Aligning dm+d VMP class medicinal products to the SNOMED International drug model

The scope of this work is the modelling of virtual medicinal product (VMP) classes, their attributes, and their descriptions.

Attribute alignment

To align the current dm+d VMP model to the SNOMED International drug model, several attributes need to be reviewed (either removed or added to the model).

These are:

Has specific active ingredient (phase 1)
Has NHS BoSS (Basis of Strength Substance) (phase 1)
Count of base of active ingredient (phase 1)
Strength values and units (phase 1)
Has manufactured dose form (phase 2)
Has Unit of presentation (phase 2)

Several attributes will remain unchanged as they do not require any modification.

These are:

Freeness indicator
Prescribing status
Non-availability indicator
Has controlled drug category
Combination product indicator
Dose form indicator
Has ontology form and route
Has route of administration
Unit of administration (for insulin and drop dose forms)
Has dispensed dose form

Description alignment

VMP class descriptions to be reviewed are:

fully specified names (FSN)*
synonyms

*The proposal by SNOMED International to increase the maximum length of fully specified name (FSN) and synonym descriptions, from 255 to 4096 characters, will impact FSNs created in the SNOMED CT UK Drug Extension.

Description generation patterns

Clauses:

BoSS = <Boss> or <Boss> (as <Precise active ingredient>) if BoSS != precise active ingredient

StrengthNumerator = <strength numerator value> <strength numerator unit of measure>

StrengthDenominator = <strength denominator value> <strength denominator unit of measure>

DispensedDoseForm = <dispensed dose form>

UnitDoseForm = <UDFS> <UDFS_UOMCD> <UNIT_DOSE_UOMCD>

Freeness = <freeness if applicable>

Discrete without denominator

FSN: Product containing precisely <Boss> <strength numerator value>/1 each <dispensed dose form> <UDFS> <freeness if applicable> (clinical drug)

Acceptable synonym: <Boss> <strength numerator value> <dispensed dose form><UDFS> <freeness if applicable>

Discrete with denominator

FSN: Product containing precisely <Boss> <strength numerator value>/<strength denominator value> <dispensed dose form> <UDFS> <freeness if applicable> (clinical drug)

Acceptable synonym: <Boss> <strength numerator value> /<strength denominator value> <dispensed dose form><UDFS> <freeness if applicable>

Continuous

FSN: Product containing precisely <Boss> <strength numerator value>/<strength denominator value> <dispensed dose form> <freeness if applicable> (clinical drug)

Acceptable synonym: <Boss> <strength numerator value> /<strength denominator value> <dispensed dose form> <freeness if applicable>

FSN, preferred terms and acceptable synonyms examples for single ingredient products

Principles and templates follow the new VMP description generation rules:

FSN: Use the SNOMED International FSN term

Preferred term: Use the dm+d term

Acceptable synonym: Use the SNOMED International Preferred Term

Discrete dose form with denominator

Before

Current VMP descriptions

FSN: Phenol 7.5% in Glycerol solution for injection 5ml ampoules (product)

Preferred term: Phenol 7.5% in Glycerol solution for injection 5ml ampoules

Acceptable synonym: None

Current VMP FSN and attributes visualisation

Download the current discrete dose form with denominator VMP FSN and attributes visualisation

Image description

This diagram illustrates the primitive concept definition for 'Phenol 7.5% in Glycerol solution for injection 5ml ampules (product) |32769711000001109|'.

The numerical reference given with each concept and attribute is the SNOMED CT identifier.

