NAV

Introduction

Please note that the example data provided alongside this document does describe a single drug. Because some drugs may not include any information in some parts of the xml, the examples you see are a composite from multiple drugs.

For up-to-date and complete drug information in this format, please visit http://go.drugbank.com/releases/latest.

Versions

<drugbank xmlns="http://www.drugbank.ca"
  xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
  xsi:schemaLocation="http://www.drugbank.ca http://www.drugbank.ca/docs/drugbank.xsd" version="5.1">

Schema version can be determined by the version attribute of the <drugbank> element at the root of the XML document. The current schema is version 5.1. Older schemas are available for reference at the following locations:

Release Notes

Each change to the DrugBank XML schema is accompanied with release notes, available at http://go.drugbank.com/release_notes.

Drugs

<drug type="small molecule"
  created="2005-06-13"
  updated="2016-04-13">

Drugs are represented by <drug> elements.

Substance other than water and food that when administered by any route can cause a physiological or biological change in the body.

Attributes

Attribute Type Description
type string Either small molecule, or biotech. Biotech is used for any drug that is derived from living systems or organisms, usually composed of high molecular weight mixtures of protein, while small molecule describes a low molecular weight organic compound.
created date Date that this drug was first added to DrugBank.
updated date Denotes when this drug was last updated in DrugBank.

General Information

<drugbank-id primary="true">DB00943</drugbank-id>
<drugbank-id>APRD00562</drugbank-id>

<name>Zalcitabine</name>
<description>
A dideoxynucleoside compound in which the 3'-hydroxyl group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of 5' to 3' phosphodiester linkages, which are needed for the elongation of DNA chains, thus resulting in the termination of viral DNA growth. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [PubChem]
</description>
<simple-description>A medication used to treat HIV.</simple-description>
<clinical-description>A dideoxynucleoside used to treat HIV.</clinical-description>
<therapeutically-significant>true</therapeutically-significant>
<cas-number>7481-89-2</cas-number>
<unii>6L3XT8CB3I</unii>
<average-mass>211.2178</average-mass>
<monoisotopic-mass>211.095691297</monoisotopic-mass>
<state>solid</state>
<groups>
  <group>approved</group>
</groups>
<biotech-categories>
  <biotech-category group="Vaccines">Other vaccines</biotech-category>
</biotech-categories>
<affected-organisms>
  <affected-organism>Human Immunodeficiency Virus</affected-organism>
</affected-organisms>
<ahfs-codes>
  <ahfs-code>28.12</ahfs-code>
</ahfs-codes>
<pdb-entries>
  <pdb-entry>1VOT</pdb-entry>
</pdb-entries>
<fda-label>
https://s3-us-west-2.amazonaws.com/drugbank/fda_labels/DB00943.pdf?1265922808
</fda-label>
<msds>
https://s3-us-west-2.amazonaws.com/drugbank/msds/DB00943.pdf?1265922746
</msds>
<food-interactions>
  <food-interaction>
  Do not take calcium, aluminium, magnesium or iron supplements within 2 hours of taking this medication.
  </food-interaction>
</food-interactions>

Element Type Description
drugbank-id string Other identifiers that may be associated with the drug.
name string
description string Descriptions of drug chemical properties, history and regulatory status.
simple-description string The simple description uses non-technical language and summarizes the most common uses for the drug.
clinical-description string The clinical description includes the key details about indications and mechanism to quickly summarize the drug for a professional user.
therapeutically-significant boolean Indicates whether the drug is used therapeutically.
cas-number string The Chemical Abstracts Service (CAS) registry number assigned to the drug.
unii string Unique Ingredient Identifier (UNII) of this drug.
average-mass floating point The weighted average of the isotopic masses of the drug.
monoisotopic-mass floating point The mass of the most abundant isotope of the drug.
state string One of solid, liquid, or gas.
groups Contains <group> elements which denote the groups this drug belongs to. Groups include approved, vet_approved, nutraceutical, illicit, withdrawn, investigational, and experimental. Other groups that this drug belongs to. May include any of: approved, vet_approved, nutraceutical, illicit, withdrawn, investigational, and experimental.
biotech-categories Contains <biotech-category> elements, each describing a category this drug belongs to (BioTech drugs only). Categorizations of Biotech drug purpose and source. Each category has a name and a group.
affected-organisms Contains <affected-organism> elements which describe organisms affected by this drug. Organisms in which the drug may display activity; activity may depend on local susceptibility patterns and resistance.
ahfs-codes Contains <ahfs-code> elements containing AHFS codes for this drug. The American Hospital Formulary Service (AHFS) identifier for this drug.
pdb-entries Contains <pdb-entry> elements containing PDB identifiers for this drug. Protein Data Bank (PDB) identifiers for this drug.
fda-label URI Contains a URL for accessing the uploaded United States Food and Drug Administration (FDA) Monograph for this drug.
msds URI Contains a URL for accessing the Material Safety Data Sheet (MSDS) for this drug.
food-interactions Contains <food-interaction> elements containing descripts of interactions this drug has with food. Food that may interact with this drug.
general-references See references.
synthesis-reference string Citation for synthesis of the drug molecule.

The list elements (documented above) contain zero or more of their respective child elements:

Element Child Element
<groups> <group>, with string body
<affected-organisms> <affected-organism>, with string body
<ahfs-codes> <ahfs-code>, with string body
<pdb-entries> <pdb-entry>, with string body
<food-interactions> <food-interaction>, with string body

Drug Classification

<classification>
  <description>
  This compound belongs to the class of organic compounds known as pyrimidine nucleosides. These are compounds comprising a pyrimidine base attached to a ribosyl or deoxyribosyl moiety.
  </description>
  <direct-parent>Pyrimidine nucleosides</direct-parent>
  <kingdom>Organic compounds</kingdom>
  <superclass>Nucleosides, nucleotides, and analogues</superclass>
  <class>Pyrimidine nucleosides</class>
  <subclass/>
  <alternative-parent>Aminopyrimidines and derivatives</alternative-parent>
  <alternative-parent>Pyrimidones</alternative-parent>
  <substituent>Pyrimidone</substituent>
  <substituent>Hydrocarbon derivative</substituent>
</classification>

A description of the hierarchical chemical classification of the drug; imported from ClassyFire.

The <classification> element contains child elements of the following types:

Element Description
description
direct-parent
kingdom
superclass
class
subclass
alternative-parent One or more alternative parents
substituent One or more substituents

Synonyms

<synonyms>
  <synonym language="" coder="">2',3'-Dideoxycytidine</synonym>
  <synonym language="" coder="">
  4-amino-1-[(2R,5S)-5-(Hydroxymethyl)tetrahydrofuran-2-yl]pyrimidin-2(1H)-one
  </synonym>
  <synonym language="" coder="">DDC</synonym>
  <synonym language="" coder="">DDCYD</synonym>
  <synonym language="" coder="">Dideoxycytidine</synonym>
</synonyms>

Other names or identifiers that are associated with this drug.

<drug> elements may have one or more <synonym> elements as children of the <synonyms> element.

Each <synonym> element has the following attributes.

Attribute Type Description
language string One or more languages for which the synonym represents. This is typically based on INN naming, and synonyms can exist in multiple languages.
coder string Organisation or source providing the synonym. For example, INN indicates the synonym is an International Nonproprietary Name, while IUPAC indicates the synonym is the nomenclature designated by the International Union of Pure and Applied Chemistry.

External Codes

<external-codes>
  <external-code>RO 24-2027/000</external-code>
</external-codes>

Any other identifiers that might be linked to the drug. This often includes numerical codes used during research and development of the drug.

<drug> elements may have one or more <external-code> elements as children of the <external-codes> element.

Pharmacology

<indication>
  For the treatment of Human immunovirus (HIV) infections in conjunction with other antivirals.
</indication>
<pharmacodynamics>
  Zalcitabine is an analog of 2'-deoxycytidine that is pharmacologically related to but structurally different from other nucleotide reverse transcriptase inhibitors (NRTIs). Zalcitabine inhibits the activity of HIV-1 reverse transcriptase (RT) both by competing with the natural substrate dGTP and by its incorporation into viral DNA.
</pharmacodynamics>
<mechanism-of-action>
  Zalcitabine is a nucleoside reverse transcriptase inhibitor (NRTI) with activity against Human Immunodeficiency Virus Type 1 (HIV-1). Within cells, zalcitabine is converted to its active metabolite, dideoxycytidine 5'-triphosphate (ddCTP), by the sequential action of cellular enzymes. ddCTP interferes with viral RNA-directed DNA polymerase (reverse transcriptase) by competing for utilization of the natural substrate deoxycytidine 5'-triphosphate (dCTP), as well as incorpating into viral DNA. Due to it's lack of a 3'-OH group, the formation of a 5' to 3' phosphodiester linkage that is necessary for DNA chain elongation is inhibited, thus leading to the termination of viral DNA growth.
</mechanism-of-action>
<toxicity>
  Acute overdose: Inadvertent pediatric overdoses have occurred with doses up to 1.5 mg/kg zalcitabine. Chronic overdose: in an initial dose-finding study in which zalcitabine was administered at doses 25 times (0.25 mg/kg every 8 hours) the currently recommended dose, one patient discontinued zalcitabine after 1½ weeks of treatment subsequent to the development of a rash and fever.
</toxicity>
<metabolism>Hepatic</metabolism>
<absorption>
  Bioavailability is over 80% following oral administration.
</absorption>
<half-life>2 hours</half-life>
<protein-binding>Less than 4%</protein-binding>
<route-of-elimination>
  Renal excretion of unchanged drug appears to be the primary route of elimination, accounting for approximately 80% of an intravenous dose and 60% of an orally administered dose within 24 hours after dosing (n=19). Renal clearance exceeds glomerular filtration rate suggesting renal tubular secretion contributes to the elimination of zalcitabine by the kidneys.
</route-of-elimination>
<volume-of-distribution>* 0.304 to 0.734 L/kg</volume-of-distribution>
<clearance>
  * 285 mL/min [HIV-infected patients receiving 1.5 mg IV infusion for 1 hour]
</clearance>

Describes the use, mechanism of action, pharmacokinetics, pharmacodynamics, and physiological or biochemical effects in the body.

Element Type Description
indication string The approved conditions, diseases, or states for which a drug can safely and effectively be used. An indication is considered to be FDA-approved when it has any of the following designations: NDA, ANDA, BLA, or OTC. May also include indications in other countries, such as Canada (through Health Canada) or in Europe (through the European Medicines Agency).
pharmacodynamics string A description of how the drug modifies or affects the organism it is being used in. May include effects in the body that are desired (enzyme or protein targets for example) and undesired (also known as “side effects”). This is in contrast to pharmacokinetics, which describes how the body modifies the drug being used.
mechanism-of-action string A component of pharmacodynamics that describes the biochemical interaction through which a drug produces its intended effect. May include the exact molecular protein or enzyme targets and/or a description of the physiological effects produced.
toxicity string Any adverse reaction, or side effect, that may or may not occur with use of the drug. May be attributed to a number of effects including: an enhanced therapeutic effect, rare anaphylactic reactions, interactions with other medications, or unanticipated binding of the molecule at different sites within the body.
metabolism string A description of the chemical degradation of the drug molecule within the body; most commonly by enzymes from the Cytochrome P450 (CYP) system in the liver.
absorption string A description of the movement of the drug from the site of administration into the bloodstream or target tissue. Common pharmacokinetic metrics used to evaluate absorption include Area Under the Curve (AUC), bioavailability (F), maximum concentration (Cmax), and time to maximum concentration (Tmax).
half-life string The period of time it takes for the amount of drug in the body to be reduced by one half. Provides a description of how quickly the drug is being eliminated and how much is available in the bloodstream.
protein-binding string A description of the drug’s affinity for plama proteins and the proportion of the drug that is bound to them when in circulation within the body.
route-of-elimination string A description of the pathway that is used to excrete the drug from the body. Common pharmacokinetic parameters used to evaluate excretion include elemination half life, renal clearance, and tracking of radiolabelled compounds through the renal and GI system.
volume-of-distribution string The Vd of a drug represents the degree to which it is distributed into body tissue compared to the plasma.
clearance string A pharmacokinetic measurement of the rate of removal of the drug from plasma, expressed as mL/min; reflects the rate of elimination of the drug.

Regional Availability

<regional-availabilities>
  <regional-availability region="CA">
    <max-phase>4</max-phase>
    <marketed-prescription>true</marketed-prescription>
    <generic-available>false</generic-available>
    <pre-market-cancelled>false</pre-market-cancelled>
    <post-market-cancelled>false</post-market-cancelled>
 </regional-availability>
 <regional-availability region="EU">
    <max-phase>0</max-phase>
    <marketed-prescription>false</marketed-prescription>
    <generic-available>false</generic-available>
    <pre-market-cancelled>false</pre-market-cancelled>
    <post-market-cancelled>false</post-market-cancelled>
 </regional-availability>
 <regional-availability region="US">
    <max-phase>4</max-phase>
    <marketed-prescription>true</marketed-prescription>
    <generic-available>false</generic-available>
    <pre-market-cancelled>false</pre-market-cancelled>
    <post-market-cancelled>false</post-market-cancelled>
 </regional-availability>
</regional-availabilities>

<drug> elements may have one or more <regional-availability> elements as children of the <regional-availabilities> element.

Each <regional-availability> element has the following elements.

Element Type Description
max-phase int Maximum phase achieved during development.
marketed-prescription boolean Whether the drug has been marketed for prescription use.
generic-available boolean Whether the drug has been available as a generic
pre-market-cancelled boolean Whether the drug was cancelled before market-availability.
post-market-cancelled boolean Whether the drug was cancelled after market-availability.

In addition, each <regional-availability> element has one attribute which denotes the region this element describes.

Attribute Type Description
region string A country or other jurisdiction.

International Brands

<international-brands>
  <international-brand>
    <name>Acaril-S</name>
    <company>Medifarma</company>
  </international-brand>
</international-brands>

The proprietary names used by the manufacturers for commercially available forms of the drug, focusing on brand names for products that are available in countries other than Canada and the Unites States.

<drug> elements may have one or more <international-brand> elements as children of the <international-brands> element.

Each <international-brand> element has the following elements.

Element Type Description
brand string The proprietary, well-known name for given to this drug by a manufacturer.
company string The company or manufacturer that uses this name.

Mixtures

<mixtures>
  <mixture>
    <name>Cophylac Drops</name>
    <ingredients>Normethadone + Oxilofrine</ingredients>
  </mixture>
</mixtures>

All commercially available products in which this drug is available in combination with other drug molecules.

<drug> elements may have one or more <mixture> elements as children of the <mixtures> element.

Each <mixture> element has the following attributes .

Element Type Description
name string The proprietary name provided by the manufacturer for this combination product.
ingredients string A list of ingredients, separated by addition symbols.
supplemental-ingredients string List of additional active ingredients which are not clinically relevant to the main indication of the product, separated by addition symbols.

