Natalie Kupferberg, MLS, MA, AHIP
Pharmacy, Psychology and Speech Librarian
Ohio State University

Content

Lexicomp Online is a drug compendium geared for healthcare practitioners and students who need up-to-date, comprehensive drug information on prescription and over–the-counter drugs at the point of care. Its drug information databases include AHFS (American Hospital Formulary Service) Drug Information and Drug Information Essentials; Lexidrugs, which has more basic drug information; several toxicology databases; 450 drug medical safety data sheets and information on antidotes, decontaminants, and household products; a database of natural products; and three patient education databases. There is also an infectious disease database, information on laboratory tests and diagnostic procedures, and brief information about some drugs available outside North America.

In addition to the databases, the compendium features clinical decision tools including a drug interaction database, which allows researchers to enter more than one drug for a report on how they interact; clinical calculators; a pill identifier where users can type in a drug’s imprint, dosage form, shape, and color; and an intravenous-drug interaction tool.

The drug databases provide pharmacists, physicians, nurses, and dentists with in-depth information on adverse reactions, contraindications, dosing, FDA special alerts, medication safety issues, use in pregnancy and lactation, pharmacodynamics/kinetics, pharmacogenomic information, and trade names from over 100 countries. Some items not always found in other drug information sources are pronunciation guides with audio, drug shortages with links to therapeutic alternatives, off label uses, and prices. The monographs include extensive references with links to PubMed, of which 65.5 percent are journal articles and 28.8 percent are evidence-based guidelines.

Specific drug databases for pediatric/neonatal and geriatric populations include detailed guidelines and specific dosing information for these groups.

The information in the databases is created by Lexicomp’s editorial team who are mostly pharmacists and by the American Society of Health-System Pharmacists. All entries list the date that the information was last updated.

Features/Functionality

Searching in Lexicomp is straightforward. There is a single search box that searches all the general categories: drugs, diseases, toxicology, patient education, laboratory databases, and international drugs. Or, users can limit their search to a specific category. The single search box can be filtered by 11 specific terms, including adverse reactions, contraindications, pharmacologic category, and manufacturer. This way, users can quickly find a list of drugs that cause side effects.

When users search the drug monographs, they can use the “navigation tree” located on the left side of the page to go the section they are interested in, e.g., pregnancy and lactation. Or they can jump to a section via a box on the right side. By selecting the image tab, users can see a picture of the drug. Pharmacotherapy pearls (small bits of free standing, clinically relevant information based on experience or observation) are also presented for many medications.

The monographs have helpful charts including comparative tables listing key properties of medications within the same class. They are available by selecting “Charts/special topics” within each drug database.

Probably the most useful clinical tool in the database is the interaction module, which displays potential drug-drug interactions, drug-allergy interactions, and drug-food interactions. Each interaction has an assigned risk rating (A, B, C, D, or X) along with suggestions on therapy modification, a discussion and references.

The home screen shows a list of new FDA approvals and special safety alerts from each month. Clicking on these will take users to the appropriate monograph.

The three separate patient education databases are on adult medications, pediatric medications, and conditions and procedures. The content, most of it available in English and Spanish, is written at a fifth to sixth grade reading level with some medication information available in up to 19 languages. The condition and procedure database also includes discharge instructions and advice on healthy living taken from the UpToDate database. It is easiest to find this information by using the browse feature.

The Lexicomp database presently links to Facts & Comparison’s off-label uses, Briggs Drugs in Pregnancy and Lactation, and occasional clinical guidelines within the drug monographs. However, users cannot get directly to these sources from the single search box.

The strength of this product is that it is comprehensive and easy to use. While the majority of databases in the collection give point-of-care information, users who want more detail can access the databases produced by the American Hospital Formulary Service or consult the numerous references. There also is a helpful user guide.

A weakness is that Lexicomp often changes the sources they use. At the end of this year, the company will be changing the available drug compatibility tool. And, although it is clear how much individuals must pay, institutions have to contact Lexicomp directly for pricing.

Business Model

Lexicomp can be purchased by organizations (hospitals and academic institutions, community chains), but they must contact the vendor for pricing information. Institutions can request usage data through customer service.

Individual subscription prices for a mobile device range from $75 to $285 annually, depending on the databases selected. Individual subscriptions that include the web-based and mobile products are $798 a year. Since many options are available, subscribers should contact the company directly.

Breakthrough

All health clinicians (pharmacists, physicians, nurses, dentists) should find Lexicomp Online easy to use, with comprehensive but succinct content. The interaction tool is invaluable in both the inpatient and outpatient setting. It is recommended as a top choice for prescription and nonprescription drug information.

1. Koppen L, Phillips J, Papageorgiou R. Analysis of reference sources used in drug-related Wikipedia articles. Journal of the Medical Library Association: JMLA. 2015;103(3):140-144. doi:10.3163/1536-5050.103.3.007. Table 1. Source type by information resource; p. 142.

2. Lorin MI, Palazzi DL, Turner TL, Ward MA. What is a clinical pearl and what is its role in medical education? Med Teach. 2008;30(9-10):870-874.

3. Malone PM, Kier KL, Stanovich JE, Malone MJ. Drug information: A guide for pharmacists. Fifth ed. New York: McGraw-Hill; 2014.pp. 912-913.