Phenol 7.5% in Glycerol solution for injection 5ml ampules (product)' |32769711000001109|, has subtype relationships of:

the defined concept 'Phenol (product) |777168008|'
the concept 'Virtual medicinal product (product) |10363801000001108|'

Phenol 7.5% in Glycerol solution for injection 5ml ampules (product)' |32769711000001109|, has the defining attributes:

VMP non-availability indicator (attribute) |8940601000001102|, with concept 'Available (qualifier value) |8940901000001109|'
Has NHS dm+d (dictionary of medicines and devices) controlled drug category (attribute) |13089101000001102|, with concept 'Controlled drug category No Controlled Drug Status (qualifier value) |8481000001100|'
Has dispensed dose form (attribute) |10362901000001105|, with defined concept 'Conventional release solution for injection (dose form) |385219001|'
Has NHS dm+d dose form indicator (attribute) |13088701000001106|, with concept 'Discrete dose form indicator (qualifier value) |8181000001105|'
Has NHS dm+d VMP route of administration (attribute) |13088401000001104|, with concept 'Intrathecal route (qualifier value) |72607000|'
Has specific active ingredient (attribute) |10362801000001104|, with concept 'Phenol (substance) |116613007|'
Has NHS dm+d VMP ontology form and route (attribute) |13088501000001100|, with concept 'solutioninjection.intrathecal ontology form and route (qualifier value) |3431000001105|'
VMP prescribing status (attribute) |8940001000001105|, with concept 'VMP valid as a prescribable product (qualifier value) |8940201000001104|'

After

VMP generation description following new FSN description rules:

FSN: Product containing precisely phenol 75 milligram/1 gram conventional release solution for injection 5 milliliter ampule (clinical drug)

Preferred term: Phenol 7.5% in Glycerol solution for injection 5ml ampoules

Acceptable synonym: Phenol 75 mg/gram solution for injection 5 ml ampoule

New VMP FSN and attributes visualisation

Download the new discrete dose form with denominator VMP FSN and attributes visualisation.

Image description

This diagram illustrates the primitive concept definition for 'Product containing precisely phenol 75 milligram/1 gram conventional release solution for injection 5 milliliter ampule (clinical drug) |32769711000001109|'. Note - this is a 'concept', despite not being contained in a blue rectangular box like other concepts in the diagram.

The numerical reference given with each concept and attribute is the SNOMED CT identifier.

Product containing precisely phenol 75 milligram/1 gram conventional release solution for injection 5 milliliter ampule (clinical drug) |32769711000001109|, has subtype relationships of:

the defined concept 'Phenol (product) |777168008|'
the concept 'Virtual medicinal product (VMP) (product) |10363801000001108|'

Product containing precisely phenol 75 milligram/1 gram conventional release solution for injection 5 milliliter ampule (clinical drug) |32769711000001109|, has the defining attributes:

VMP non-availability indicator (attribute) |8940601000001102|, with concept 'Available (qualifier value) |8940901000001109|'
Has NHS dm+d (dictionary of medicines and devices) controlled drug category (attribute) |13089101000001102|, with concept 'Controlled drug category No Controlled Drug Status (qualifier value) |8481000001100|'
Has dispensed dose form (attribute) |10362901000001105|, with defined concept 'Conventional release solution for injection (dose form) |385219001|'
Has NHS dm+d dose form indicator (attribute) |13088701000001106|, with concept 'Discrete dose form indicator (qualifier value) |8181000001105|'
Has NHS dm+d VMP route of administration (attribute) |13088401000001104|, with concept 'Intrathecal route (qualifier value) |72607000|'
Has NHS dm+d VMP ontology form and route (attribute) |13088501000001100|, with concept 'solutioninjection.intrathecal ontology form and route (qualifier value) |3431000001105|'
VMP prescribing status (attribute) |8940001000001105|, with concept 'VMP valid as a prescribable product (qualifier value) |8940201000001104|'
Count of base active ingredient (attribute) |1142139005|, with the concrete value of 1

Product containing precisely phenol 75 milligram/1 gram conventional release solution for injection 5 milliliter ampule (clinical drug) |32769711000001109|, also has an attribute group with the defining attributes:

Has presentation strength denominator unit (attribute) |732947008|, with concept 'gram (qualifier value) |258682000|'
Has presentation strength numerator unit (attribute) |732945000|, with concept milligram (qualifier value) |258684004|'
Has basis of strength substance (attribute) |732943007|, with concept 'Phenol (substance) |116613007|'
Has precise active ingredient (attribute) |762949000|, with concept 'Phenol (substance) |116613007|'
Has presentation strength denominator value (attribute), with the concrete value of 1
Has presentation strength numerator value (attribute) |1142135004|, with the concrete value of 75

Discrete dose form without denominator

Before

Current VMP descriptions:

FSN: Lamotrigine 100mg tablets (product)

Preferred term: Lamotrigine 100mg tablets

Acceptable synonym: None

Current VMP FSN and attributes visualisation

Download the current discrete dose form without denominator VMP FSN and attributes visualisation.