Packagers

<packagers>
  <packager>
    <name>J T Baker</name>
    <url>http://www.jtbaker.com</url>
  </packager>
</packagers>

A list of companies that are packaging the drug for re-distribution.

<drug> elements may have one or more <packager> elements as children of the <packagers> element.

Each <packager> element has the following attributes .

Element Type Description
name string
url URI A link to any companies that are packaging the drug for re-distribution.

Manufacturers

<manufacturers>
  <manufacturer generic="false" url="">Hoffmann la roche inc</manufacturer>
</manufacturers>

A list of companies that are manufacturing the commercially available forms of this drug that are available in Canada and the Unites States.

<drug> elements may have one or more <manufacturer> elements as children of the <manufacturers> element.

Each <manufacturer> element has the following attributes .

Attribute Type Description
generic boolean A list of companies that are manufacturing the generic form of the drug.
url URI A link to the companies that are manufacturing the drug.

The text content of the <manufacturer> element is the name or description of the manufacturer.

Prices

<prices>
  <price>
    <description>Benzyl benzoate</description>
    <cost currency="USD">0.16</cost>
    <unit>ml</unit>
  </price>
</prices>

Unit drug prices.

<drug> elements may have one or more <price> elements as children of the <prices> element.

Each <price> element has the following elements.

Element Type Description
description string
cost decimal amount Drug price per unit.
unit string

<cost> elements have the following attributes:

Attribute Type Description
currency string Currency of price, example: USD.

Categories

<categories>
  <category>
    <category>Anti-HIV Agents</category>
    <mesh-id>D019380</mesh-id>
  </category>
</categories>

General categorizations of the drug.

<drug> elements may have one or more <category> elements as children of the <categories> element.

Each <category> element has the following elements.

Element Type Description
category string Category name
mesh-id string The Medical Subjects Headings (MeSH) identifier for the category.

Therapeutic Categories

<therapeutic-categories>
    <therapeutic-category>
      <category>Nonergot Dopamine Agonist</category>
      <drugbank-id primary="true">DBCAT003313</drugbank-id>
      <epc-id>N0000175768</epc-id>
    </therapeutic-category>
</therapeutic-categories>

Therapeutic categorizations of the drug.

<drug> elements may have one or more <therapeutic-category> elements as children of the <therapeutic-categories> element.

Each <therapeutic-category> element has the following elements.

Element Type Description
category string Category name.
epc-id string FDA EPC identifier for the category.

Dosages

<dosages>
  <dosage>
    <form>Tablet</form>
    <route>oral</route>
    <strength>.375 mg</strength>
  </dosage>
</dosages>

A list of the commercially available dosages of the drug.

<drug> elements may have one or more <dosage> elements as children of the <dosages> element.

Each <dosage> element has the following elements.

Element Type Description
form string The pharmaceutical formulation by which the drug is introduced into the body.
route string The path by which the drug or product is taken into the body.
strength string The amount of active drug ingredient provided in the dosage.

ATC Codes

<atc-codes>
  <atc-code code="J05AF03">
    <level code="J05AF">
    Nucleoside and nucleotide reverse transcriptase inhibitors
    </level>
    <level code="J05A">DIRECT ACTING ANTIVIRALS</level>
    <level code="J05">ANTIVIRALS FOR SYSTEMIC USE</level>
    <level code="J">ANTIINFECTIVES FOR SYSTEMIC USE</level>
  </atc-code>
</atc-codes>

The Anatomical Therapeutic Classification (ATC) code for the drug assigned by the World Health Organization Anatomical Chemical Classification System.

<drug> elements may have one or more <atc-code> elements as children of the <atc-codes> element.

Each <atc-code> element has one or more child <level> elements. The <atc-code> and <level> elements each have a code attribute which specifies the code assigned by the World Health Organization Anatomical Therapeutic Chemical Classification system.

Patents

<patents>
  <patent>
    <number>8372431</number>
    <country>United States</country>
    <approved>2010-04-17</approved>
    <expires>2030-04-17</expires>
    <pediatric-extension>false</pediatric-extension>
  </patent>
</patents>

A property right issued by the United States Patent and Trademark Office (USPTO) to an inventor for a limited time, in exchange for public disclosure of the invention when the patent is granted. Drugs may be issued multiple patents.

<drug> elements may have one or more <patent> elements as children of the <patents> element.

Each <patent> element has the following elements.

.

Element Type Description
number string The patent number(s) associated with the drug.
country string The country that issued the patent rights.
approved date The date that the patent request was filed.
expires date The date that the patent rights expire.
pediatric-extension boolean Indicates whether or not a pediatric extension has been approved for the patent. Granted pediatric extensions provide an additional 6 months of market protection.

Drug Interactions

<drug-interactions>
  <drug-interaction>
    <drugbank-id>DB01238</drugbank-id>
    <name>Aripiprazole</name>
    <description>
    The serum concentration of Aripiprazole can be decreased when it is combined with Eslicarbazepine acetate.
    </description>
  </drug-interaction>
</drug-interactions>

Drug-drug interactions detailing drugs that, when administered concomitantly with the drug of interest, will affect its activity or result in adverse effects. These interactions may be synergistic or antagonistic depending on the physiological effects and mechanism of action of each drug.

<drug> elements may have one or more <drug-interaction> elements as children of the <drug-interactions> element.

Each <drug-interaction> element has the following elements.

.

<drug-interaction> elements describe interactions between the drug being described by the outer <drug> element, and another drug.

Element Type Description
drugbank-id string Drugbank ID of the interacting drug.
name string Name of the interacting drug.
description text Textual description of the physiological consequences of the drug interaction.

Structured Drug Interactions

<structured-drug-interaction role="subject">
  <subject-drug>
    <name>Ibuprofen</name>
    <drugbank-id>DB01050</drugbank-id>
  </subject-drug>
  <affected-drug>
    <name>Imatinib</name>
    <drugbank-id>DB00619</drugbank-id>
  </affected-drug>
  <severity>moderate</severity>
  <summary>The serum concentration of Imatinib can be decreased when it is combined with Ibuprofen.</summary>
  <action>decrease_serum_concentration</action>
  <subject-dosage/>
  <affected-dosage/>
  <extended-description>The co-administration of ibuprofen with imatinib causes decreased levels of imatinib [A34733]. More specifically, ibuprofen will decrease imatinib intracellular concentrations. The proposed mechanism for this interaction is through ibuprofen decreasing OCT-1 activity of imatinib, thus decreasing its concentrations intracellularly, and decreasing its therapeutic efficacy. Imatinib interaction with NSAIDS (including ibuprofen) may increase the risk of bleeding [T272, L3504].</extended-description>
  <management>Consider using an alternative to ibuprofen in patients who are being treated with imatinib. Available evidence suggests other NSAIDs do not interact in a similar manner.</management>
  <evidence-level>1</evidence-level>
  <conditions/>
  <references>
    <articles>
      <article>
        <ref-id>A34733</ref-id>
        <pubmed-id>22531634</pubmed-id>
        <citation>Wang J, Hughes TP, Kok CH, Saunders VA, Frede A, Groot-Obbink K, Osborn M, Somogyi AA, D'Andrea RJ, White DL: Contrasting effects of diclofenac and ibuprofen on active imatinib uptake into leukaemic cells. Br J Cancer. 2012 May 22;106(11):1772-8. doi: 10.1038/bjc.2012.173. Epub 2012 Apr 24.</citation>
      </article>
    </articles>
    <textbooks>
      <textbook>
        <ref-id>T272</ref-id>
        <isbn>9780323399159</isbn>
        <citation>33. (2017). In Pharmacology - E-Book: A Patient-Centered Nursing Process Approach (9th ed., pp. 483). Elsevier Health Sciences.</citation>
      </textbook>
    </textbooks>
    <links>
      <link>
        <ref-id>L3504</ref-id>
        <title>Ibuprofen - Drug Summary - Drug Interactions - Prescribers Digital Reference</title>
        <url>http://www.pdr.net/drug-summary/Ibuprofen-Tablets-ibuprofen-2618.3945</url>
      </link>
    </links>
    <attachments>
      <attachment>
        <ref-id>F488</ref-id>
        <title>Drug Interactions in Cancer Patients Requiring Concomitant Chemotherapy and Analgesics</title>
        <url>//s3-us-west-2.amazonaws.com/drugbank-stage/cite_this/attachments/files/000/000/488/original/Drug_Interactions_in_Cancer_Patients_Requiring_Concomitant_Chemotherapy_and_Analgesics.pdf?1531235136</url>
      </attachment>
    </attachments>
  </references>
</structured-drug-interaction>

Structured drug interaction data described below is available to subscribers to DrugBank+. See www.drugbank.com/data to learn more.

Structured drug-drug interactions detailing drugs that, when administered concomitantly with the drug of interest, will affect its activity or result in adverse effects. These interactions may be synergistic or antagonistic depending on the physiological effects and mechanism of action of each drug.

Property Type Description
subject-drug drug reference The drug which creates the interaction.
affected-drug drug reference The drug which is affected by the interaction.
subject-category category reference For interactions based on a drug-category or category-category interaction, the category that affected-drug belongs to which is the basis for this interaction.
affected-category category reference For interactions based on a drug-category or category-category interaction, the category that affected-drug belongs to which is the basis for this interaction.
severity string The severity of this drug interaction; either minor, moderate, or major.
summary string A short summary of the interaction and its effects.
action string The resulting effect of this interaction on the pharmacological activity of the drug.
subject-dosage string Dosage form or dosage quantitiy that will be mainly producing the interaction.
affected-dosage string Dosage form or dosage quantitiy that will be mainly affected by the interaction.
extended-description string Extended descrciption of the mechanism of action and particular properties of the drug interaction.
management string Clinical recommendation when the concomitant administration of the drugs is considered.
evidence-level integer Level of evidence for the structured interaction. An evidence level of 1 indicates that the interaction is mentioned in the drug monograph (FDA, Health Canada, EMA, etc) and has been confirmed in clinical studies (cohort, case-control, case study etc.)
An evidence level of 2 indicates that the interaction has been confirmed in at least 1 cohort, case-control, or case study and may or may not be mentioned in a drug monograph.
conditions string Patient conditions that will produce a more significant effect on the interaction.
references See references.

One of <subject_drug> or <affected_drug> will be the drug which embeds these interactions. The role attribute of <structured-drug-interaction> elements indicates the role of the embedding drug in the interaction, taking the value of either subject or affected.

The optional <subject-category> and <affected-category> elements are included when the interaction is created on the basis of a category-category or drug-category interaction.

Severity

Interaction severity is represented with a string value. These values and their interpretation are listed below:

Severity Value Risk Level Description
Minor minor observe and adjust These medications may interact in a clinically significant manner, however, the benefits of concomitant use usually outweigh any risks. A monitoring plan should be put in place and dosage adjustments may be needed.
Moderate moderate adjustment should be considered The benefits of continuing concomitant therapy should be evaluated on an individual basis. Actions such as aggressive observation, dosage changes, or alternative medications may need to be taken.
Major major combination should be avoided Concomitant therapy with this combination may cause more harm than benefit and alternative medications or means of therapy should be employed.

Evidence Level

Interaction evidence level is represented with an integer value. These values and their interpretations are listed below.

Evidence Level Definition
1 Mentioned in the the drug monograph (FDA, Health Canada, EMA, etc) and has been confirmed in clinical studies (cohort, case-control, case study etc.)
2 Has been confirmed in at least 1 cohort, case-control, or case study and may or not be mentioned in a drug monograph.

Sequences

<sequences>
  <sequence format="FASTA">
  > Pegfilgrastim sequence MTPLGPASSLPQSFLLKCLEQVRKIQGDGAALQEKLCATYKLCHPEELVLLGHSLGIPWA PLSSCPSQALQLAGCLSQLHSGLFLYQGLLQALEGISPELGPTLDTLQLDVADFATTIWQ QMEELGMAPALQPTQGAMPAFASAFQRRAGGVLVASHLQSFLEVSYRVLRHLAQP
  </sequence>
</sequences>

The amino acid sequence; provided if the drug is a peptide.

<drug> elements may have one or more <drug-interaction> elements as children of the <drug-interactions> element.

Describes peptide sequences of biotech drugs. The <sequence> element contains a textual representation of the sequence, in the format described by the format attribute. Currently, only the FASTA format is used.

Calculated Properties

Drug properties that have been predicted by ChemAxon or ALOGPS based on the inputed chemical structure. Associated links below will redirect to descriptions of the specific term.

<drug> elements may have one or more <property> elements as children of the <calculated-properties> element.

Each <property> element has the following elements.

Element Type Description
kind string Name of the property.
value strin/numeric Predicted physicochemical properties; obtained by the use of prediction software such as ALGOPS and ChemAxon.
source string Name of the software used to calculate this property, either ChemAxon or ALOGPS.

The following calculated properties are provided:

Property Type Description
logP string The predicted partition coefficient (LogP) based on the ratio of solubility of the molecule in 1-octanol compared to water; predicted by ALOGPS.
logS string The predicted solubility (LogS) of the molecule; predicted by ALOGPS.
IUPAC Name string The predicted International Union of Pure and Applied Chemistry (IUPAC) nomenclature for the structure; predicted by ChemAxon.
Traditional IUPAC Name string The non-systematic (or common) name for the molecule, which is not recognized by any formal nomenclature system; imported from ChemAxon.
Molecular Weight string The predicted ratio of the average mass of one molecule of an element or compound to one twelfth of the mass of an atom of carbon-12; calculated by ChemAxon.
Monoisotopic Weight string The predicted mass of the most abundant isotope of the drug; calculated by ChemAxon.
SMILES string The simplified molecular-input line-entry system (SMILES) is a line notation used for describing the structure of chemical species using short ASCII strings; calculated by ChemAxon.
InChI string A prediction of the IUPAC International Chemical Identifier (InChI); imported by ChemAxon.
InChIKey string The condensed digital representation of the IUPAC International Chemical Identifier (InChI); imported by ChemAxon.
Polar Surface Area (PSA) string A descriptor, based on the polarized atoms of the molecule, that allows estimation of transport properties and of the passive molecular transport through membranes of the drug; predicted by ChemAxon.
Refractivity string The predicted molar refractivity of the molecule, which is strongly related to the volume of the molecules and to London dispersive forces that play crucial part in drug-receptor interactions; predicted by ChemAxon.
Polarizability string The predicted relative tendency of the electron cloud (charge distribution) of the molecule to be distorted by an external electric field; polarizability values predicted by ChemAxon.
Rotatable Bond Count string The predicted number of rotatable bonds in the molecule; predicted by ChemAxon. Unsaturated bonds, and single bonds connected to hydrogens or terminal atoms, single bonds of amides, sulphonamides and those connecting two hindered aromatic rings (having at least three ortho substituents) are considered non-rotatable.
H Bond Acceptor Count string A calculation of the sum of the hydrogen bond acceptor atoms. An acceptor atom always has a lone electron pair/lone electron pairs that is capable of establishing a H bond. Predicted by ChemAxon.
H Bond Donor Count string A calculation of the sum of the atoms in the molecule which have hydrogen bond donor property. Predicted by ChemAxon.
pKa (strongest acidic) string The strongest acidic pka value of the molecule; predicted by ChemAxon.
pKa (strongest basic) string The strongest basic pka value of the molecule; predicted by ChemAxon.
Physiological Charge string Charge of the molecule at physiological pH; predicted by ChemAxon.
Number of Rings string A calculation of the number of rings in the molecule; predicted by ChemAxon.
Bioavailability string Fraction of administered dose that is predicted to reach the systemic circulation; predicted by ChemAxon.
Rule of Five string A reflection of the absorption or permeation of a molecule; considered “yes” when the molecular weight is under 500 g/mol, the value of logP is lower than 5, and the molecule has utmost 5 H-donor and 10 H-acceptor atoms; predicted by ChemAxon.
Ghose Filter string A filter that defines drug-likeness constraints as follows: calculated log P is between -0.4 and 5.6, molecular weight is between 160 and 480, molar refractivity is between 40 and 130, and the total number of atoms is between 20 and 70. Imported from ChemAxon.
MDDR-Like Rule string Indicates compliance of drug-like characteristics based on number of rings, rigid bonds and rotatable bonds; calculated by ChemAxon.

