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Gingival intended site sits separately in the hierarchy from other oromucosal concepts; we think that "gingival" should be a child of oromucosal


Release Characteristics

13 January 2022 : PDF concepts should not use release characteristic concepts with more than one release characteristic (e.g.  NOT gastro-resistant and prolonged release).  There is some additional thinking to do around the release characteristic hierarchy and particularly "modified release" as a grouper concept

385213000: Conventional release vapor solution for inhalation (dose form)

We feel this should not be “no transformation” BUT we also freel feel the EDQM transform of “mixing” doesn’t feel right.  The AdmDF would be “vapour for inhalation”.  But “mixing” is not the correct transformation as can put solution on a handkerchief and inhale the vapour directly

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Dose formComments
Prolonged-release solution for injectionUsed for products like Buvidal, where it is the dose form (the formulation of the solution for injection) causes the prolonged release; the substance is (still) plain buprenorphine
Oral/rectal solution (and others)

Multiple intended site dose forms should be included, following the pattern that already exists for eye/ear/nose drops.  BUT not all EDQM should be added - there should be evaluation (e.g. EDQM have rejected a "Solution for injection/infusion/rectal use" concept because "it is not appropriate for safety reasons, owing to the different microbiological requirements for the routes of administration covered"

For the decision support use case, grouping concepts by their intended site is often very helpful (for example)

If there is a multiple site manufactured dose form being used by products, the appropriate administrable dose form should be created in SNOMED CT even if there are no products using this directly….since some countries/implementations will be representing the administrable concept as well as the manufactured concept.  The example for this in our list is the “Powder for intravesical solution/solution for injection” with its administrable dose form of “Intravesical solution/solution for injection”

7738

 Implant dose forms

785910004 | Prolonged-release intralesional implant (dose form) |

This PDF is the only one (we think) using "intralesional" as the intended site.  It also is used by only one CD (carmustine).  EDQM does not have the "intralesional" site - it uses parenteral.  Intralesional is not (currently) a child of parenteral so these would not classify up together.  

We would like to discuss whether this "extra" specificity is bringing clinical value.  If this could be "implant", we would have a better match with EDQM and would reflect the authorised dose form.

764842006 | Prolonged-release ocular implant (dose form) |

This PDF is used by a small number of CDs (steroid, antiviral).  The EDQM PDF concept is just "implant" BUT there is a CMT in EDQM that is "intravitreal implant with applicator" that is used on the SmPC for these products (and also by the FDA).   The use of "ocular" as the intended site - whilst not incorrect - does not seem to reflect the actual PDF; would intraocular have been a better choice?  Would "intravitreal" be even more appropriate?

7764842006 | Prolonged-release ocular implant (dose form) |64842006 | Prolonged-release ocular implant (dose form) |764842006 | Prolonged-release ocular implant (dose form) |

73Rel8943003

| Gingival (inteRelended 7738738943003 | Gingival (intended site) |43003 | Gingival (intended site) |8943003 | Gingival (intended site) |3738943003 | Gingival (intended site) |8943003 | Gingival (intended site) |