Image description

This diagram illustrates the primitive concept definition for 'Lamotrigine 100mg tablets (product) |42130611000001108|'.

The numerical reference given with each concept and attribute is the SNOMED CT identifier.

Lamotrigine 100mg tablets (product) |42130611000001108| has subtype relationships of:

the defined concept 'Lamotrigine (product) |776470002|'
the concept 'Virtual medicinal product (VMP) (product) |10363801000001108|'

Lamotrigine 100mg tablets (product) |42130611000001108|, has the defining attributes:

VMP non-availability indicator (attribute) |8940601000001102|, with concept 'Available (qualifier value) |8940901000001109|'
Has NHS dm+d (dictionary of medicines and devices) controlled drug category (attribute) |13089101000001102|, with concept 'Controlled drug category No Controlled Drug Status (qualifier value) |8481000001100|'
Has dispensed dose form (attribute) |10362901000001105|, with defined concept 'Conventional release oral tablet (dose form) |421026006|'
Has NHS dm+d dose form indicator (attribute) |13088701000001106|, with concept 'Discrete dose form indicator (qualifier value) |8181000001105|'
Has specific active ingredient (attribute) |10362801000001104|, with concept 'Lamotrigine (substance) |387562000|'
Has NHS dm+d VMP route of administration (attribute) |13088401000001104|, with concept 'Oral route (qualifier value) |26643006|'
Has NHS dm+d VMP ontology form and route (attribute) |13088501000001100|, with concept 'tablet.oral ontology form and route (qualifier value) |21000001106|'
VMP prescribing status (attribute) |8940001000001105|, with concept 'VMP valid as a prescribing product (qualifier value) |8940201000001104|'

After

New VMP descriptions:

FSN: Product containing precisely lamotrigine 100 milligram/1 each conventional release oral tablet 1 tablet tablet (clinical drug)

Preferred term: Lamotrigine 100mg tablets

Acceptable synonym: Lamotrigine 100 mg oral tablet 1 tablet tablet

New VMP FSN and attributes visualisation

Download the new discrete dose form without denominator VMP FSN and attributes visualisation.

Image description

This diagram illustrates the primitive concept definition for 'Product containing precisely lamotrigine 100 milligram/1 each conventional release oral tablet 1 tablet tablet (clinical drug) |42130611000001108|'. Note - this is a 'concept', despite not being contained in a blue rectangular box like other concepts in the diagram.

The numerical reference given with each concept and attribute is the SNOMED CT identifier.

Product containing precisely lamotrigine 100 milligram/1 each conventional release oral tablet 1 tablet tablet (clinical drug) |42130611000001108|, has subtype relationships of:

the defined concept 'Lamotrigine (product) |776470002|'
the concept 'Virtual medicinal product (VMP) (product) |10363801000001108|'

Product containing precisely lamotrigine 100 milligram/1 each conventional release oral tablet 1 tablet tablet (clinical drug) |42130611000001108|, has the defining attributes:

VMP non-availability indicator (attribute) |8940601000001102|, with concept 'Available (qualifier value) |8940901000001109|'
Has NHS dm+d (dictionary of medicines and devices) controlled drug category (attribute) |13089101000001102|, with concept 'Controlled drug category No Controlled Drug Status (qualifier value) |8481000001100|'
Has dispensed dose form (attribute) |10362901000001105|, with defined concept 'Conventional release oral tablet (dose form) |421026006|'
Has NHS dm+d dose form indicator (attribute) |13088701000001106|, with concept 'Discrete dose form indicator (qualifier value) |8181000001105|'
Has NHS dm+d VMP route of administration (attribute) |13088401000001104|, with concept 'Oral route (qualifier value) |26643006|'
Has NHS dm+d VMP ontology form and route (attribute) |13088501000001100|, with concept 'tablet.oral ontology form and route (qualifier value) |21000001106|'
VMP prescribing status (attribute) |8940001000001105|, with concept 'VMP valid as a prescribing product (qualifier value) |8940201000001104|'
Count of base active ingredient (attribute) |1142139005|, with the concrete value of 1