Experimental Properties

<experimental-properties>
  <property>
    <kind>Water Solubility</kind>
    <value>7.64E+004 mg/L (at 25 °C)</value>
    <source>PHYSICIANS DESK REFERENCE (2001)</source>
  </property>
  <property>
    <kind>Melting Point</kind>
    <value>217-218 °C</value>
    <source>PhysProp</source>
  </property>
</experimental-properties>

Drug properties that have been experimentally proven.

<drug> elements may have one or more <property> elements as children of the <experimental-properties> element.

Each <property> element has the following elements.

Element Type Description
kind string Name of the property.
value string/numeric Drug properties that have been experimentally proven.
source string Reference to the source of this experimental data.

The following experimental properties are provided:

Property Description
Water Solubility The experimentally determined aqueous solubility of the molecule.
Molecular Formula Protein formula of Biotech drugs.
Molecular Weight Protein weight of Biotech drugs.
Melting Point The experimentally determined temperature at which the drug molecule changes from solid to liquid at atmospheric temperature.
Boiling Point The experimentally determined temperature at which the drug molecule changes from liquid to gas at atmospheric temperature.
Hydrophobicity The ability of a molecule to repel water rather than absorb or dissolve water.
Isoelectric Point The pH value at which the net electric charge of a molecule is zero.
caco2 Permeability A continuous line of heterogenous human epithelial colorectal adenocarcinoma cells, CAC02 cells are employed as a model of human intestinal absorption of various drugs and compounds. CAC02 cell permeability is ultimately an assay to measure drug absorption.
pKa The experimentally determined pka value of the molecule.
logP The experimentally determined partition coefficient (LogP) based on the ratio of solubility of the molecule in 1-octanol compared to water.
logS The intrinsic solubility of a given compound is the concentration in equilibrium with its solid phase that dissolves into solution, given as the natural logarithm (LogS) of the concentration.
Radioactivity The property to spontaneously emit particles (alpha, beta, neutron) or radiation (gamma, K capture), or both at the same time, from the decay of certain nuclides.

External Identifiers

<external-identifiers>
  <external-identifier>
    <resource>Drugs Product Database (DPD)</resource>
    <identifier>884</identifier>
  </external-identifier>
</external-identifiers>

Identifiers used in other websites or databases providing information about this drug.

<drug> elements may have one or more <external-identifier> elements as children of the <external-identifiers> element.

Each <external-identifier> element has the following elements.

Element Type Description
resource string Name of the source database.
identifier string Identifier for this drug in the given resource.

Drug identifiers may be provided for the following resources:

Links to other websites or databases providing information about this drug.

<drug> elements may have one or more <external-link> elements as children of the <external-links> element.

Each <external-link> element has the following elements.

Element Type Description
resource string Name of the source website.
identifier string Identifier for this drug in the given resource.

Links may be provided for the following resources:

Pathways

<pathways>
  <pathway>
    <smpdb-id>SMP00746</smpdb-id>
    <name>Zalcitabine Action Pathway</name>
    <category>drug_action</category>
    <drugs>
      <drug>
        <drugbank-id>DB00131</drugbank-id>
        <name>Adenosine monophosphate</name>
      </drug>
      <drug>
        <drugbank-id>DB00171</drugbank-id>
        <name>Adenosine triphosphate</name>
      </drug>
      <drug>
        <drugbank-id>DB00943</drugbank-id>
        <name>Zalcitabine</name>
      </drug>
      <drug>
        <drugbank-id>DB04160</drugbank-id>
        <name>Diphosphate</name>
      </drug>
    </drugs>
    <enzymes/>
  </pathway>
</pathways>

Metabolic, disease, and biological pathways that the drug is involved in, as identified by the Small Molecule Protein Database (SMPDB).

<drug> elements may have one or more <pathway> elements as children of the <pathways> element.

Each <pathway> element has the following elements.

Element Type Description
smpdb-id string Small Molecule Pathway Database identifier for this pathway.
name string Pathway name.
category string Pathway category.
drugs One or more <drug> elements with <drugbank-id> and <name> child elements.
enzymes Enzymes involved in this pathway.

The list elements (documented above) contain zero or more of their respective child elements:

Element Child Element
<drugs> <drug>, containing <drugbank-id> and <name> elements.
<enzymes> <uniprot-id>

Reactions

<reactions>
  <reaction>
    <sequence>1</sequence>
    <left-element>
      <drugbank-id>DB09119</drugbank-id>
      <name>Eslicarbazepine acetate</name>
    </left-element>
    <right-element>
      <drugbank-id>DBMET01408</drugbank-id>
      <name>Eslicarbazepine [(S)-licarbazepine]</name>
    </right-element>
    <enzymes/>
  </reaction>
</reactions>

A sequential representation of the metabolic reactions that this drug molecule is involved in. Depending on available information, this may include metabolizing enzymes, reaction type, substrates, products, pharmacological activity of metabolites, and a structural representation of the biochemical reactions.

<drug> elements may have one or more <reaction> elements as children of the <reactions> element.

Each <reaction> element has the following elements.

Element Type Description
sequence integer Reactions are displayed within a numerical sequence.
left-element string The substrate of the reaction. May be a drug or a metabolite.
right-element string The product of the reaction. May be a drug or a metabolite.
enzymes One or more <enzyme> elements with <drugbank-id>, <name>, and <uniprot-id> child elements. Enzymes involved in metabolizing this drug.

The elements (documented above) contain the following child elements:

Element Child Element
<left-element> <drugbank-id> and <name>
<right-element> <drugbank-id> and <name>
<enzymes> zero or more <enzme> elements, each with <drugbank-id>, <name>, and <uniprot-id> child elements.

SNP Effects

<snp-effects>
  <effect>
    <protein-name>
    Cystic fibrosis transmembrane conductance regulator
    </protein-name>
    <gene-symbol>CFTR</gene-symbol>
    <uniprot-id>P13569</uniprot-id>
    <rs-id>rs75527207</rs-id>
    <allele/>
    <defining-change>A allele (G > A)</defining-change>
    <description>
    Cystic Fibrosis patients with the A allele will response to ivacaftor
    </description>
    <pubmed-id>23757359</pubmed-id>
  </effect>
</snp-effects>

A list of single nucleotide polymorphisms (SNPs) relevent to drug activity or metabolism, and the effects these may have on pharmacological activity. SNP effects in the patient may require close monitoring, an increase or decrease in dose, or a change in therapy.

<drug> elements may have one or more <effect> elements as children of the <snp-effects> element.

Each <effect> element has the following elements.

Element Type Description
protein-name string Proteins involved in this SNP.
gene-symbol string Genes involved in this SNP.
uniprot-id string Universal Protein Resource (UniProt) identifiers for proteins involved in this pathway.
rs-id string The SNP Database identifier for this single nucleotide polymorphism.
allele string The alleles associated with the identified SNP.
defining-change string
description string A written description of the SNP effects.
pubmed-id string Reference to PubMed article.

SNP Adverse Drug Reactions

<snp-adverse-drug-reactions>
  <reaction>
    <protein-name>Cytochrome P450 2D6</protein-name>
    <gene-symbol>CYP2D6</gene-symbol>
    <uniprot-id>P10635</uniprot-id>
    <rs-id>rs3892097</rs-id>
    <allele>CYP2D6*4</allele>
    <adverse-reaction>C > T</adverse-reaction>
    <description>
    Those that are homozygous for the poorly metabolizing CYP2D6 alleles are at an increased risk of side effects and decrease drug metabolism
    </description>
    <pubmed-id>18070221</pubmed-id>
  </reaction>
</snp-adverse-drug-reactions>

The adverse drug reactions that may occur as a result of the listed single nucleotide polymorphisms (SNPs).

<drug> elements may have one or more <reaction> elements as children of the <snp-adverse-drug-reactions> element.

Each <reaction> element has the following elements.

Element Type Description
protein-name string Proteins involved in this SNP.
gene-symbol string Genes involved in this SNP.
uniprot-id string Universal Protein Resource (UniProt) identifiers for proteins involved in this pathway.
rs-id string The SNP Database identifier for this single nucleotide polymorphism.
allele string The alleles associated with the identified SNP.
adverse-reaction string
description string
pubmed-id string Reference to PubMed article.

Products

<products>
  <product>
    <name>Hivid Tab 0.375mg</name>
    <labeller>Hoffmann La Roche Limited</labeller>
    <ndc-id/>
    <ndc-product-code/>
    <dpd-id>01990918</dpd-id>
    <ema-product-code/>
    <ema-ma-number/>
    <started-marketing-on>1992-12-31</started-marketing-on>
    <ended-marketing-on>2003-07-30</ended-marketing-on>
    <dosage-form>tablet</dosage-form>
    <strength>.375 mg</strength>
    <route>oral</route>
    <fda-application-number/>
    <generic>false</generic>
    <over-the-counter>false</over-the-counter>
    <approved>true</approved>
    <country>Canada</country>
    <source>DPD</source>
    <standing>good</standing>
    <jurisdiction-marketing-category>MARKETED</jurisdiction-marketing-category>
    <branded>true</branded>
    <prescription>false</prescription>
    <unapproved>false</unapproved>
    <vaccine>false</vaccine>
    <allergenic>false</allergenic>
    <cosmetic>false</cosmetic>
    <kit>false</kit>
    <solo>true</solo>
    <available>true</available>
  </product>
</products>

A list of commercially available products in Canada and the United States that contain the drug.

<drug> elements may have one or more <product> elements as children of the <products> element.

Each <product> element has the following elements.

Child Elements

The generic, approved, branded, prescription, unapproved, vaccine, allergenic, cosmetic, kit, solo, and available are boolean product filter fields, which can be useful in limiting search results or analysis to certain types of products.

Element Type Description
name string The proprietary name(s) provided by the manufacturer for any commercially available products containing this drug.
labeller string The corporation responsible for labelling this product.
ndc-id string The National Drug Code (NDC) identifier of the drug.
ndc-product-code string The National Drug Code (NDC) product code from the FDA National Drug Code directory.
dpd-id string Drug Product Database (DPD) identification number from the Canadian Drug Product Database. Only present for drugs that are marketed in Canada.
ema-product-code string EMA product code from the European Medicines Agency Database. Only present for products that are authorised by central procedure for marketing in the European Union.
ema-ma-number string EMA marketing authorisation number from the European Medicines Agency Database. Only present for products that are authorised by central procedure for marketing in the European Union.
started-marketing-on date The starting date for market approval.
ended-marketing-on date The ending date for market approval.
dosage-form string The pharmaceutical formulation by which the drug is introduced into the body.
strength string The amount of active drug ingredient provided in the dosage.
route string The path by which the drug or product is taken into the body.
fda-application-number string The New Drug Application [NDA] number assigned to this drug by the FDA.
over-the-counter boolean A list of Over The Counter (OTC) forms of the drug.
generic boolean Whether this product is a generic drug.
approved boolean Indicates whether this drug has been approved by the regulating government.
country string The country where this commercially available drug has been approved.
source string Source of this product information. For example, a value of DPD indicates this information was retrieved from the Canadian Drug Product Database.
standing string One of good, discordant, or deprecated. Distinguishes products with up to date ingredient information (good) from products with conflicting information (discordant) or products that have been removed from an active label (deprecated).
standing-updated-on date The date on which the standing was last updated
standing-reason string Explains the non-good standing of the product. One of: ingredient_change, code_duplication, invalid, or removed.
jurisdiction-marketing-category string The marketing category of this product in its jurisdiction
branded boolean Whether this product has a named brand
prescription boolean Whether this product is only available with a prescription
unapproved boolean Whether this product is not approved in its jurisdiction
vaccine boolean Whether this product is a vaccine
allergenic boolean Whether this product is used in allergenic testing
cosmetic boolean Whether this product is a cosmetic, such as sunscreen
kit boolean Whether this product is a kit composed of multiple distinct parts
solo boolean Whether this product has only a single active ingredient
available boolean Whether this product can be sold in its jurisdiction

References

In several locations within DrugBank XML files, a collection of references is provided. These references may be to articles, textbooks, or websites. Each of these categories of reference has a defined XML structure.

A list of articles and textbooks used to inform the information provided about this drug.

Article References

<articles>
  <article>
    <ref-id>A36981</ref-id>
    <pubmed-id>9179531</pubmed-id>
    <citation>
    Adkins JC, Peters DH, Faulds D: Zalcitabine. An update of its pharmacodynamic and pharmacokinetic properties and clinical efficacy in the management of HIV infection. Drugs. 1997 Jun;53(6):1054-80.
    </citation>
  </article>
</articles>

A list of articles that were used as references for this item.

<drug> elements may have one or more <article> elements as children of the <articles> element.

Each <article> element has the following elements.

Element Type Description
ref-id string Identifier for the article being referenced. This is unique across all reference types.
pubmed-id string The PubMed identifier for the article.
citation string Article citation in a standard format.

Textbook References

<textbooks>
  <textbook>
    <ref-id>T272</ref-id>
    <isbn>978-0-85369-840-1</isbn>
    <citation>
    Sweetman, Sean C. (2009). Contrast Media. In Martindale : The Complete Drug Reference, 36th Edition 2 Volume Set (36th ed., pp. 1478). Pharmaceutical Press.
    </citation>
  </textbook>
</textbooks>

A list of textbooks that were used as references for this item.

<drug> elements may have one or more <textbook> elements as children of the <textbooks> element.

Each <textbook> element has the following elements.

Element Type Description
ref-id string Identifier for the textbook being referenced. This is unique across all reference types.
isbn string ISBN identifying the textbook.
citation string Textbook citation in a standard format.
<links>
  <link>
    <ref-id>L3504</ref-id>
    <title>Sebelipase alfa FDA Approval</title>
    <url>
    http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm476013.htm
    </url>
  </link>
</links>

A list of websites that were used as references for this item.

<drug> elements may have one or more <link> elements as children of the <links> element.

