse effect named in the product labeling, which can number in the hundreds.
- Editors also assess other factors when determining which ADRs to list in the Common Reactions section, including seriousness, severity, frequency, and strength of causal association with the drug.
- If an ADR doesn’t meet our inclusion criteria as a serious or common ADR, but that ADR is nonetheless serious, severe, frequent, and/or is strongly associated with the use of the drug, it will be included at the end of the Common Reactions.
How are Common Adverse Reactions listed? - Common Reactions are usually listed in descending order of frequency (if available), with the most common listed first. Occasionally, similar or related effects are listed together for ease of use (eg, nausea/vomiting). Epocrates’ medical information editors may synthesize data from multiple sources and for multiple indications to arrive at an order that may differ from what appears in the drug's prescribing information for a single dose or indication. Although editors strive to present these effects in general descending order of frequency whenever possible, this shouldn’t be taken as an absolute for any given patient, indication, or dose. For combination over-the-counter (OTC) products, the relative frequency of common reactions attributable to each active ingredient is usually less widely available or reliable; thus, Common Reactions for OTC monographs are instead listed in alphabetical order.
How are Serious Adverse Reactions listed? - Serious Reactions are included regardless of incidence and aren’t listed in order of frequency. These effects are typically grouped by organ system or severity, but may sometimes be listed in other ways, such as alphabetically. 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.
What's in the Drug Interactions section of Epocrates drug monographs? - The Drug Interactions section of Epocrates drug monographs includes clinically relevant identified and evidence-based theoretical interactions that are both pharmacokinetic and pharmacodynamic in nature. Epocrates’ medical information editors go far beyond the prescribing information when researching drug interactions, often extrapolating broad statements involving mechanisms, such as cytochrome P-450 (CYP), P-glycoprotein (P-gp), and pharmacodynamic activity, and extending them to carefully researched lists that are maintained to help track metabolic and clinical effects. Attributes such as inhibition potency, substrate exclusivity, and therapeutic index are all taken into account when determining clinical significance.
Drug Interactions are organized according to clinical management (action required by the clinician) and involve categories such as "Contraindicated," "Avoid/Use Alternative," "Monitor/Modify Tx," and "Caution Advised." Each interaction lists the action necessary for clinical management, the expected or possible effects of the drug combination, and the proposed mechanism of interaction. As such, the categories are not intended as severity levels; “Caution Advised” interactions may have serious clinical consequences and should not be dismissed categorically.
The Drug Interactions section includes an Overview section that lists the drug name, the pharmacologic classification, when relevant, and a list of Interaction Characteristics for that particular drug. This section gives a “big picture” view of a drug’s overall interaction potential and risks. For example, the Drug Interactions Overview section of the repaglinide monograph indicates that this drug is a meglitinide and lists the clinically relevant Interaction Characteristics: CYP2C8 substrate, CYP3A4 substrate, OATP1B1 substrate, and antidiabetic agents.
What's in the Safety/Monitoring section of Epocrates standard drug monographs? - The Safety/Monitoring section of Epocrates drug monographs includes special content directly related to the safe use and safety monitoring of the drug. This section includes laboratory and objective, safety monitoring parameters. Additional content included (only when applicable) are therapeutic drug levels, special ingredient considerations, and look/sound-alike content (including "tall man" lettering).
What's in the Pregnancy/Lactation section of Epocrates drug monographs? - The Pregnancy/Lactation section of Epocrates drug monographs includes clinical details on risks during pregnancy and breastfeeding. When relevant, information about impact on contraception and fertility, pregnancy testing, and contact details for pregnancy registries may also be found in the Pregnancy section. For most oral combination OTC products, the pregnancy and lactation sections are listed by individual ingredient.
What's in the Pharmacology section of Epocrates standard drug monographs? - The Pharmacology section of an Epocrates drug monograph contains concise information on the metabolism, excretion, and mechanism of action of that particular drug. For products that are systemically absorbed to a clinically significant extent, we include specific cytochrome P-450 (CYP450) and other metabolic pathways by which a drug is metabolized in the Metabolism subsection. The terminal elimination half-life for a drug can be found under the Excretion subsection. The known or proposed mechanism of therapeutic action is also given in this section.
In addition, the Pharmacology section lists the Epocrates subclasses to which the drug belongs. Epocrates' class/subclass structure, a combination of both functional (therapeutic) and pharmacologic classes, allows Epocrates monographs to be discovered with efficiency and speed when browsing by class. For example, the "Gastrointestinal" class includes both functional subclasses (eg, "Nausea/Vomiting") and pharmacologic subclasses (eg, "H2 Blockers," "PPIs"). Additional information about the pharmacologic class can often be found in the mechanism of action statement, where appropriate.
What's in the Manufacturer/Pricing section of Epocrates drug monographs? - The Manufacturer/Pricing section of Epocrates Rx monographs includes content about the manufacturer of the drug or identifies it as a generic drug product, the legal status of the product (eg, OTC, Rx, or controlled substance), and retail pricing, when available. Epocrates considers the manufacturer to be the company a healthcare professional would contact for information about the drug, even if another company physically manufactures or distributes the drug.
Epocrates' pricing partner, GoodRx, provides retail prices for the most frequently dispensed quantities of each medication. At this time, pricing information is limited to the products sold via the GoodRx prescription pharmacy division.
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