Product containing precisely lamotrigine 100 milligram/1 each conventional release oral tablet 1 tablet tablet (clinical drug) |42130611000001108|, also has an attribute group with the defining attributes:

Has basis of strength substance (attribute) |732943007|, with concept 'Lamotrigine (substance) |387562000|'
Has precise active ingredient (attribute) |762949000|, with concept 'Lamotrigine (substance) |387562000|
Has presentation strength numerator unit (attribute) |732945000|, with concept milligram (qualifier value) |258684004|'
Has presentation strength numerator value (attribute) |1142135004|, with the concrete value of 100

Continuous dose form

Before

Current VMP descriptions:

FSN: Acetazolamide 18mg/5ml oral solution (product)

Preferred term: Acetazolamide 18mg/5ml oral solution

Acceptable synonym: None

Current VMP FSN and attributes visualisation

Download the current continuous dose form VMP FSN and attributes visualisation.

Image description

This diagram illustrates the primitive concept definition for 'Acetazolamide 18mg/5ml oral solution (product) |11651111000001106|'.

The numerical reference given with each concept and attribute is the SNOMED CT identifier.

Acetazolamide 18mg/5ml oral solution (product) |11651111000001106|, has subtype relationships of:

the defined concept 'Acetazolamide (product) |774413005|'
the concept 'Virtual medicinal product (VMP) (product) |10363801000001108|'

Acetazolamide 18mg/5ml oral solution (product) |11651111000001106| has the defining attributes:

Has specific active ingredient (attribute) |10362801000001104|, with concept 'Acetazolamide (substance) |372709008|
VMP non-availability indicator (attribute) |8940601000001102|, with concept 'Available (qualifier value) |8940901000001109|'
Has NHS dm+d (dictionary of medicines and devices) dose form indicator (attribute) |13088701000001106|, with concept 'Continuous dose form indicator (qualifier value) |8171000001108|'
Has NHS dm+d controlled drug category (attribute) |13089101000001102|, with concept 'Controlled drug category No Controlled Drug Status (qualifier value) |8481000001100|'
Has dispensed dose form (attribute) |10362901000001105|, with defined concept 'Conventional release oral solution (dose form) |385023001|'
Has NHS dm+d VMP route of administration (attribute) |13088401000001104|, with concept 'Oral route (qualifier value) |26643006|'
Has NHS dm+d VMP ontology form and route (attribute) |13088501000001100|, with concept 'solution.oral ontology form and route (qualifier value) |271000001109|'
VMP prescribing status (attribute |8940001000001105|, with concept 'VMP valid as a prescribable product (qualifier value) |8940201000001104|'

After

VMP generation description following new FSN description rules:

FSN: Product containing precisely acetazolamide 3.6 milligram/1 milliliter conventional release oral solution (clinical drug)

Preferred term: Acetazolamide 18mg/5ml oral solution

Acceptable synonym: Acetazolamide 3.6mg/5ml oral solution

New VMP FSN and attributes visualisation

Download the new continuous dose form VMP FSN and attributes visualisation.

Image description

This diagram illustrates the primitive concept definition for 'Product containing precisely acetazolamide 3.6 milligram/1 milliliter conventional release oral solution (clinical drug) |11651111000001106|'. Note - this is a 'concept', despite not being contained in a blue rectangular box like other concepts in the diagram.

The numerical reference given with each concept and attribute is the SNOMED CT identifier.