Each <link> element has the following elements.

Element Type Description
ref-id string Identifier for the link being referenced. This is unique across all reference types.
title string The title of the website.
url URI The url of the website.

Attachment References

<attachments>
  <attachment>
    <ref-id>F1538</ref-id>
    <title>Mifepristone FDA Label</title>
    <url>//s3-us-west-2.amazonaws.com/drugbank-stage/cite_this/attachments/files/000/001/538/original/202107Orig1s000Lbl.pdf?1537305458</url>
  </attachment>
</attachments>

A list of attached files that were used as references for this item.

<drug> elements may have one or more <attachment> elements as children of the <attachments> element.

Each <attachment> element has the following elements.

Element Type Description
ref-id string Identifier for the attachment being referenced. This is unique across all reference types.
title string The title of the attachment.
url URI The url to download the attachment from.

Structured Indications

<structured-indications>
  <structured-indication off-label="false" otc-use="false">
    <kind>treatment_of</kind>
    <regions>
      <region>Canada</region>
    </regions>

    <condition>
      <title>Fallopian tube cancer</title>
      <drugbank-id primary="true">DBCOND0008444</drugbank-id>
      <meddra-id kind="low_level_term">10016180</meddra-id>
      <synonyms>
        <synonym>Fallopian Tube Cancers</synonym>
        <synonym>Fallopian tube cancer NOS</synonym>
        <synonym>Carcinoma of fallopian tube</synonym>
      </synonyms>
    </condition>

    <combination-drug>
      <name>Olaparib</name>
      <drugbank-id>DB09075</drugbank-id>
    </combination-drug>
    <adjunct-category>
      <title>Cyclodecanes</title>
      <drugbank-id>DBCAT001310</drugbank-id>
      <mesh-id />
    </adjunct-category>

    <product-concept>
      <title>Olaparib Oral Capsule</title>
      <drugbank-pcid primary="true">DBPC0213810</drugbank-pcid>
    </product-concept>
    <product-concept>
      <title>Olaparib Oral</title>
      <drugbank-pcid primary="true">DBPC0213806</drugbank-pcid>
    </product-concept>
    <with-product-concept>
      <title>Docetaxel Intravenous</title>
      <drugbank-pcid primary="true">DBPC0213806</drugbank-pcid>
    </with-product-concept>
  </structured-indication>

Structured indication data described below is available to subscribers to DrugBank+. See www.drugbank.com/data to learn more.

Describes the approved conditions, diseases, or states for which a drug can safely and effectively be used. DrugBank drug indications have been structured based on their designation through the Food and Drug Administration (FDA) in the United States.

<drug> elements may have one or more <structured-indication> elements as children of the <structured-indications> element.

Each <structured-indication> element has the following attributes and elements.

Attributes

Element Type Description
off-label boolean Unapproved conditions that this drug has been shown to treat or modify. Unapproved indicates that it has not gone through the FDA approval process.
otc-use boolean Conditions that can be treated with products available over the counter (does not require a prescription).

Child Elements

Element Type Repeats Description
kind string 1 Denotes the kind of use this indication describes.
timeline string 0..1 Specifies the timeline (ex. short-term), if necessary.
route string 0..* Route of administration of the drug(s) in the indication.
dose-form string 0..* Dose form in which the indication applies.
dose-strength string 0..* Dose strength in which the indication applies.
regions list of elements 0..1 A list of regions to which this indication applies.
sex-group string 0..1 Sex group of patients to which the indication applies. Possible values are null, “male”, “female”, or “all”.
min-age age-type 0..1 This indication applies only to patients this age or older.
max-age age-type 0..1 This indication applies only to patients this age or younger.
age-groups age-type 0..* List of age groups to which this indication applies.
excluded-age-groups age-type 0..* List of age groups to which this indication does not apply.
genetic-factors Genetic Factor 0..* Genetic factors related to this indication.
combination-drug elements with drug name and drugbank-id 0..* Denotes drugs administered in combination for this indication.
adjunct-drug elements with drug name and drugbank-id 0..* Denotes drugs administered as adjuncts for this indication.
combination-category elements with category name, drugbank-id and mesh-id 0..* Denotes drug categories administered in combination for this indication.
adjunct-category elements with category name, drugbank-id and mesh-id 0..* Denotes drug categories administered as adjuncts for this indication.
product-concept elements with product concept title, and drugbank-pcid children 0..* Relevant product concepts containing the main drug of the indication.
with-product-concept elements with product concept title, and drugbank-pcid 0..* Relevant product concepts not containing the main drug of the indication, taken in adjunct or combination.

Within indications, it is commonly required to describe a medical condition. The format of conditions is described below, in the conditions section. The following <structured-indication> children take this form:

Element Occurrences Description
condition 0..1 The condition which that this drug has been approved to treat.
induction-of 0..1 A condition which is induced by the drug.
process 0..1 Denotes a diagnosic process in diagnost indications.
therapy 0..1 Used when the drug is indicated for use as a therapy rather than in the treatment or management of a condition or disease.
mechanism 0..1 Denotes the mechanism through which this drug achieves/contributes to the desired change.
condition-associated-with 0..* Other descriptors or conditions that are associated with the main indication.
with-therapies 0..* Denotes adjunct therapies in adjunct indications.
patient-characteristics 0..* List of one or more patient characteristics. Example: “immunocompromised”.

The <patient-characteristics> element contains a list of <include> and <exclude> conditions which serve to limit the patients to which this indication applies.

Ages

<structured-indication>
  <min-age unit="week">10</min-age>
  <max-age unit="year">3</min-age>
  <age-groups>
    <include>infant</include>
    <include>toddler</include>
    <exclude>neonate</exclude>
  </age-groups>
</structured-indication>

The optional <min-age> and <max-age> children in <structured-indication> elements have a unit which can be year, month, week, or day.

The <age-groups> element contains a list of <include> and <exclude> elements, which each describe an age group of patients to be included or excluded from this indication.

Genetic Factors

<structured-indication>
  <genetic-factors>
    <include>
      <title>BRAFV600E mutation</title>
      <synonyms>
          <synonym>BRAF V600E</synonym>
      </synonyms>

      <gene>
        <title>BRAF</title>
        <drugbank-id primary="true">DBCOND0006299</drugbank-id>
        <uniprot-id kind="ac">P15056</uniprot-id>
      </gene>

      <mutation>
        <title>BRAF V600E mutation</title>
        <drugbank-id primary="true">DBCOND0010075</drugbank-id>
      </mutation>

      <positive-finding>
        <title>BRAF V600E mutation positive</title>
        <drugbank-id primary="true">DBCOND0006282</drugbank-id>
        <meddra-id kind="low_level_term">10075676</meddra-id>
        <synonyms>
          <synonym>BRAF gene mutation</synonym>
        </synonyms>
      </positive-finding>

      <negative-finding>
        <title>BRAF V600E mutation negative</title>
        <drugbank-id primary="true">DBCOND0006300</drugbank-id>
      </negative-finding>
    </include>
  </genetic-factors>
</structured-indication>

The <structured-indication> element may contain a <genetic-factors> element, which includes one or more <include> or <exclude> elements. These are genetic factors which affect whether this indication applies to a patient. Patients with genetic factors matching <include> elements may be in the target population for this indication. Patients with genetic factors matching <exclude> elements are excluded from this indication.

Genetic factors related to this indication.

Property Occurrences Description
gene 0..1 A condition describing the gene which is most central to this genetic factor.
mutation 0..1 A condition describing the genetic mutation which is most central to this genetic factor.
positive_finding 0..1 A condition describing a positive finding of this genetic mutation.
negative_finding 0..1 A condition describing a negative finding of this genetic mutation.
related_gene 0..* Genes related to this genetic factor.
related_mutation 0..* Genetic mutations related to this genetic factor.

Conditions

<structured-indication>
  <condition>
    <title>BRAF V600E mutation positive</title>
    <drugbank-id primary="true">DBCOND0006282</drugbank-id>
    <meddra-id kind="low_level_term">10075676</meddra-id>
    <synonyms>
      <synonym>BRAF gene mutation</synonym>
    </synonyms>
  </condition>
</structured-indication>

Condition elements with names and identifiers are used in several places in structured indication objects. Often, condition objects denote a medical condition, but they are also used to describe procedures, therapies, and genes.

Condition elements have the following child elements:

Property Type Description
title identifier Name/description of the condition.
drugbank_id identifier DrugBank condition identifier.
synonyms identifier Other names for this synonym.
modification-of See below.
combination-of See below.

The elements below all take the same form: the a text identifier with a kind attribute which specifies the kind of entity the identifier refers to in the source vocabulary. For instance, a <meddra-id> element with kind="low_level_term" provides the MedDRA code for a low level term.

Property Type Description
meddra_id identifier Medical Dictionary for Regulatory Activities (MedDRA) identifier.
icd10_id identifier International Statistical Classification of Diseases and Related Health Problems 10th Revision(ICD-10) identifier.
uniprot_id identifier Universal Protein Resource (UniProt) identifer; used for describing genes associated with the specific condition.

combination-of

<condition>
    <title>Conjunctivitis caused by chlamydia</title>
    <drugbank-id primary="true">DBCOND0005035</drugbank-id>
    <combination-of>
        <caused-by>
            <title>Chlamydia</title>
            <drugbank-id primary="true">DBCOND0004462</drugbank-id>
            <meddra-id kind="low_level_term">10067198</meddra-id>
            <synonyms>
                <synonym>Chlamydia trachomatis infection</synonym>
            </synonyms>
        </caused-by>
        <include>
            <title>Conjunctivitis</title>
            <drugbank-id primary="true">DBCOND0001911</drugbank-id>
            <meddra-id kind="low_level_term">10010741</meddra-id>
            <icd10-id kind="concept">H10</icd10-id>
            <synonyms>
                <synonym>Conjunctivitis NOS</synonym>
                <synonym>Conjunctivitis, unspecified</synonym>
                <synonym>Eye infection</synonym>
            </synonyms>
        </include>
    </combination-of>
</condition>

This element describes the outer Condition as a combination of other conditions. Often, this is used to tie a group of conditions to each individual condition which are more likely to have a MedDRA ID, ICD10 ID, etc.

Property Type Description
caused_by Condition Used to describe when the condition is caued by another, prior disease, condition, or physiological state.
include Condition Conditions that may be treated with this drug.
exclude Condition Conditions that can not be treated with this drug.
characteristic string Characteristic of the combination condition.

modification-of

<condition>
    <title>Severe Acne vulgaris</title>
    <drugbank-id primary="true">DBCOND0005031</drugbank-id>
    <modification-of>
        <base>
            <title>Acne Vulgaris</title>
            <drugbank-id primary="true">DBCOND0012172</drugbank-id>
            <meddra-id kind="low_level_term">10000519</meddra-id>
            <icd10-id kind="concept">L70.0</icd10-id>
            <synonyms>
                <synonym>Common acne</synonym>
            </synonyms>
        </base>
        <severity>
            <include>severe</include>
        </severity>
    </modification-of>
</condition>

This element describes the outer Condition as a modification to another condition. Often, this is used to tie a slightly more specific form of a condition to a more general form, which is more likely to have a MedDRA ID, ICD10 ID, etc. For instance, “severe acne vulgaris” could be considered to be “acne vulgaris” with the additional modifier “severe”.

Property Type Description
base Condition The main condition which is being modified.
location string Used to describe when drug use is specific to a condition in/on a certain body part.
stage string A more specific form of condition descriptors that are used to designate cancer stages. These provide a description of the extent to which a neoplasm has developed or spread from its site of origin.
status string Condition status descriptors are similar to condition severity descriptors, but are more closely related to the progression of the disease or the disease course. These are often used to describe chronic conditions or infections with alternating periods of active and suppressed symptoms, such as Multiple Sclerosis.
severity list of included/excluded strings A specific type of condition association that describes the severity of the main condition; may be informed by duration, symptoms, and/or stages of the main condition or disease.

Structured Adverse Effects

<structured-adverse-effects>
  <structured-adverse-effect>
    <effect>
      <title>Abdominal Pain Upper</title>
      <drugbank-id primary="true">DBCOND0044979</drugbank-id>
      <drugbank-id>DBCOND0044979</drugbank-id>
      <meddra-id kind="">10000087</meddra-id>
      <icd10-id kind="">R10.1</icd10-id>
      <synonyms>
        <synonym>Pain localized to upper abdomen</synonym>
        <synonym>Upper Abdominal Pain</synonym>
      </synonyms>
    </effect>
    <incidences>
      <incidence kind="experimental">
        <name/>
        <percent>3%</percent>
      </incidence>
      <incidence kind="placebo">
        <name/>
        <percent>1%</percent>
      </incidence>
    </incidences>
    <evidence-type>clinical_trial</evidence-type>
    <regions>
      <region>US</region>
    </regions>
    <age-groups>
      <include>unspecified</include>
    </age-groups>
    <patient-characteristics>
      <include>
        <title>Restless Legs Syndrome</title>
        <drugbank-id primary="true">DBCOND0003364</drugbank-id>
        <drugbank-id>DBCOND0003364</drugbank-id>
        <drugbank-id>DBCOND0003364</drugbank-id>
        <drugbank-id>DBCOND0003364</drugbank-id>
        <drugbank-id>DBCOND0003364</drugbank-id>
        <meddra-id kind="">10058920</meddra-id>
        <icd10-id kind="">G25.81</icd10-id>
        <synonyms>
          <synonym>Legs restless</synonym>
          <synonym>Restless Leg Disorder</synonym>
          <synonym>Restless Leg Syndrome</synonym>
          <synonym>Restless Leg Syndrome (RLS)</synonym>
          <synonym>Restless Legs</synonym>
          <synonym>Restless Legs Syndrome (RLS)</synonym>
          <synonym>Syndrome restless legs</synonym>
        </synonyms>
      </include>
    </patient-characteristics>
  </structured-adverse-effect>
</structured-adverse-effects>

Structured adverse effect data described below is available to subscribers to DrugBank+. See www.drugbank.com/data to learn more.

Each structured adverse effect represents a known adverse effect of a given drug, when used in a specific situation. For instance, some adverse effects are specific to a certain route of administration, or patients of a certain age group. The data within an adverse effect can thus be divided into two categories: data describing the adverse effect, and data describing the situation in which it is expected to arise.

<drug> elements may have one or more <structured-adverse-effect> elements as children of the <structured-adverse-effects> element.

Each <structured-adverse-effect> element has the following elements.

