Saturday, October 3, 2009

Pill Identification for Canadian pills

What is the best way to identify a stray pill?

Except for the round, white, unmarked tablets; color, shape, score lines and imprint codes can assist with identification.

There are many pill identification tools online and I have been asked several times for my professional opinion on the usefulness of one or more of these programs for the identification of pills from Canada. Many of these databases are of US origin and their accuracy in identifying Canadian pills is unknown.

For a more objective comparison I decided to search for 3 different Canadian pills using 9 different ID tools available online. From my past experiences, one is more likely to identify the correct pill when searching via imprint codes alone. Addition of color and shape often leave you with no results and descriptions of color and shape are not standardized. For example the same pill could be described as oval, capsule shaped, or caplet; or a peach toned pill could be labelled as orange or pink. Also imprints codes are almost guaranteed to be unique to the product, where as there are limited colors and shapes for any pill.

I used an imprint code search for the following Canadian pills:
  • Co ciprofloxacin 500 mg tablet, made by Cobalt Pharmaceuticals, a generic manufacturer in both the US and Canada.
  • Description in the eCPS: Each white to off-white, capsule shaped, biconvex, film-coated tablet, embossed “CR 500” on one side and (embossed arrowhead or greater than sign) on the other side.
  • I searched for CR 500 (symbols can not be used in these databases)
  • Comment: It appears that this pill has the same markings in Canada and the US, therefore I would expect to find it in almost all of the databases.

  • Hyzaar 50 mg/12.5 mg (losartan 50 mg & hydrochlorothizaide 12.5 mg). Made by Merck Frost, a large brand name manufacturer in the US and Canada.
  • Description in the eCPS: Each yellow, oval shaped, film-coated tablet, marked with code 717 on one side and plain on the other.
  • I searched for 717.
  • Comment: In November 2008 Merck Frosst changed the tablet shape and imprint codes in Canada, but not the US, therefore I would expect that the US based databases will only find the US product.
  • Novamoxin 500 mg capsules, made by NovoPharm, a large generic manufacturer in Canada only.
  • Description in the eCPS: Each hard gelatin capsule with opaque scarlet cap and yellow body, size #0, printed white NOVO and 500 on opposing cap and body portions of the capsule.
  • I searched for Novo 500.
  • Comment: NovoPharm products are not available in the US, therefore I would not expect to find this drug in the US databases.


Pill identification databases searched:

FREE DATABASES:

  • Pillbox beta enables identification of solid dosage forms based on imprint, shape, color, size and scoring. It is currently under development by the National Library of Medicine and National Institute of Health and is not intended for clinical use (then why is it freely available online??). As of September 2009 is contains 5,693 records, but only 779 have images. Additional drug information is provided by DailyMed and the Drug Information Portal. This database is US based. I used the HMTL-based screen reader compatible version as my office computer did not allow use of the Adobe Flex version.
  • DailyMed Product Identification System is also provide by the National Library of Medicine and contains 5128 approved prescription drugs in the US. One can search via imprint, color, shape, size and scoring. Additional drug information is provided from the official FDA labels
  • Drugs.com Pill Identifier content is provided by Cerner Multum and Thomson-Reuter Micromedex. This website has a disclaimer that it is intended for use by consumers in the United States only. One can search for pills via imprint (mandatory), color and shape (both optional). Provides links to addition drug information from Physicians' Desk Reference, Cerner Multum, Micromedex and Wolter Kluwer Health. US based database.
  • RxList.com Pill Identification Tool is another US based database that allows consumers to search for pills via imprint, color, shape, and brand/generic name. RxList is owned and operated by WebMD. I could not find what sources of drug information are used for this database.
SUBSCRIPTION DATABASES: (requires paid subscription for access)
  • Micromedex Identidex is produced by Thomson Reuters. Users can search via imprint code, color, shape or pattern. It contains more than 74,000 indexed terms to identify pharmaceuticals based on imprint codes. Micromedex Identidex is US based, but they attempt to include international products as well. Links to additional drug information (DrugDex monograph or PoisonDex, if user has subscription to these databases).
  • Facts & Comparisons 4.0 Drug Identifier is produced by Wolter Kluwer and contains more than 5,000 images. Users can search via imprint, dose form, score, shape, color 1, color 2, trade/generic name, labeler/manufacturer name, or NDC/labeler code. Once a product is found links to Drug Facts and Comparisons monograph and MedFacts/Medguide patient handouts are available. All Facts & Comparisons products are US based.
  • eCPS Product Identification Tool is the only exclusively Canadian identification tool that I am aware of. Product information and images are provided by the manufacturer. One can search via dosage form, shape, color, imprint, scored, brand name or generic name. There are no links to complete product monographs, users must return to the eCPS general search for additional information. This tool only contains brand name products, therefore it will not be able to identify generic pills. It also contains images of injections, transdermal patches, topical products, powders, inhalers, eye/ear product, suppositories, etc.
  • eCPS Advanced Search is not specifically designed as a product identification tool, but can be used as such, if one searches for imprint codes in the product information section of the monographs. This advanced search will search all monographs in the eCPS, including generic products and is a useful compliment to the Product Identification Tool.
  • Lexi-Drug ID provided by Lexi-Comp searches for pills based on imprint, dosage form, shape or colors. Links are provided to search other Lexi-Comp databases for additional drug information once product has been identified. It is a US based tool.

RESULTS: Documented whether each site found the correct drug, if the manufacturer was identified and if an image of the pill was available for verification.

Results are in Google Docs spreadsheet (as I could not figure out how to insert my original Word table here!)

No single pill identification database found all three pills via imprint codes. Micromedex Identidex and the eCPS Advanced Search identified 2 out of the 3 pills. The eCPS Product Identification Tool was the only database that provided an image to confirm the identity of a pill (Hyzaar). The free US based databases did not find any of the Canadian pills.

