Hello tom136
These resources will all be useful when searching for adverse drug
effects. Which you use will depend on the depth and detail of
information you require:
A. Free Online Databases
There are two sorts of databases. The literature databases, such as
Medline and Toxline, contain records to individual articles that have
appeared in scientific journals. The factual databases, such as DART,
MedlinePlus, Rx.com, contain information that has been synthesized
from such articles and also from other systems of information, such as
post-marketing surveillance (“yellow cards” etc) by physicians. One
thing to remember about literature databases is that adverse effects
will not always be mentioned in the abstract, especially if the focus
of the article was on something else. Therefore, you will not
necessarily pull out every relevant article.
1. Medline
This database is available at the National Library of Medicine:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?SUBMIT=y
If you just plug in the name of the drug, you may find that there are
too many references to review.
You can narrow down your search to identify articles which just deal
with adverse effects by using a MeSH qualifier in your search term,
like this:
salbutamol /adverse effects
When I searched on salbutamol alone, I got 6808 references on Medline.
Searching on salbutamol /adverse effects reduced this to 669
references.
You can reduce this still more by using the limits feature. Click on
“limits”. You are taken to a page where you can define the types of
articles you want. For example, using the salbutamol/adverse effects
search, I got the number down to 646 references, by setting the search
to look for articles describing only human studies, not animal
studies. Limiting the search again, this time to articles written in
English only, brings the number down to 555, and limiting it further
to articles which appear with a summary in the Medline record brings
it down to 391 references. Limiting to articles with a summary is the
logical thing to do if you have to rely just on Medline records
without being able to follow up through a library the articles you
retrieve.
As well as /adverse effects, you can also use /toxicity as a
qualifier, although this will retrieve articles more to do with cases
of poisoning, or with preclinical studies carried out in animals.
2. Toxnet
This is a set of databases, also at the National Library of Medicine,
which deal with toxicology of chemicals, including drugs. There is
now a common search box for all the databases. Once you have done the
search, you can then select to view records retrieved from each
database in turn. Unfortunately, the search features are primitive.
I put salbutamol in as a search term, and got the information that
there are 45 records in HSDB (Hazardous Substances Database), 80 in
DART (Developmental and Reproductive Toxicology database) and 1083 in
Toxline.
HOWEVER, when I went into HSDB, it told me there was no primary record
for this substance, ie the records retrieved mention it, but only in
connection to other chemicals. For example, a record might give
details of a case report on something completely different where the
subject happened to be using salbutamol as well. Therefore, in this
particular example, I would not look further at the HSDB records.
DART did give relevant information about the effects of using
salbutamol in pregnancy, for example. However, the retrieved records
did also include animal studies.
TOXLINE gives a huge number of records. However, these again are a
mixture of laboratory studies in animals or cell culture, case
reports, clinical studies, etc.
I tend to use Toxnet more as a backup if I cannot find enough
information on Medline, because the amount of information retrieved
can be overwhelming and it is not possible to limit the searches.
However, one very useful feature of Toxnet is the ChemIDplus database.
Select the ChemIDplus record, and then select “names and synonyms”,
and you will get a list of the chemical, generic and brand names for
the compound, as well as the code numbers used in trials.
Our example substance, salbutamol, gives two records: albuterol and
levalbuterol. If you select the full record for albuterol, and then
look at synonyms, you will find the following information:
The MeSH heading for this compound is albuterol, not salbutamol. MeSH
is the indexing system used for Medline. You now know that any record
of an article that deals with this compound will be indexed with the
term “albuterol”, therefore, if you search Medline using the term
“albuterol”, rather than “salbutamol”, you will pull out all records,
regardless of whether the authors referred to salbutamol, albuterol,
Ventolin or any of the other names used.
Other names used for this compound are:
-(tert-Butylaminomethyl)-4-hydroxy-m-xylene-alpha1,alpha3-diol;
2-(tert-Butylamino)-1-(4-hydroxy-3-hydroxymethylphenyl)ethanol;
4-Hydroxy-3-hydroxymethyl-alpha-((tert-butylamino)methyl)benzyl
alcohol; AH 3365; Aerolin; Albuterol; BRN 2213614;
DL-N-tert-Butyl-2-(4-hydroxy-3-hydroxymethylphenyl)-2-hydroxyethylamine;
EINECS 242-424-0; Proventil HFA; Proventil Inhaler; Salbutamol;
Salbutamolum [INN-Latin]; Saventol; Sultanol; Sultanol N; Ventolin;
Ventolin Inhaler; Volmax;
alpha'-((tert-Butylamino)methyl)-4-hydroxy-m-xylene-alpha,alpha'-diol;
alpha(sup 1)-((tert-Butylamino)methyl)-4-hydroxy-m-xylene-alpha,alpha'-diol;
dl-Albuterol; dl-Salbutamol; m-Xylene-alpha,alpha'-diol,
alpha-((tert-butylamino)methyl)-4-hydroxy-
This can be extremely useful information to have when accessing other
information resources.