Child Elements

Element Type Occurrences Description
effect Condition 1..* The main adverse effect.
associated-with Condition 0..* Other conditions that are associated with the adverse effect.
incidences Effect Incidence 0..* Observed incidences of the adverse effect.
evidence-type string 0..* Source of evidence for this adverse effect. Example: “clinical_trial”.
trial-name string 0..* Name of the trial from which the adverse effect was determined.
route string 0..* Route of administration of the drug(s) in the adverse effect.
dose-form string 0..* Dose form in which the adverse effect applies.
dose-strength string 0..* Dose strength in which the adverse effect applies.
event string 0..* Specific event that causes this adverse effect. Example: “discontinuation”.
admin string 0..* Type of administration for which the adverse effect applies. Example: “Multiple dose”.
timeline string 0..* Specifies the timeline (ex. short-term), if necessary.
usage string 0..* Specific usage of which the adverse effect applies. Example: “First-line therapy”.
regions list of elements 0..1 The source region of the adverse effect.
with_therapy Condition 0..1 A therapy the patient must be undergoing for the adverse effect to apply.
with-drug elements with drug name and drugbank-id 0..* Drugs which contribute to the combination of drugs to which the adverse effect applies.
with-category elements with category name, drugbank-id and mesh-id 0..* Drug categories which contribute to the combination of drugs to which the adverse effect applies.
sex-group string 0..1 Sex group of patients to which the adverse effect applies. Possible values are null, “male”, “female”, or “all".
min-age age-type 0..1 Minimum age of the patient in which the adverse effect applies.
max-age age-type 0..1 Maximum age of the patient in which the adverse effect applies.
age-groups age-type 0..* List of age groups to which this adverse effect applies.
excluded-age-groups age-type 0..* List of age groups to which this adverse effect does not apply.
patient-characteristics Condition 0..* List of one or more patient characteristics. Example: “immunocompromised”.
excluded-patient-characteristics Condition 0..* List of characteristics which exclude patients from this adverse effect.

Within adverse effects, it is commonly required to describe a medical condition. The format of conditions is described in the conditions section. The following <structured-adverse-effect> children take this form:

  • effect
  • associated-with
  • with-therapy
  • patient-characteristics
  • excluded-patient-characteristics

Within adverse effects, the min-age, max-age and age-groups elements follow the same structure as they do in structured indications.

Adverse Effect Incidences

<structured-adverse-effect>
  <incidences>
    <incidence kind="experimental">
      <name>cyclophosphamide</name>
      <percent>3%</percent>
    </incidence>
    <incidence kind="placebo">
      <name>normal saline</name>
      <percent>1%</percent>
    </incidence>
  </incidences>
</structured-adverse-effect>

<structured-adverse-effect> elements may have one or more <incidence> elements as children of the <incidences> element.

Each <incidence> element describes the reported statistics for the prevalence of this effect among different groups, such as control, placebo, comparator, or experimental.

Each <incidence> element has the following attributes and elements.

Attributes

Property Type Description
kind string Affected group/arm: control, placebo, comparator or experimental.

Child Elements

Property Type Occurrences Description
name string 0..1 Optional description of the incidence, e.g. the name of the comparator.
p-value string 0..1 p-value of the evidence, if known.
percent string 0..1 Percentage of incidence.
percent-descriptor string 0..1 Optional description of the percentage.

Structured Contraindications

<structured-contraindications>
  <structured-contraindication>
    <patient-condition>
      <title>History of deep-vein thrombosis</title>
      <drugbank-id primary="true">DBCOND0107915</drugbank-id>
    </patient-condition>
    <route>oral</route>
    <regions>
      <region>US</region>
    </regions>
  </structured-contraindication>
  <structured-contraindication>
    <patient-condition>
      <title>History of pulmonary embolus</title>
      <drugbank-id primary="true">DBCOND0107916</drugbank-id>
    </patient-condition>
    <route>oral</route>
    <regions>
      <region>US</region>
    </regions>
  </structured-contraindication>
  <structured-contraindication>
    <with-category-coadmin>
      <category>Coumarins</category>
      <drugbank-id primary="true">DBCAT000641</drugbank-id>
      <mesh-id>D003374</mesh-id>
    </with-category-coadmin>
    <regions>
      <region>US</region>
    </regions>
  </structured-contraindication>
</structured-contraindications>

Structured contraindication data described below is available to subscribers to DrugBank+. See www.drugbank.com/data to learn more.

Contraindications for a drug. Each contraindication describes a case in which the drug is contraindicated. Each field adds a criteria to the contraindication, and if all of these are fulfilled, the contraindication applies.

<drug> elements may have one or more <structured-contraindication> elements as children of the <structured-contraindication> element.

Each <structured-contraindication> element has the following elements.

Child Elements

Element Type Occurrences Description
patient-condition Condition 0..* A condition the patient must have for the contraindication to apply.
patient-condition-associated-with Condition 0..* Conditions with which the patient-condition is associated.
recommended-action string 0..* Recommended actions to mitigate the contraindication, if possible.
lab-value string 0..* Patient measurements which cause contraindication to apply.
route string 0..* Route of administration of the drug(s) in the contraindication.
dose-form string 0..* Dose form in which the contraindication applies.
regions list of elements 0..1 The source region of the contraindication.
hypersensitivity string 0..* Hypersensitivity which contraindicates the drug. The drug is contraindicated if a patient has an allergy/hypersensitivity to any of the given drugs/categories/chemicals. A hypersensitivity of “true” indicates any product of this drug is contraindicated if the patient is hypersensitive to any ingredients (active or otherwise) of the drug product.
time-period string 0..1 Specifies the timeline (ex. short-term), if necessary.
with_therapy Condition 0..1 A therapy the patient must be undergoing for the contraindication to apply.
with-drug elements with drug name and drugbank-id 0..* Drugs which contribute to the combination of drugs to which the contraindication applies.
with-drug-coadmin elements with drug name and drugbank-id 0..* Drugs which, when co-administered, contribute to the combination of drugs to which the contraindication applies.
with-category elements with category name, drugbank-id and mesh-id 0..* Drug categories which contribute to the combination of drugs to which the contraindication applies.
with-category-coadmin elements with category name, drugbank-id and mesh-id 0..* Drug categories which, when co-administered, contribute to the combination of drugs to which the contraindication applies.
sex-group string 0..1 Sex group of patients to which the contraindication applies. Possible values are null, “male”, “female”, or “all".
above-age age-type 0..1 Minimum age of the patient in which the contraindication applies.
below-age age-type 0..1 Maximum age of the patient in which the contraindication applies.
age-groups age-type 0..* Age groups, at least one of which the patient must belong to in order for the contraindication to apply.
excluded-age-groups age-type 0.. Age groups which the patient must not belong to in order for the contraindication to apply.

Within contraindications, it is commonly required to describe a medical condition. The format of conditions is described in the conditions section. The following <structured-contraindication> children take this form:

  • patient-condition
  • patient-condition-associated-with
  • with-therapy

Within contraindications, the min-age, max-age and age-groups elements follow the same structure as they do in structured indications.

Structured Blackbox Warnings

<structured-blackbox-warnings>
    <structured-blackbox-warning>
        <kind>warning</kind>
        <risk>
            <title>Increased susceptibility to infection</title>
            <drugbank-id primary="true">DBCOND0097792</drugbank-id>
            <meddra-id kind="preferred_term">10021866</meddra-id>
            <synonyms>
                <synonym>Increased susceptibility to infections</synonym>
                <synonym>Increased susceptibility to infections NOS</synonym>
                <synonym>Infection susceptibility incr</synonym>
                <synonym>Infection susceptibility increased</synonym>
            </synonyms>
        </risk>
    </structured-blackbox-warning>
    <structured-blackbox-warning>
        <kind>warning</kind>
        <risk>
            <title>Lymphoma</title>
            <drugbank-id primary="true">DBCOND0006647</drugbank-id>
            <drugbank-id>DBCOND0006647</drugbank-id>
            <drugbank-id>DBCOND0006647</drugbank-id>
            <drugbank-id>DBCOND0006647</drugbank-id>
            <drugbank-id>DBCOND0006647</drugbank-id>
            <meddra-id kind="low_level_term">10025316</meddra-id>
            <icd10-id kind="concept">C85.9</icd10-id>
            <synonyms>
                <synonym>Lymphoma NOS</synonym>
                <synonym>Lymphoma malignant</synonym>
                <synonym>Lymphoma, Malignant</synonym>
                <synonym>Lymphomas</synonym>
                <synonym>Malignant Lymphoma</synonym>
                <synonym>Malignant Lymphomas</synonym>
                <synonym>Malignant lymphoma NOS</synonym>
            </synonyms>
        </risk>
    </structured-blackbox-warning>
</structured-blackbox-warnings>

Structured blackbox warning data described below is available to subscribers to DrugBank+. See www.drugbank.com/data to learn more.

Structured data representing warnings from the black box section of drug labels. Black box warnings may include specific criteria as to when they apply, as well as potential risks, contraindications, or adverse effects.

<drug> elements may have one or more <structured-blackbox-warning> elements as children of the <structured-blackbox-warning> element.

Each <structured-blackbox-warning> element has the following elements.

Child Elements

Element Type Occurrences Description
kind string 1 The type of black box warning.
management string 0..1 Directions for the health care practictioner to manage risk/adverse effects.
administration string 0..1 Describes the administration of the drug in this warning.
recommendation string 0..1 Short description of the warning, expected action.
timeline string 0..1 Timeline of drug administration/usage.
risk Condition 0..1 A serious adverse effect which may occur with the usage of the drug.
required-use Condition 0..1 The only approved/safe usage of the drug.
misuse Condition 0..* Incorrect usage of the drug.
lab-value string 0..* Relevant lab values for which this warning applies.
route string 0..* Drug routes for which this warning applies.
dose-form string 0..* Dose forms to which this warning applies.
with-drug elements with drug name and drugbank-id 0..* Additional drugs which a patient must be using for the warning to apply.
with-drug-coadmin elements with drug name and drugbank-id 0..* Additional drugs which a patient must be coadministered for the warning to apply.
with-category elements with category name, drugbank-id and mesh-id 0..* Additional categories of drugs which a patient must be using for the warning to apply.
with-category-coadmin elements with category name, drugbank-id and mesh-id 0..* Additional categories of drugs which a patient must be coadministered for the warning to apply.
patient-characteristics list of conditions as <include> and <exclude> elements 0..* Patient characteristics that cause warning to apply to the patient.
sex-group string 0..1 Sex group of the patient for which the warning applies.
above-age age-type 0..1 Minimum age of the patient for which the warning applies.
below-age age-type 0..1 Maximum age of the patient for which the warning applies.
age-groups list of strings as <include> and <exclude> elements 0..* Age groups to which this warning applies.

Within blackbox warnings, it is commonly required to describe a medical condition. The format of conditions is described in the conditions section. The following <structured-blackbox-warning> children take this form:

  • risk
  • misuse
  • required-use
  • patient-characteristic

The <age-groups> element contains a list of <include> and <exclude> elements, which each describe an age group of patients to be included or excluded from this warning. Similarly, the <patient-characteristics> element contains a list of <include> and <exclude> conditions.

Clinical Trials

<clinical-trials>
    <clinical-trial identifier="NCT00019825">
        <title>Decitabine in Treating Patients With Unresectable Lung or Esophageal Cancer or Malignant Mesothelioma of the Pleura</title>
        <official-title>Phase I Study of Decitabine Mediated Induction of Tumor Antigen and Tumor Suppressor Gene Expression in Lung Cancer Patients</official-title>
        <brief-summary>RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. PURPOSE: Phase I trial to study the effectiveness of decitabine in treating patients who have unresectable lung or esophageal cancer or malignant mesothelioma of the pleura.</brief-summary>
        <status>completed</status>
        <purpose>treatment</purpose>
        <start-date>1999-10-01</start-date>
        <phases>
            <phase>1</phase>
        </phases>
        <countries>
            <country>United States</country>
        </countries>
        <condition>
            <title>Malignant Mesothelioma</title>
            <drugbank-id primary="true">DBCOND0003835</drugbank-id>
            <synonyms>
                <synonym>Cancer, mesothelioma</synonym>
            </synonyms>
        </condition>
        <condition>
            <title>Metastatic Cancer</title>
            <drugbank-id primary="true">DBCOND0003752</drugbank-id>
            <meddra-id kind="low_level_term">10025690</meddra-id>
            <synonyms>
                <synonym>Carcinomatosis</synonym>
                <synonym>Disseminated malignant neoplasm</synonym>
                <synonym>Malignant neoplasm disseminated</synonym>
                <synonym>Metastatic neoplasm</synonym>
            </synonyms>
        </condition>
        <browse-condition>
          <title>Esophageal Neoplasms</title>
          <condition>
            <title>Esophageal Neoplasms</title>
            <drugbank-id primary="true">DBCOND0012305</drugbank-id>
          </condition>
        </browse-condition>
        <intervention kind="drug">
            <title>decitabine</title>
            <description>decitabine</description>
            <names />
            <drug>
                <name>Decitabine</name>
                <drugbank-id>DB01262</drugbank-id>
            </drug>
            <product>
                <name>Decitabine</name>
                <ndc-product-code>0781-3139</ndc-product-code>
                <dpd-id />
                <source>FDA NDC</source>
            </product>
        </intervention>
        <results-references>
            <articles />
            <textbooks />
            <links />
        </results-references>
        <general-references>
            <articles>
                <article>
                    <pubmed-id>11216765</pubmed-id>
                    <citation>
    Weiser TS, Ohnmacht GA, Guo ZS, Fischette MR, Chen GA, Hong JA, Nguyen DM, Schrump DS. Induction of MAGE-3 expression in lung and esophageal cancer cells. Ann Thorac Surg. 2001 Jan;71(1):295-301; discussion 301-2.
    </citation>
                </article>
                <article>
                    <pubmed-id>11265773</pubmed-id>
                    <citation>
    Weiser TS, Guo ZS, Ohnmacht GA, Parkhurst ML, Tong-On P, Marincola FM, Fischette MR, Yu X, Chen GA, Hong JA, Stewart JH, Nguyen DM, Rosenberg SA, Schrump DS. Sequential 5-Aza-2 deoxycytidine-depsipeptide FR901228 treatment induces apoptosis preferentially in cancer cells and facilitates their recognition by cytolytic T lymphocytes specific for NY-ESO-1. J Immunother. 2001 Mar-Apr;24(2):151-61.
    </citation>
                </article>
            </articles>
            <textbooks />
            <links />
        </general-references>
        <detailed-description>OBJECTIVES: - Determine the pharmacokinetics, toxicity, and maximum tolerated dose of decitabine in patients with unresectable primary small cell or non-small cell lung cancer, unresectable esophageal cancer, or malignant pleural mesothelioma./detailed-description>
    </clinical-trial>
</clinical-trials>

Clinical Trial data described below is available to subscribers to DrugBank+. See www.drugbank.com/data to learn more.

<drug> elements may have one or more <clinical-trial> elements as children of the <clinical-trials> element.

Each <clinical-trial> element has the following attributes and elements.

Attributes

Element Type Description
identifier string clinicaltrials.gov identifier.