Several databases identified Co ciprofloxacin 500 mg because the US and Canadian products have the exact same imprint codes, but this would not necessarily be known to the searcher and not all manufacturers use the same imprint codes for US and Canadian products.

Hyzaar 50 mg/12.5 mg was only identified by the eCPS, all of the other databases found the US product which is also imprinted with 717, but after the November 2008 manufacturing change, this would not be helpful for identifying the Canadian product. Searching only for 717 resulted in numerous results on several of the websites, in this case narrowing by color or shape would have helped to decreased the number of results.

Novamoxin, the exclusively Canadian product was only identified by Micromedex. The eCPS Product Identification Tool only includes brand name products, and the Advanced Search function found 500+ results when searching for Novo 500. No results were found the other databases.

LIMITATIONS: Results only apply to identification of Canadian pills, as the majority of the databases were US in origin, one would expect better results when attempting to identify US pills. Databases were selected based on familiarity and accesibility, therefore other important pill identification databases may have been excluded. The three pills were selected with the knowledge that many of the databases were US based, this may have biased the results against the US databases. Use of the subscription databases are restricted to paid users, which limits their usefulness for those who do not have access.

DISCUSSION: There are a couple other methods for identification of Canadian pills. The easiest method is to ask a dispensing pharmacist or technician who see these products on a daily basis, in many cases they can identify the pill with a quick glance.

Most Canadian provinces attempt to control drug costs by using generic products, therefore many requests for pill identification will be from a Canadian generic manufacturer. Companies like Apotex, NovoPharm, Pharmascience, GenPharm (now Mylan), and Cobalt use distinct and easily recognized imprint codes (Apotex =APO; Novopharm = NOVO, Pharmascience = P or PMS, etc). Each of these companies websites maintain a product directory with product images, therefore once the pill manufacutrer is identified, the website can used for confirmation. These sites do not allow imprint code searching, therefore probably would not be useful to the non-pharmacist, but this is the method that I use to identify generic products in Canada.

Other Canadian databases that are not useful for identification of pills from imprint codes, shape or color include the Drug Product Database (DPD) from Health Canada. This website allows searching via DIN (Drug Identification Number), ATC (Anatomical Therapeutic Classification), Company, Product Name (brand), Active Ingredient (generic), and Active Ingredient Group Number). Some of the entries have links to the complete Canadian product monograph, therefore DPD could be used for confirmation after a pill is identified, but at the moment is not useful for inital searching. This database probably has the most potential for development into a pill ID tool.

Medbroadcast.com for Canadian consumers is produced by MediResource provides Canadian drug information, but is only searchable via DIN or drug name.

Ident-a-drug from Therapeutic Research Center (publishers of Pharmacists' Letter and Natural Medicines Comprehensive Database, two of my favorites) allows searching via imprint code, US NDC or Canadian DIN or advanced searching. This is a subscription database that I do not have access to, therefore I could not include it, but it appears promising.

CONCLUSION: The best pill identification websites for identification of Canadian pills via imprint codes are the eCPS (Product Identification Tool and Advanced Search) and Micromedex Identidex. As expected the US based databases failed to identify Canadian products, except when the imprint codes were exactly the same in both countries (Co ciprofloxacin). Even then, confirmation with a Canadian resource is require to confirm this, as some pills have different imprint codes in the US and Canada (Hyzaar). Pills from exclusively Canadian manufacturers (Novamoxin) will not be found in US databases.

There is a need for a comprehensive Canadian pill identification tool as reliance on US based databases is inappropriate and inadequate. Pharmacists currently must work with several sources (eCPS, Micromedex, generic manufacturer websites) when attempting to identify pills via imprint codes and there are no freely available pill ID sites for Canadian consumers. In my opinion organizations such as Health Canada or the Canadian Pharmacists Association (publisher of the CPS) are in the best position to develop such a tool.

7 comments:

  1. Thanks for a terrific review! We're looking to support the Canadian market with our PASS Rx product, and this review points out some very important concerns that are relevant to us.

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  2. Thanks. Another interesting site on this topic Pills Giude

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  3. Thanks for the info. It can be a little scary if you find some stray pills. My dad found some pills at his house and didn't know what they were. He took them to his local pharmacy and they helped him identify them, but just imagine if he took the wrong pills! That's so scary.

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    1. This is an extremely important issue. I am currently trying to identify a tablet my father has been taking.. given to him by the pharmacy, in place of Warfarin. His blood levels are so terrible now... he's headed for a stroke. I am so mad I could spit.
      Fantastic research paper. Thank you.

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  4. Thanks for doing all this research. Everything online seems to be U.S. based. What about us here in Canada? I have a pill that I'd like to ID but can't find it in any info source I've looked into. I will no doubt be able to get it at the Library. They usually have a copy of the 'COMPENDIUM OF PHARMACEUTICALS AND SPECIALTIES, THE CANADIAN REFERENCE FOR HEALTH PROFESSIONALS' in their Reference area. It's a huge blue book with about 800 pages and has all sorts of info but since it's designed for Doctors, alot of what's in it may be too technical for the average person. But has pages and pages of photos of pills which help you to identify just about anything. I actually have a copy, but it's a 1984 - still valid for old meds, but obviously not for the newer drugs of today.

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  5. Thank you so much for taking the time to provide us with the research info. I have been trying for months to identify certain pills and get information on these pills I will try a few of the identifiers you mentioned. we do need more web sites available for Canadian medication. it is so kind of you to take the time to make this information available to us. keep up the great reports.

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  6. Pill identifier for Canadian pills, including generics - http://canadian-pill-identifier.com/pill-identifier.php?site_language=english

    ReplyDelete