You can reach ChemIDplus directly from
http://chem.sis.nlm.nih.gov/chemidplus/
BTW, there is also a feature to input and view chemical structures.
This requires a plug-in, however, not having a plug-in does not
prevent you accessing the textual information.
3. Medline Plus
This is a resource for patients. However, the drug information
section is useful if you want a quick overview of side effects as
listed on packet inserts:
http://www.nlm.nih.gov/medlineplus/druginformation.html
You can search for the drug by name, or browse an alphabetical list of
generic and brand names. The browse option is useful if you are not
sure whether you have the correct spelling (it has helped me many
times!!!).
Here, salbutamol did not show up, so I searched on albuterol - and
incidentally realised that I started my example answers using the UK
version of a drug name :) You have a choice, for some drugs, of
looking at a Medmaster record or a USP (US Pharmacopoiea) one. The
USP records have more details.
The USP record here is a general one for adrenergic bronchodilators
taken by inhalation. All the drugs that act through the same
mechanisms are listed here, together with the most common brand names
under which they are sold. The side effects are categorised as
common, less common or rare, and those which require immediate
reporting are listed separately. There is also a listing of
medications which could cause problems if taken with albuterol.
4. Rx.com http://www.rx.com
This links to various online pharmacies, but is a useful source of
drug information as well
You can search by name or browse. Firstly, once you have skipped the
intro, choose “drug information”. You can then search by name or
browse an alphabetical list. The record has two parts. One is patient
education information, and the other is clinical information.
Clinical information provides much more detail.
B. Paid Online Databases
1. Embase This is a literature database produced by the Dutch company
Elsevier. It is known for its detailed coverage of drug-related
literature. Also, it is generally considered to give better coverage
than Medline of non-US sources. It is available through hosts such as
Dialog http://www.dialog.com/ or through a service for educational
institutions such as Science Direct .
Embase also has qualifiers:
/side-effect
/adverse-drug-reaction
/drug-interaction
/drug-toxicity
Information on how to search Embase at Science Direct
http://www.info.sciencedirect.com/sd_updates/sd_connect/issues/Nov2000/sdcx_sdc_5.html
You can search Dialog on a non-subscriber basis, paying for each
separate search by credit card. This is Dialog’s Open Access option.
The drug-related medical search is at
http://openaccess.dialog.com/med/ Note that the drop-down menu
allows you to limit your search to adverse effects. If you select
this, the system will automatically format your search for all the
databases you have selected, so you don’t have to worry about using
qualifiers. You have a choice of one, two or all three of Medline,
Embase and Biosis (another large biological and medical literature
database). Remember that if you search Medline on Dialog, there will
be a fee to pay, while if you search at NLM, it is free. However, the
cost of Medline is fairly low, compared to that of Embase and Biosis.
If you do want to use Embase on Dialog, you can search it together
with Medline, and then make sure all duplicate records are selected
from Medline not Embase. Otherwise, you can search Medline first at
NLM, and then manually exclude duplicates that come up in your Embase
search (tiresome, but keeps costs to the minimum possible).
2. Meyler's Side Effects of Drugs
Available on Dialog under the name SEDBASE, but NOT on Open Access,
also available on CD-ROM from Silver Platter. This is a resource you
would need to access through a library or educational institution.
Information from Dialog:
http://library.dialog.com/bluesheets/html/bl0070.html
C Other lists of helpful resources and hints
Medwatch: the FDA safety information and adverse event reporting
program http://www.fda.gov/medwatch/
“serves both healthcare professionals and the medical product-using
public. We provide important and timely clinical information about
safety issues involving medical products, including prescription and
over-the-counter drugs, biologics, medical and radiation-emitting
devices, and special nutritional products (e.g., medical foods,
dietary supplements and infant formulas).
Medical product safety alerts, recalls, withdrawals, and important
labeling changes that may affect the health of all Americans are
quickly disseminated to the medical community and the general public
via this web site and the MedWatch E-list.”
You may find it useful to subscribe to the list.
“Considering adverse effects of interventions - and beneficial side
effects - in Cochrane reviews: interim recommendations”
http://www.aston.ac.uk/lhs/teaching/pharmacy/cebp/cpharm/adr4rt~1.htm
Adverse drug reactions (links to publishers of resources, including
journals) http://www.dal.ca/~pharmwww/druginfo/adversedrug.html (from
Dalhousie University)
With respect to journals, the Dalhousie site mentions a couple
specifically dealing with adverse reactions. However, reports on
adverse reactions can also be published in general journals of
medicine and toxicology, and also in journals relating to specific
medical conditions. The best approach is to make a note of the
journals that come up in your database searches most often, since
these will be the most relevant to you. Many publishers will now
email you the contents list from each new issue if you sign up for
this on their web site. |
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