Child Elements

Element Type Description
title string Clinical Trial title, usually similar to the official title but less detailed.
official-title string Official clinicaltrials.gov title.
brief-summary string Brief description of the trial, usually written to be understandable by the general public.
status string Denotes the stage/progress of the trial.
purpose string Denotes the goal of the trial,eg: treatment.
start-date date When the trial started or will start.
end-date date with kind attribute When the trial ended or is expected to end.
phases string Clinical trial phases. Trials are given a phase of 0, 1, 2, 3, or 4. Some trials cover multiple phases.
countries list of country elements A list of countries covered by the trial.
condition list of condition elements Conditions that the trial focuses on. For instance, the condition being treated by an investigational drug.
browse-condition list of browse-condition elements
results-references reference list Articles conveying results of the trial.
general-references reference list Articles discussing or referring to the trial
detailed-description string Detailed description of the trial, often with technical terms and descriptions of methodology, statistics, demographics, etc.
arm-group list of arm-group elements A division of interventions used in the clinical trial. In trials with arm groups, participants are assigned to groups to determine what interventions will be applied to them.
intervention list of intervention elements An intervention is the treatment applied to participants. Often, this is a drug or group of drugs. It may also be a placebo, a specific dosing regimen, or others.
browse-intervention list of browse-intervention elements

Clinical trials include intervention and arm-group data. There can be 0 or more of both elements. Arm groups are identified by the value of their <label> child element, and are referenced from <intervention> elements.

Arm Groups

<arm-group>
    <label>Arm A (Phase 1B)</label>
    <description>PF-04449913 in combination with low dose ARA-C (LDAC)</description>
    <kind>experimental</kind>
</arm-group>

Arm Groups contain the following elements:

Element Occurrences Description
label 1 Each arm group has a unique label which identifies the group. This label is referenced by interventions.
description 1 Description of the group or the interventions applied to the participants in this arm group.
kind 1 Kind denotes what role this group has in the study design, for instance, a group can be the control, the experimental group, or the active comparator group.

<kind> can include the following values

  • experimental
  • active_comparator
  • placebo_comparator
  • sham_comparator
  • no_intervention
  • other
  • control
  • unknown

Browse Conditions

<browse-condition>
  <title>Stomach Neoplasms</title>
  <condition>
    <title>Stomach Neoplasms</title>
    <drugbank-id primary="true">DBCOND0003448</drugbank-id>
    <meddra-id kind="">10051828</meddra-id>
    <synonyms>
      <synonym>Gastric neoplasm</synonym>
      <synonym>Gastric neoplasm NOS</synonym>
      <synonym>Stomach Neoplasm</synonym>
    </synonyms>
  </condition>
</browse-condition>

<browse-condition> elements describe a potential condition that was studied in this trial. These conditions are extracted algorithmically from clinical trial descriptions by clinicaltrials.gov. Each browse-condition is potentially matched to a DrugBank condition, indicated by the presence of a <condition> element.

Element Occurrences Description
title 1
condition 0..1

Browse Interventions

  <browse-intervention>
    <title>Cetuximab</title>
    <drugbank-id>DB00002</drugbank-id>
  </browse-intervention>

<browse-intervention> elements describe a potential intervention that was used in this trial. These interventions are extracted algorithmically from clinical trial descriptions by clinicaltrials.gov. Each browse-intervention is potentially matched to a DrugBank drug, indicated by the presence of a <drugbank-id> element.

Element Occurrences Description
title 1 Intervention title.
drugbank-id 0..1
 <related-clinical-trials>
    <clinical-trial identifier="NCT00225784">
      <!-- ... -->
    </clinical-trial>
 </related-clinical-trials>

If a drug is matched to a clinical trial algorithmically via the <browse-intervention> element, but not as part of a specific intervention of a the same trial, then it will be included as a <clinical-trial> child of the<related-clinical-trials> element.

Interventions

<intervention kind="drug">
    <title>Decitabine</title>
    <description>Decitabine</description>
    <names/>
    <drug>
        <name>Decitabine</name>
        <drugbank-id>DB01262</drugbank-id>
    </drug>
    <product>
        <name>Decitabine</name>
        <ndc-product-code>0781-3139</ndc-product-code>
        <dpd-id/>
        <source>FDA NDC</source>
    </product>
    <arm-group>Myeloproliferative neoplasms</arm-group>
</intervention>

<intervention> elements describe an intervention in the trial. Each intervention can be applied to 0 or more arm groups. This relationship is described with the <arm-group> elements, which reference trial <arm-group> elements by their <label>.

Element Occurrences Description
title 1 Intervention title. Often drug/product names.
description 1 Description of the intervention.
names 1 Names associated with the intervention. May be drug/product names, code names, etc.
drug 0..* Drugs which have been matched to this intervention.
product 0..* Products which have been matched to this intervention (may not be the exact route/form/etc. That was used in the trial).

The <names> element is a list of 0 or more <name> children.

Drugs

Drugs that match the details of this intervention are embedded as <drug> elements with <name> and <drugbank-id> child elements.

Products

Products that match the details of this intervention are embedded as <product> elements with <name>, <ndc-product-code>, <dpd-id>, and <source> child elements.

Salts

<salts>
  <salt>
    <drugbank-id primary="true">DBSALT001920</drugbank-id>
    <name>Oxilofrine hydrochloride</name>
    <synonyms>
      <synonym>4-hydroxyephedrine hydrochloride</synonym>
      <synonym>Hydroxyephedrine hydrochloride, p-</synonym>
      <synonym>Oxilofrine HCl</synonym>
      <synonym>p-hydroxyephedrine hydrochloride</synonym>
      <synonym>Suprifen hydrochloride</synonym>
    </synonyms>
    <external-codes>
      <external-code>J5.704E HCl</external-code>
    </external-codes>
    <unii>3O9694M5EO</unii>
    <cas-number>942-51-8</cas-number>
    <inchikey>ICBZSKCTKKUQSY-YUWZRIFDSA-N</inchikey>
    <average-mass>217.69</average-mass>
    <monoisotopic-mass>217.0869565</monoisotopic-mass>
    <smiles>Cl.[H][C@@](C)(NC)[C@]([H])(O)C1=CC=C(O)C=C1</smiles>
    <inchi>InChI=1S/C10H15NO2.ClH/c1-7(11-2)10(13)8-3-5-9(12)6-4-8;/h3-7,10-13H,1-2H3;1H/t7-,10-;/m0./s1</inchi>
    <formula>C10H16ClNO2</formula>
  </salt>
</salts>

Available salt forms of the drug. Ions such as hydrochloride, sodium, and sulfate are often added to the drug molecule to increase solubility, dissolution, or absorption.

<drug> elements may have one or more <salt> elements as children of the <salts> element.

Each <salt> element has the following elements.

Element Type Description
drugbank-id string One has the attribute primary="true" DrugBank identfiers of the available salt form(s).
name string Name of the available salt form(s).
unii string Unique Ingredient Identifier (UNII) of the available salt form(s).
cas-number string Chemical Abstracts Service (CAS) registry number assigned to the salt form(s) of the drug.
inchikey string IUPAC International Chemical Identifier (InChi) key identfier for the available salt form(s).
average-mass floating point Average molecular mass: the weighted average of the isotopic masses of the salt.
monoisotopic-mass floating point The mass of the most abundant isotope of the salt.
smiles string The simplified molecular-input line-entry system (SMILES) is a line notation used for describing the structure of chemical species using short ASCII strings; calculated by ChemAxon.
inchi string A prediction of the IUPAC International Chemical Identifier (InChI); imported by ChemAxon.
formula string Indicates the simple numbers of each type of atom within the molecule; calculated by ChemAxon.

<salt> elements also include <synonyms> and <external-codes> elements, which have string <synonym> and <external-code> child elements, respectively.

Element Type Description
synonyms string Other names or identifiers that are associated with this salt.
external-codes string Any other identifiers that might be linked to the salt. This often includes numerical codes used during research and development of the salt.

Targets / Enzymes / Carriers / Transporters

Protein targets of drug action, enzymes that are inhibited/induced or involved in metabolism, and carrier or transporter proteins involved in movement of the drug across biological membranes. Each of <targets>, <enzymes>, <carriers> and <transporters> contain one or more child elements named <target>, <enzyme>, <carrier> and <transporter>, respectively. These elements include the following children:

General Information

<transporters>
  <transporter position="1">
    <id>BE0001066</id>
    <name>Solute carrier family 22 member 6</name>
    <organism>Human</organism>
    <actions>
      <action>substrate</action>
    </actions>
    <known-action>unknown</known-action>
    <polypeptide id="Q4U2R8" source="Swiss-Prot"> (SEE BELOW )</polypeptide>
  </transporter>
</transporters>
Attribute Type Description
position integer
Element Type Description
id string Universal Protein Resource (UniProt) identification number.
name string
organism string Organism that the protein comes from.
known-action string Whether the pharmacological action of the drug is due to this taget interaction.
inhibition-strength string Whether the strength of enzyme inhibition is strong, moderate, or unknown. Only applies to enzymes.
induction-strength string Whether the strength of enzyme induction is strong or unknown. Only applies to enzymes.
references See references.
polypeptide See polypeptides.
actions Collection of <action> elements.

Polypeptides

<polypeptide id="P23975" source="Swiss-Prot">
  <name>Sodium-dependent noradrenaline transporter</name>
  <general-function>Norepinephrine:sodium symporter activity</general-function>
  <specific-function>
  Amine transporter. Terminates the action of noradrenaline by its high affinity sodium-dependent reuptake into presynaptic terminals.
  </specific-function>
  <gene-name>SLC6A2</gene-name>
  <locus>16q12.2</locus>
  <cellular-location>Membrane</cellular-location>
  <transmembrane-regions>
  65-85 93-112 136-156 235-253 262-279 315-332 344-365 398-417 444-462 478-498 519-538 557-575
  </transmembrane-regions>
  <signal-regions/>
  <theoretical-pi>7.53</theoretical-pi>
  <molecular-weight>69331.42</molecular-weight>
  <chromosome-location>16</chromosome-location>
  <organism ncbi-taxonomy-id="9606">Human</organism>
  <external-identifiers>
    <external-identifier>
      <resource>HUGO Gene Nomenclature Committee (HGNC)</resource>
      <identifier>HGNC:11048</identifier>
    </external-identifier>
  </external-identifiers>
  <synonyms>
    <synonym>NAT1</synonym>
    <synonym>NET</synonym>
  </synonyms>
  <amino-acid-sequence format="FASTA">
  >lcl|BSEQ0000970|Sodium-dependent noradrenaline transporter MLLARMNPQVQPENNGADTGPEQPLRARKTAELLVVKERNGVQCLLAPRDGDAQPRETWG KKIDFLLSVVGFAVDLANVWRFPYLCYKNGGGAFLIPYTLFLIIAGMPLFYMELALGQYN REGAATVWKICPFFKGVGYAVILIALYVGFYYNVIIAWSLYYLFSSFTLNLPWTDCGHTW NSPNCTDPKLLNGSVLGNHTKYSKYKFTPAAEFYERGVLHLHESSGIHDIGLPQWQLLLC LMVVVIVLYFSLWKGVKTSGKVVWITATLPYFVLFVLLVHGVTLPGASNGINAYLHIDFY RLKEATVWIDAATQIFFSLGAGFGVLIAFASYNKFDNNCYRDALLTSSINCITSFVSGFA IFSILGYMAHEHKVNIEDVATEGAGLVFILYPEAISTLSGSTFWAVVFFVMLLALGLDSS MGGMEAVITGLADDFQVLKRHRKLFTFGVTFSTFLLALFCITKGGIYVLTLLDTFAAGTS ILFAVLMEAIGVSWFYGVDRFSNDIQQMMGFRPGLYWRLCWKFVSPAFLLFVVVVSIINF KPLTYDDYIFPPWANWVGWGIALSSMVLVPIYVIYKFLSTQGSLWERLAYGITPENEHHL VAQRDIRQFQLQHWLAI
  </amino-acid-sequence>
  <gene-sequence format="FASTA">
  >lcl|BSEQ0010343|Sodium-dependent noradrenaline transporter (SLC6A2) ATGCTTCTGGCGCGGATGAACCCGCAGGTGCAGCCCGAGAACAACGGGGCGGACACGGGT CCAGAGCAGCCCCTTCGGGCGCGCAAAACTGCGGAGCTGCTGGTGGTGAAGGAGCGCAAC GGCGTCCAGTGCCTGCTGGCGCCCCGCGACGGCGACGCGCAGCCCCGGGAGACCTGGGGC AAGAAGATCGACTTCCTGCTGTCCGTAGTCGGCTTCGCAGTGGACCTGGCCAACGTGTGG CGCTTCCCCTACCTCTGCTACAAGAACGGCGGCGGTGCCTTCTTGATCCCGTACACACTG TTCCTTATCATCGCGGGGATGCCCCTGTTCTACATGGAGCTGGCTCTGGGACAGTACAAC CGGGAGGGGGCTGCCACCGTTTGGAAAATCTGCCCATTCTTCAAAGGCGTTGGCTATGCT GTCATCCTGATCGCCCTGTACGTTGGCTTCTACTACAACGTCATCATCGCCTGGTCACTC TACTACCTCTTCTCCTCCTTCACCCTCAACCTGCCCTGGACCGACTGTGGCCACACCTGG AACAGCCCCAACTGTACCGACCCCAAGCTCCTCAATGGCTCCGTGCTTGGCAACCACACC AAGTACTCCAAGTACAAGTTCACGCCGGCAGCCGAGTTTTATGAGCGTGGTGTCCTGCAC CTTCACGAGAGCAGCGGGATTCATGACATCGGCCTGCCCCAGTGGCAGCTCTTGCTCTGT CTGATGGTCGTCGTCATCGTCTTGTATTTTAGCCTCTGGAAAGGGGTGAAGACATCAGGA AAGGTGGTGTGGATCACAGCCACGCTGCCTTACTTCGTGCTGTTCGTGCTCCTGGTCCAT GGCGTCACGCTGCCCGGAGCCTCCAATGGCATCAATGCCTACCTGCACATCGACTTCTAC CGCTTGAAAGAGGCCACGGTATGGATTGATGCCGCAACTCAGATATTTTTTTCCTTGGGG GCTGGATTTGGAGTATTGATTGCATTTGCCAGTTACAACAAATTTGACAACAACTGTTAC AGGGATGCCCTGCTGACCAGCAGCATCAACTGTATCACCAGCTTCGTCTCTGGGTTCGCC ATCTTCTCCATCCTTGGTTACATGGCCCATGAACACAAGGTCAACATTGAGGATGTGGCC ACAGAAGGAGCTGGCCTAGTGTTCATCCTGTATCCAGAGGCCATTTCTACCCTGTCTGGA TCTACATTCTGGGCTGTTGTGTTTTTCGTCATGCTCCTGGCGCTGGGCCTTGACAGCTCA ATGGGAGGCATGGAGGCTGTCATCACGGGCCTGGCAGATGACTTCCAGGTCCTGAAGCGA CACCGGAAACTCTTCACATTTGGCGTCACCTTCAGCACTTTCCTTCTCGCCCTGTTCTGC ATAACCAAGGGTGGAATTTACGTCTTGACCCTCCTGGACACCTTTGCTGCGGGCACCTCC ATCCTTTTTGCTGTCCTCATGGAAGCCATCGGAGTTTCCTGGTTTTATGGAGTGGACAGG TTCAGCAACGACATCCAGCAGATGATGGGGTTCAGGCCGGGTCTATACTGGAGACTGTGC TGGAAGTTCGTCAGTCCTGCCTTCCTCCTGTTCGTGGTTGTGGTCAGCATCATCAACTTC AAGCCACTCACCTACGACGACTACATCTTCCCGCCCTGGGCCAACTGGGTGGGGTGGGGC ATCGCCCTGTCCTCCATGGTCCTGGTGCCCATCTACGTCATCTATAAGTTCCTCAGCACG CAGGGCTCTCTTTGGGAGAGACTGGCCTATGGCATCACGCCAGAGAACGAGCACCACCTG GTGGCTCAGAGGGACATCAGACAGTTCCAGTTGCAACACTGGCTGGCCATCTGA
  </gene-sequence>
  <pfams>
    <pfam>
      <identifier>PF00209</identifier>
      <name>SNF</name>
    </pfam>
  </pfams>
  <go-classifiers>
    <go-classifier>
      <category>component</category>
      <description>membrane</description>
    </go-classifier>
  </go-classifiers>
</polypeptide>

Descriptions of identified polypeptide targets, enzymes, carriers, or transporters.