Product containing precisely acetazolamide 3.6 milligram/1 milliliter conventional release oral solution (clinical drug) |11651111000001106|, has subtype relationships of:

the defined concept 'Acetazolamide (product) |774413005|'
the concept 'Virtual medicinal product (VMP) (product) |10363801000001108|'

Product containing precisely acetazolamide 3.6 milligram/1 milliliter conventional release oral solution (clinical drug) |11651111000001106|, has the defining attributes:

VMP non-availability indicator (attribute) |8940601000001102|, with concept 'Available (qualifier value) |8940901000001109|'
Has NHS dm+d (dictionary of medicines and devices) dose form indicator (attribute) |13088701000001106|, with concept 'Continuous dose form indicator (qualifier value) |8171000001108|'
Has NHS dm+d controlled drug category (attribute) |13089101000001102|, with concept 'Controlled drug category No Controlled Drug Status (qualifier value) |8481000001100|'
Has dispensed dose form (attribute) |10362901000001105|, with defined concept 'Conventional release oral solution (dose form) |385023001|'
Has NHS dm+d VMP route of administration (attribute) |13088401000001104|, with concept 'Oral route (qualifier value) |26643006|'
Has NHS dm+d VMP ontology form and route (attribute) |13088501000001100|, with concept 'solution.oral ontology form and route (qualifier value) |271000001109|'
VMP prescribing status (attribute |8940001000001105|, with concept 'VMP valid as a prescribable product (qualifier value) |8940201000001104|'
Count of base active ingredient (attribute) |1142139005|, with the concrete value of 1

Product containing precisely acetazolamide 3.6 milligram/1 milliliter conventional release oral solution (clinical drug) |11651111000001106|, also has an attribute group with the defining attributes:

Has precise active ingredient (attribute) |762949000|, with concept 'Acetazolamide (substance) |372709008|'
Has basis of strength substance (attribute) |732943007|, with concept 'Acetazolamide (substance) |372709008|'
Has concentration strength numerator unit (attribute) |733725009|, with concept 'milligram (qualifier value) |258684004|'
Has concentration strength denominator unit (attribute) |733722007|, with concept 'Milliliter (qualifier value) |258773002|'
Has concentration strength denominator value (attribute) |1142137007|, with the concrete value of 1
Has concentration strength numerator value (attribute) |1142138002|, with the concrete value of 3.6

FSN, preferred terms and acceptable synonyms examples for multiple ingredient products

Principles follow those above for single ingredient products.

FSN: Use the SNOMED International FSN term

Preferred term: Use the dm+d term

Acceptable synonym: Use the SNOMED International Preferred Term

Discrete dose form with denominator

FSN: Product containing precisely ammonium chloride 20 milligram/1 milliliter and diphenhydramine 2.5 milligram/1 milliliter conventional release oral solution 5 milliliter spoonful sugar free

Preferred term: 8016611000001102 Ammonium chloride 100mg/5ml / Diphenhydramine 12.5mg/5ml oral solution sugar free

Acceptable synonym: Ammonium chloride 100 mg/1 ml and diphenhydramine 2.5 mg/1 ml oral solution 5 ml spoonful sugar free

Discrete dose form without denominator

FSN: Product containing precisely hydroflumethiazide 25 milligram and spironolactone 25 milligram/1 each conventional release oral tablet 1 tablet tablet (clinical drug)

Preferred term: 42207811000001102|Co-flumactone 50mg/50mg tablets

Acceptable synonym: Hydroflumethiazide 25 mg and spironolactone 25 mg oral tablet 1 tablet tablet

Continuous dose form

FSN: Product containing precisely 9 cis-octadecenoic acid 5 milligram/1 milliliter and anhydrous lanolin 10 milligram/1 milliliter and arachis oil 500 milligram/1 milliliter and calamine 50 milligram/1 milliliter cutaneous liquid

Preferred term: 35914411000001107 Calamine oily lotion

Acceptable synonym: Arachis oil 500 mg/ml and calamine 50 mg/ml cutaneous liquid and oleic acid 5 mg/ml and wool fat 10 mg/1 ml cutaneous liquid

Last edited: 27 June 2025 1:09 pm