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The Anatomical Therapeutic Chemical (ATC) Classification System is a drug classification system that classifies the
active ingredient An active ingredient is any ingredient that provides biologically active or other direct effect in the diagnosis, cure, mitigation, treatment, or prevention of disease or to affect the structure or any function of the body of humans or animals. The ...
s of drugs according to the organ or system on which they act and their
therapeutic A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis. As a rule, each therapy has indications and contraindications. There are many different ...
,
pharmacological Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemica ...
and chemical properties. Its purpose is an aid to monitor drug use and for
research Research is " creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, characterized by a particular attentiveness ...
to improve quality medication use. It does not imply drug recommendation or efficacy. It is controlled by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
Collaborating Centre for Drug Statistics Methodology (WHOCC), and was first published in 1976.


Coding system

This pharmaceutical coding system divides drugs into different groups according to the organ or system on which they act, their
therapeutic A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis. As a rule, each therapy has indications and contraindications. There are many different ...
intent or nature, and the drug's chemical 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 example
acetylsalicylic acid Aspirin, also known as acetylsalicylic acid (ASA), is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and/or inflammation, and as an antithrombotic. Specific inflammatory conditions which aspirin is used to treat ...
(aspirin) has as a drug for local
oral The word oral may refer to: Relating to the mouth * Relating to the mouth, the first portion of the alimentary canal that primarily receives food and liquid **Oral administration of medicines ** Oral examination (also known as an oral exam or or ...
treatment, as a platelet inhibitor, and as an analgesic and
antipyretic An antipyretic (, from ''anti-'' 'against' and ' 'feverish') is a substance that reduces fever. Antipyretics cause the hypothalamus to override a prostaglandin-induced increase in temperature. The body then works to lower the temperature, which r ...
; as well as one code can represent more than one active ingredient, for example is the combination of perindopril with amlodipine, two active ingredients that have their own codes ( and respectively) when prescribed alone. The ATC classification system is a strict hierarchy, 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, 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.


History

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). This system, confusingly also called ATC, was initiated in 1971 by the
European Pharmaceutical Market Research Association European, or Europeans, or Europeneans, may refer to: In general * ''European'', an adjective referring to something of, from, or related to Europe ** Ethnic groups in Europe ** Demographics of Europe ** European cuisine, the cuisines of Europe a ...
(EphMRA) and is being maintained by the EphMRA and Intellus. Its codes are organised into four levels. The WHO's system, having five levels, is an extension and modification of the EphMRA's. It was first published in 1976.


Classification

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


First level

The first level of the code indicates the anatomical main group and consists of one letter. There are 14 main groups: ''Example'': C Cardiovascular system


Second level

The second level of the code indicates the therapeutic subgroup and consists of two digits. ''Example'': C03
Diuretic A diuretic () is any substance that promotes diuresis, the increased production of urine. This includes forced diuresis. A diuretic tablet is sometimes colloquially called a water tablet. There are several categories of diuretics. All diuretics i ...
s


Third level

The third level of the code indicates the therapeutic/pharmacological subgroup and consists of one letter. ''Example'': C03C High-ceiling diuretics


Fourth level

The fourth level of the code indicates the chemical/therapeutic/pharmacological subgroup and consists of one letter. ''Example'': C03CA Sulfonamides


Fifth level

The fifth level of the code indicates the chemical substance and consists of two digits. ''Example'': C03CA01
furosemide Furosemide is a loop diuretic medication used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. It may also be used for the treatment of high blood pressure. It can be taken by injection into a vein or by m ...


Other ATC classification systems


ATCvet

The ''Anatomical Therapeutic Chemical Classification System for veterinary medicinal products'' (ATCvet) is used to classify
veterinary Veterinary medicine is the branch of medicine that deals with the prevention, management, diagnosis, and treatment of disease, disorder, and injury in animals. Along with this, it deals with animal rearing, husbandry, breeding, research on nutri ...
drugs. 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 code QC03CA01. Some codes are used exclusively for veterinary drugs, such as '' QI Immunologicals'', '' QJ51 Antibacterials for intramammary use'' or ''QN05AX90 amperozide''.


Herbal ATC (HATC)

The Herbal ATC system (HATC) is an ATC classification of herbal substances; it differs from the regular ATC system by using 4 digits instead of 2 at the 5th level group. The herbal classification is not adopted by WHO. The
Uppsala Monitoring Centre Uppsala Monitoring Centre (UMC), located in Uppsala, Sweden, is the field name for the World Health Organization Collaborating Centre for International Drug Monitoring. UMC works by collecting, assessing and communicating information from member c ...
is responsible for the Herbal ATC classification, and it is part of the WHODrug Global portfolio available by subscription.


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, " e DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults."


Adaptations and updates

National issues of the ATC classification, such as the German ''Anatomisch-therapeutisch-chemische Klassifikation mit Tagesdosen'', may include additional codes and DDDs not present in the WHO version. ATC follows guidelines 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 the ''WHO Drug Information'' for 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 and ''WHO Drug Information'' and implemented in the annual print/on-line ACT/DDD Index on January 1. 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. An updated version of the complete on-line/print ATC index with DDDs is published annually on January 1.


See also

*
Classification of Pharmaco-Therapeutic Referrals The ''Classification of Pharmaco-Therapeutic Referrals'' (''CPR'') is a taxonomy focused on defining and grouping together situations requiring a referral from pharmacists to physicians (and vice versa) regarding the pharmacotherapy used by the ...
(CPR) * ICD-10 International Classification of Diseases *
International Classification of Primary Care The International Classification of Primary Care (ICPC) is a classification method for primary care encounters. It allows for the classification of the patient’s reason for encounter (RFE), the problems/diagnosis managed, primary or general hea ...
(ICPC-2) /
ICPC-2 PLUS ICPC-2 PLUS is an extended terminology classified to ICPC-2 International Classification of Primary Care, which aids data entry, retrieval and analysis. ICPC-2 PLUS takes into account the frequency distribution of problems seen in primary health car ...
*
Medical classification A medical classification is used to transform descriptions of medical diagnoses or procedures into standardized statistical code in a process known as clinical coding. Diagnosis classifications list diagnosis codes, which are used to track diseas ...
*
Pharmaceutical care Pharmaceutical care is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life. Definition Hepler and Linda Strand's definition is the most well-known ...
*
Pharmacotherapy Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement (physical therapy), or other modes. Among physicians, sometimes the term ''medical ther ...
* RxNorm


References


External links

* * Quarterly journal providing an overview of topics relating to medicines development and regulation. * from
EphMRA Anatomical Classification (ATC and NFC)

atcd
R script to scrape the ATC data from the WHOCC website; contains link to download entire ATC tree. {{portal bar , Medicine Drugs Pharmacological classification systems World Health Organization