<target>, <enzyme>, <carrier> and <transporter> elements include a child element (<polypeptides>) which may contain one or more <polypeptide> elements.

Attribute Type Description
id string Universal Protein Resource (UniProt) identifier.
source string Specifies whether the identified polypeptide ID is associated with any of the following UniProt knowledgebases: Swiss-Prot, which is manually annotated and reviewed, or TrEMBL, which is automatically annotated and not reveiwed.
Element Type Description
name string
general-function text General summary of the physiological function of the polypeptide.
specific-function text A more specific description of the polypeptide’s physiological function within the cell.
gene-name string The short name commonly associated with the associated gene. Eg. PTGS1.
locus string The specific chromosomal location or position of the gene’s sequence on a chromosome.
cellular-location string The cellular location of the polypeptide.
transmembrane-regions string Areas of the polypeptide sequence that span a biological membrane.
signal-regions string Location of any signal peptides within the polypeptide sequence.
theoretical-pi floating point Theoretical isoelectric point.
molecular-weight floating point The molecular weight of the polypeptide.
chromosome-location integer The chromosomal location of the polypeptide gene.
organism string The organism in which this polypeptide functions.
external-identifiers External identifiers, such as numerical codes associated with its research or development.
synonyms Alternate names or identifiers that may be associated with this polypeptide.
amino-acid-sequence string The amino acid sequence of the polypeptide.
gene-sequence The sequence of the associated gene.
pfams The protein family (pfam) identifier.
go-classifiers The Gene Ontology (GO) Consortium identifier.

The list elements (documented above) contain zero or more of their respective child elements:

Element Child Element
<external-identifiers> <external-identifier>, see external-identifiers
<synonyms> <synonym>
<pfams> <pfam>, with <identifier> and <name> elements
<go-classifiers> <go-classifier>, with <category> and <description> elements.

Allergies

Allergy Details

<allergy-details>
  <allergy-detail>
    <summary>Hypersensitivity to Cetuximab can present as: Cutaneous Manifestations of Drug Allergy, Stevens-Johnson Syndrome Toxic Epidermal Necrolysis Spectrum, Anaphylaxis, Infusion related reaction, Angioedema, Exanthema, and Bronchospasm</summary>
    <info>Hypersensitivity reactions to cetuximab include anaphylaxis and angioedema, as well as a generalized rash, loss of consciousness, hypotension, and cardiorespiratory arrest in more severe cases.[A216143, A221805] Other documented reactions include toxic epidermal necrolysis (TEN), acneiform exanthems, and folliculitis.[A216268] Severe hypersensitivity reactions can occur in 1 to 5% of patients.[A216143] IgE antibodies against cetuximab found in patients who were hypersensitive to the drug were shown to be specific for an oligosaccharide, galactose-α-1,3-galactose, which is present on the Fab portion of the cetuximab heavy chain. Natural exposure to galactose-α-1,3-galactose and production of IgE antibodies against this sugar structure found in non-primate mammalian proteins is possible through tick bites and red meat allergy. Patients with previous tick bites and red meat allergies have a risk of cross-sensitivity to cetuximab.[A221805] Like other monoclonal antibodies administered via intravenous infusion, cetuximab is associated with infusion-related reactions. Studies report that the rate of infusion-related reactions (grade 1 to 4) can range from 12 to 27%.[A221795,A221800]</info>
    <source-name>Cetuximab</source-name>
    <source-type>drug-specific</source-type>
    <evidence-type>case_reports</evidence-type>
    <evidence-type>review</evidence-type>
    <presentation>
      <condition>
        <title>Cutaneous Manifestations of Drug Allergy</title>
        <drugbank-id primary="true">DBCOND0131308</drugbank-id>
      </condition>
      <simple-description>A cutaneous manifestation is a skin condition or rash that can occur due to infections, medical conditions, or a drug allergy. It is sometimes accompanied by a fever, feeling generally unwell, a headache, or other symptoms.</simple-description>
      <clinical-description>Cutaneous manifestations of drug allergy normally result in a rash with or without systemic symptoms such as fever, headache, or malaise. The skin eruption can have various clinical presentations and can change or progress over time. Examples include but are not limited to maculopapular rash, morbilliform rash, fixed drug eruption, and more serious conditions such as Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN).</clinical-description>
      <management>If a drug-induced allergy is suspected or confirmed, the causative agent should be discontinued immediately. Supportive care measures and symptomatic treatment are the cornerstones of management and should be tailored to each individual’s clinical presentation. When choosing an alternative agent, consider cross-sensitivity and avoid agents that are structurally related, if possible.[A201914, A204257]</management>
      <hypersensitivity-type>Unclassified</hypersensitivity-type>
      <references>
        <articles>
          <article>
            <ref-id>A201914</ref-id>
            <pubmed-id>30135011</pubmed-id>
            <citation>Böhm R, Proksch E, Schwarz T, Cascorbi I: Drug Hypersensitivity Dtsch Arztebl Int. 2018 Jul 23;115(29-30):501-512. doi: 10.3238/arztebl.2018.0501.</citation>
          </article>
          <article>
            <ref-id>A204257</ref-id>
            <pubmed-id>30275849</pubmed-id>
            <citation>Warrington R, Silviu-Dan F, Wong T: Drug allergy. Allergy Asthma Clin Immunol. 2018 Sep 12;14(Suppl 2):60. doi: 10.1186/s13223-018-0289-y. eCollection 2018.</citation>
          </article>
        </articles>
        <textbooks/>
        <links/>
        <attachments/>
      </references>
    </presentation>
    <presentation>
      <condition>
        <title>Stevens-Johnson Syndrome Toxic Epidermal Necrolysis Spectrum</title>
        <drugbank-id primary="true">DBCOND0117748</drugbank-id>
        <synonyms>
          <synonym>Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis</synonym>
          <synonym>Stevens-Johnson syndrome/ toxic epidermal necrolysis</synonym>
        </synonyms>
      </condition>
      <simple-description>Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, potentially life-threatening reactions to medications. At first, patients with these reactions feel like they have the flu. Sores develop on the skin and sometimes the eyes, mouth, and genitals. The skin may eventually begin to peel off. This type of reaction is called Stevens-Johnson Syndrome (SJS) if less skin is involved, and Toxic Epidermal Necrolysis (TEN) when more skin is involved.</simple-description>
      <clinical-description>Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) are reactions that occur following exposure to a culprit medication that elicit a hypersensitivity response. Initially, the reaction presents with flu-like symptoms (fever, sore throat, and fatigue), and can progress to include ocular involvement, ulcers, and mucous membrane lesions.[A189309,A201965] These ulcers and lesions are most common on the lips and mouth, but may also appear on the eyes, trunk, and genitals.[A189309,A201965] SJS and TEN skin reactions cause blistering, a positive Nikolsky’s sign, skin detachment, and erythema.[A204254] Histological examination reveals keratinocyte necrosis, full-thickness epidermal necrosis, and mild inflammation (often with lymphocytic infiltrate). The diagnosis for SJS/TEN requires a negative direct immunofluorescence test to rule out other conditions characterized by antibody deposition in the skin.[A204254] This cutaneous reaction is classified as SJS when less than 10% of the skin's surface area is involved; it is classified as TEN when greater than 30% of the skin's surface area is involved.[A201965,A189309] TEN generally presents within 1 to 60 days of initial drug exposure and within 5 half-lives of stopping the drug.[A201965] SJS/TEN severity is correlated with levels of both granulysin and IL-15.[A204254] </clinical-description>
      <management>In the case of SJS/TEN  immediately withdraw the causative drug and admit the patient to a specialized unit with adequate monitoring and supportive care, such as a burn unit or the intensive care unit.[A201965] Drugs with long half-lives are associated with a higher mortality rate.[A201965] Some patients may require non-adhesive dressings over the affected areas and air fluidized beds to promote skin regrowth.[A201965] Pain management is an important part of therapy for SJS/TEN.[L15032]&#13;
&#13;
The use of antibiotics in patients with SJS/TEN has not been thoroughly investigated, however, they may be administered if an infection is suspected.[A201965,L15032] Evidence regarding the benefit of glucocorticoids, intravenous immunoglobulins, or cyclosporin A treatment is conflicting, although they have been beneficial in some cases.[A201965] Cyclophosphamide and thalidomide are no longer used as therapies for SJS/TEN, as they have not been determined to be efficacious during  clinical studies.[A201965]&#13;
</management>
      <hypersensitivity-type>Type IV</hypersensitivity-type>
      <references>
        <articles>
          <article>
            <ref-id>A189309</ref-id>
            <pubmed-id>22165859</pubmed-id>
            <citation>Warrington R, Silviu-Dan F: Drug allergy. Allergy Asthma Clin Immunol. 2011 Nov 10;7 Suppl 1:S10. doi: 10.1186/1710-1492-7-S1-S10.</citation>
          </article>
          <article>
            <ref-id>A201965</ref-id>
            <pubmed-id>29188475</pubmed-id>
            <citation>Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T: Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Clin Rev Allergy Immunol. 2018 Feb;54(1):147-176. doi: 10.1007/s12016-017-8654-z.</citation>
          </article>
          <article>
            <ref-id>A204254</ref-id>
            <pubmed-id>28476287</pubmed-id>
            <citation>Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O: Severe cutaneous adverse reactions to drugs. Lancet. 2017 Oct 28;390(10106):1996-2011. doi: 10.1016/S0140-6736(16)30378-6. Epub 2017 May 2.</citation>
          </article>
        </articles>
        <textbooks/>
        <links>
          <link>
            <ref-id>L15032</ref-id>
            <title>Merk Manual: Consumer Version: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)</title>
            <url>https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-inflammatory-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten</url>
          </link>
        </links>
        <attachments/>
      </references>
    </presentation>
    <presentation>
      <condition>
        <title>Anaphylaxis</title>
        <drugbank-id primary="true">DBCOND0001820</drugbank-id>
        <meddra-id kind="high_level_term">10002220</meddra-id>
        <icd10-id kind="concept">T78.2</icd10-id>
        <synonyms>
          <synonym>Allergic shock</synonym>
          <synonym>Anaphylactic</synonym>
          <synonym>Anaphylactic Reaction</synonym>
          <synonym>Anaphylactic reactions</synonym>
          <synonym>Anaphylactic responses</synonym>
          <synonym>Anaphylactic shock</synonym>
          <synonym>Anaphylactic symptoms</synonym>
          <synonym>Anaphylactic-type reactions</synonym>
          <synonym>Anaphylaxis reaction</synonym>
          <synonym>Anaphylaxis reactions</synonym>
          <synonym>Systemic anaphylactic reaction</synonym>
          <synonym>Systemic anaphylaxis</synonym>
        </synonyms>
      </condition>
      <simple-description>Anaphylaxis is a life-threatening allergic reaction that can cause low blood pressure, difficulty breathing, and a skin rash.</simple-description>
      <clinical-description>Anaphylaxis is an allergic reaction that causes urticaria, dyspnea, wheezing, nausea, vomiting, syncope, and hypotension. It typically manifests seconds to minutes following exposure to a drug or other allergen. Rarely, it may be delayed by several hours after exposure. Protracted anaphylaxis may last for hours to days.[A214499] Anaphylaxis is caused by activation of the immune system, causing the release of IgG, IgE, and the formation of immune complexes that lead to various symptoms.[L14378] Cardiovascular, cutaneous, and respiratory symptoms are the most frequently reported clinical manifestations of anaphylaxis, and may result in fatal outcomes.[A199128,A214499]</clinical-description>
      <management>Anaphylaxis is a life-threatening condition and is generally treated with prompt withdrawal of the offending medication, early intramuscular or subcutaneous epinephrine, and intravenous fluids.[A199128,A214499] The patient should be monitored closely. Adjunctive treatment options include antihistamines, beta agonists, and corticosteroids. In some cases, ventilatory support may be required. Patients with anaphylaxis should be monitored for protracted anaphylaxis, which may persist for hours or days without resolution of symptoms.[A214499,A215392]</management>
      <hypersensitivity-type>Type I</hypersensitivity-type>
      <references>
        <articles>
          <article>
            <ref-id>A199128</ref-id>
            <pubmed-id>29103454</pubmed-id>
            <citation>Lee SE: Management of Anaphylaxis. Otolaryngol Clin North Am. 2017 Dec;50(6):1175-1184. doi: 10.1016/j.otc.2017.08.013.</citation>
          </article>
          <article>
            <ref-id>A214499</ref-id>
            <pubmed-id/>
            <citation>Tang, Angela W.: A Practical Guide to Anaphylaxis American Family Physician.</citation>
          </article>
          <article>
            <ref-id>A215392</ref-id>
            <pubmed-id/>
            <citation>M. Winikor, J. Xu, J. Stoll, W. Khan: Protracted Anaphylaxis and Treatment Resistant Angioedema: Looking Beyond Ingestions and Skin American Journal of Respiratory Critical Care Medicine.</citation>
          </article>
        </articles>
        <textbooks/>
        <links>
          <link>
            <ref-id>L14378</ref-id>
            <title>World Allergy Organization: Anaphylaxis vs. Anaphylactoid reactions</title>
            <url>https://www.worldallergy.org/ask-the-expert/questions/anaphylaxis-vs-anaphylactoid-reactions</url>
          </link>
        </links>
        <attachments/>
      </references>
    </presentation>
    <presentation>
      <condition>
        <title>Infusion related reaction</title>
        <drugbank-id primary="true">DBCOND0012307</drugbank-id>
        <meddra-id kind="preferred_term">10051792</meddra-id>
        <synonyms>
          <synonym>Infusion Reaction</synonym>
          <synonym>Infusion Reactions</synonym>
          <synonym>Infusion-related reaction</synonym>
          <synonym>Infusion-related reactions</synonym>
        </synonyms>
      </condition>
      <simple-description>An infusion-related reaction is a type of allergic reaction that occurs when drugs are administered through an intravenous (IV) injection. It is characterized by anaphylaxis, skin rash, fever, chills, facial swelling, and difficulty breathing, along with other symptoms involving multiple organs. Symptoms of infusion-related reactions usually begin shortly after an intravenous infusion is started.</simple-description>
      <clinical-description>Infusion-related reactions are a type I hypersensitivity reaction with a wide range of severity and clinical presentations. Multiorgan involvement may occur during an infusion-related reaction. Clinical presentations can include a skin rash, anaphylaxis, fever, chills, dyspnea, hypotension, respiratory arrest, tachycardia, and rarely, death. Variable cutaneous (urticaria, pruritus, angioedema), gastrointestinal (nausea, vomiting, diarrhea, abdominal cramping), and renal (hematuria) symptoms may be observed.[A221565] Infusion-related reactions most commonly occur after the administration of anticancer drugs, such as monoclonal antibodies, administered by intravenous infusion. Infusion-related reactions can either be immunological (IgE-mediated, allergic, or anaphylactic) or non-immunological (anaphylactoid or pseudo-allergic), however, differentiation is challenging as the clinical manifestations of these conditions can be very similar. True type I allergic infusion-related reactions occur within minutes of exposure, although delayed reactions occurring 10-12 hours after drug exposure are also possible.[A221560] A pseudo-allergic infusion reaction resembles a true type I hypersensitivity reaction, can arise from direct cytokine release caused by the drug (also known as a cytokine-release syndrome), and is typically observed in the hours immediately following infusion of the culprit drug.[A221555] Such reactions are common with monoclonal antibodies and T-cell-directed immunotherapies, especially during the initial drug exposure.[A221565]</clinical-description>
      <management>If an infusion-related allergic reaction is severe, interruption of the drug infusion is recommended.[A221555] Supportive care measures and symptomatic treatment are the cornerstones of management and should be tailored to each individual’s clinical presentation.[A201914, A204257]</management>
      <hypersensitivity-type>Type I</hypersensitivity-type>
      <references>
        <articles>
          <article>
            <ref-id>A201914</ref-id>
            <pubmed-id>30135011</pubmed-id>
            <citation>Böhm R, Proksch E, Schwarz T, Cascorbi I: Drug Hypersensitivity Dtsch Arztebl Int. 2018 Jul 23;115(29-30):501-512. doi: 10.3238/arztebl.2018.0501.</citation>
          </article>
          <article>
            <ref-id>A204257</ref-id>
            <pubmed-id>30275849</pubmed-id>
            <citation>Warrington R, Silviu-Dan F, Wong T: Drug allergy. Allergy Asthma Clin Immunol. 2018 Sep 12;14(Suppl 2):60. doi: 10.1186/s13223-018-0289-y. eCollection 2018.</citation>
          </article>
          <article>
            <ref-id>A221555</ref-id>
            <pubmed-id>28881914</pubmed-id>
            <citation>Rosello S, Blasco I, Garcia Fabregat L, Cervantes A, Jordan K: Management of infusion reactions to systemic anticancer therapy: ESMO Clinical Practice Guidelines. Ann Oncol. 2017 Jul 1;28(suppl_4):iv100-iv118. doi: 10.1093/annonc/mdx216.</citation>
          </article>
          <article>
            <ref-id>A221560</ref-id>
            <pubmed-id>20350882</pubmed-id>
            <citation>Vogel WH: Infusion reactions: diagnosis, assessment, and management. Clin J Oncol Nurs. 2010 Apr;14(2):E10-21. doi: 10.1188/10.CJON.E10-E21.</citation>
          </article>
          <article>
            <ref-id>A221565</ref-id>
            <pubmed-id>27086555</pubmed-id>
            <citation>Asselin B: Immunology of infusion reactions in the treatment of patients with acute lymphoblastic leukemia. Future Oncol. 2016 Jul;12(13):1609-21. doi: 10.2217/fon-2016-0005. Epub 2016 Apr 18.</citation>
          </article>
        </articles>
        <textbooks/>
        <links/>
        <attachments/>
      </references>
    </presentation>
    <presentation>
      <condition>
        <title>Angioedema</title>
        <drugbank-id primary="true">DBCOND0013604</drugbank-id>
        <meddra-id kind="high_level_term">10002425</meddra-id>
        <icd10-id kind="concept">T78.3</icd10-id>
        <synonyms>
          <synonym>Allergic angioedema</synonym>
          <synonym>Angio-edema</synonym>
          <synonym>Angio-oedema</synonym>
          <synonym>Angioedema and urticaria</synonym>
          <synonym>Angioedemas</synonym>
          <synonym>Angioneurotic edema</synonym>
          <synonym>Angioneurotic oedema</synonym>
          <synonym>Edema Quincke's</synonym>
          <synonym>Edema angioneurotic</synonym>
          <synonym>Giant hives</synonym>
          <synonym>Giant urticaria</synonym>
          <synonym>Hives giant</synonym>
          <synonym>Oedema Quincke's</synonym>
          <synonym>Oedema angioneurotic</synonym>
          <synonym>Quincke's edema</synonym>
          <synonym>Quincke's oedema</synonym>
          <synonym>Urticaria</synonym>
          <synonym>Urticaria giant</synonym>
        </synonyms>
      </condition>
      <simple-description>Angioedema is swelling that can occur in one or more areas of the body and can sometimes lead to death if the swelling blocks the airway.</simple-description>
      <clinical-description>Angioedema is a non-pitting edema that may affect more than one site on the body, sometimes leading to laryngeal edema, asphyxia, and sudden death.[A199167,A214502,A214505] Symptoms of laryngeal edema include stridor, dysphonia, and hoarseness.[A199167] Physiologically, angioedema is a result of increased vascular permeability caused by the release of bradykinin or histamine, which separates angioedema into separate etiologies: allergic histamine-mediated angioedema and bradykinin-mediated angioedema. Unlike bradykinin-mediated angioedema, the onset of allergic angioedema symptoms occurs within minutes of exposure to a drug or allergen, and may persist for 12-24 hours. IgE mediated histamine release is the primary cause of allergic angioedema, and it results in swelling of dermal tissue, subcutaneous tissue, and submucosal tissue. Edema can appear on the face, neck, and extremities.[A1991617] In addition to visible swelling, angioedema frequently presents with urticaria, bronchospasm, wheezing, and hypotension, with or without glossal/laryngeal edema. In some cases, angioedema related swelling of the gastrointestinal tract manifests as abdominal pain.[A199167]</clinical-description>
      <management>Monitor the patient for dyspnea, hoarseness,  and other symptoms that suggest laryngeal edema. It is important to consider the subtype of angioedema (i.e. allergic or bradykinin-mediated) as they are managed differently. Distinctive clinical presentations may be useful for differentiating the angioedema subtypes. Allergic or histamine-mediated angioedema is frequently associated with rapid-onset hypotension, urticaria, bronchospasm, and abdominal pain. This type of angioedema is typically treated with antihistamines, steroids, and intramuscular epinephrine.[A199167,A214514]  &#13;
Supportive care measures and symptomatic treatment are the cornerstones of management and should be tailored to each individual’s clinical presentation.[A201914, A204257] When choosing an alternative agent for drug treatment, consider cross-sensitivity and avoid agents that are structurally related, if possible.[A201914, A204257] &#13;</management>
      <hypersensitivity-type>Type I</hypersensitivity-type>
      <references>
        <articles>
          <article>
            <ref-id>A199167</ref-id>
            <pubmed-id>31316698</pubmed-id>
            <citation>Long BJ, Koyfman A, Gottlieb M: Evaluation and Management of Angioedema in the Emergency Department. West J Emerg Med. 2019 Jul;20(4):587-600. doi: 10.5811/westjem.2019.5.42650. Epub 2019 Jul 2.</citation>
          </article>
          <article>
            <ref-id>A214502</ref-id>
            <pubmed-id>23282406</pubmed-id>
            <citation>Kaplan AP: Angioedema. World Allergy Organ J. 2008 Jun;1(6):103-13. doi: 10.1097/WOX.0b013e31817aecbe.</citation>
          </article>
          <article>
            <ref-id>A214505</ref-id>
            <pubmed-id>20589206</pubmed-id>
            <citation>Bork K: Recurrent angioedema and the threat of asphyxiation. Dtsch Arztebl Int. 2010 Jun;107(23):408-14. doi: 10.3238/arztebl.2010.0408. Epub 2010 Jun 11.</citation>
          </article>
          <article>
            <ref-id>A214514</ref-id>
            <pubmed-id>27601734</pubmed-id>
            <citation>Misra L, Khurmi N, Trentman TL: Angioedema: Classification, management and emerging therapies for the perioperative physician. Indian J Anaesth. 2016 Aug;60(8):534-41. doi: 10.4103/0019-5049.187776.</citation>
          </article>
          <article>
            <ref-id>A201914</ref-id>
            <pubmed-id>30135011</pubmed-id>
            <citation>Böhm R, Proksch E, Schwarz T, Cascorbi I: Drug Hypersensitivity Dtsch Arztebl Int. 2018 Jul 23;115(29-30):501-512. doi: 10.3238/arztebl.2018.0501.</citation>
          </article>
          <article>
            <ref-id>A204257</ref-id>
            <pubmed-id>30275849</pubmed-id>
            <citation>Warrington R, Silviu-Dan F, Wong T: Drug allergy. Allergy Asthma Clin Immunol. 2018 Sep 12;14(Suppl 2):60. doi: 10.1186/s13223-018-0289-y. eCollection 2018.</citation>
          </article>
        </articles>
        <textbooks/>
        <links/>
        <attachments/>
      </references>
    </presentation>
    <presentation>
      <condition>
        <title>Exanthemas NEC</title>
        <drugbank-id primary="true">DBCOND0103733</drugbank-id>
        <meddra-id kind="low_level_term">10015587</meddra-id>
        <icd10-id kind="concept">R21</icd10-id>
        <synonyms>
          <synonym>(Rash) or (C/O a rash)</synonym>
          <synonym>Cutaneous eruption (morphologic abnormality)</synonym>
          <synonym>Efflorescence</synonym>
          <synonym>Eruption (disorder)</synonym>
          <synonym>Eruption (morphologic abnormality)</synonym>
          <synonym>Exanthem</synonym>
          <synonym>Exanthema</synonym>
          <synonym>Rash</synonym>
          <synonym>Rash (nonspecific)</synonym>
          <synonym>Rash NOS</synonym>
          <synonym>Rash and other nonspecific skin eruption</synonym>
          <synonym>Skin eruption</synonym>
          <synonym>Skin rash</synonym>
          <synonym>[D]Exanthem</synonym>
          <synonym>[D]Exanthem (context-dependent category)</synonym>
          <synonym>[D]Rash and other nonspecific skin eruption</synonym>
          <synonym>[D]Rash and other nonspecific skin eruption (context-dependent category)</synonym>
          <synonym>[D]Rash and other nonspecific skin eruption NOS</synonym>
          <synonym>[D]Rash and other nonspecific skin eruption NOS (context-dependent category)</synonym>
        </synonyms>
      </condition>
      <simple-description>An exanthem is a skin rash - sometimes referred to as a morbilliform rash - and occurs due to a variety of infections, health conditions, or after taking certain medications. It typically begins on the chest or abdomen and spreads rapidly to other parts of the body.</simple-description>
      <clinical-description>Exanthema is a general term used to describe widespread skin eruptions caused by a variety of conditions, including infection, malignancy, drug hypersensitivity, or other conditions. Exanthemata are commonly associated with systemic symptoms, including fever, malaise, and headache. Loss of appetite, irritability, and abdominal pain are additional symptoms that occur along with the rash.[L14438] In the context of drug hypersensitivity, exanthemata often present as flat and raised (maculopapular) rashes appearing within days to weeks of exposure to a specific drug. The lesions initially appear on the trunk and rapidly progresse outwards toward the limbs in a symmetrical fashion. A low-grade fever is often present; mucous membranes are typically spared.[A189309,A214622] Pruritus and subcutaneous swelling and/or edema may also be apparent.[A214622,A214625] Histologically, the infiltration of activated lymphocytes and eosinophils in the papillary dermis and dermal-epidermal junction near the vasculature may be observed. Necrotic or abnormal keratinocytes can be seen in early exanthematous lesions.[T803, A214625]

A morbilliform rash is a subtype of a maculopapular rash, although the two terms are often used interchangeably. It is commonly associated with antibiotic therapy and may occur in isolation, or in combination with other symptoms that may denote a more serious allergic condition.[L14477] The histology for morbilliform rash is nonspecific and unlikely to confirm a diagnosis. Clinical correlation is advised if a histologic examination is performed.[A214625] The morbilliform rash commonly presents as flat and raised lesions initially appearing on the trunk with subsequent progression to the limbs. It is predominantly a T-cell mediated delayed-type hypersensitivity reaction that occurs within days to weeks after exposure to the offending drug.[A214655,A214658,L14477]
</clinical-description>
      <management>Discontinuing the offending agent normally leads to the rapid resolution of exthameta, if caused by drug-hypersensitivity. The use of emollients and topical steroid creams may be beneficial.[A214625,L14477] Supportive care measures and symptomatic treatment are the cornerstones of management and should be tailored to each individual’s clinical presentation. When choosing an alternative agent, consider cross-sensitivity and avoid agents that are structurally related if possible.[A201914,A204257]</management>
      <hypersensitivity-type>Type IV</hypersensitivity-type>
      <references>
        <articles>
          <article>
            <ref-id>A189309</ref-id>
            <pubmed-id>22165859</pubmed-id>
            <citation>Warrington R, Silviu-Dan F: Drug allergy. Allergy Asthma Clin Immunol. 2011 Nov 10;7 Suppl 1:S10. doi: 10.1186/1710-1492-7-S1-S10.</citation>
          </article>
          <article>
            <ref-id>A214622</ref-id>
            <pubmed-id>30981291</pubmed-id>
            <citation>Muzumdar S, Rothe MJ, Grant-Kels JM: The rash with maculopapules and fever in adults. Clin Dermatol. 2019 Mar - Apr;37(2):109-118. doi: 10.1016/j.clindermatol.2018.12.004. Epub 2018 Dec 5.</citation>
          </article>
          <article>
            <ref-id>A214625</ref-id>
            <pubmed-id>19398898</pubmed-id>
            <citation>Fernandez TD, Canto G, Blanca M: Molecular mechanisms of maculopapular exanthema. Curr Opin Infect Dis. 2009 Jun;22(3):272-8. doi: 10.1097/QCO.0b013e3283298e62.</citation>
          </article>
          <article>
            <ref-id>A214655</ref-id>
            <pubmed-id>9126012</pubmed-id>
            <citation>Barbaud AM, Bene MC, Schmutz JL, Ehlinger A, Weber M, Faure GC: Role of delayed cellular hypersensitivity and adhesion molecules in amoxicillin-induced morbilliform rashes. Arch Dermatol. 1997 Apr;133(4):481-6.</citation>
          </article>
          <article>
            <ref-id>A214658</ref-id>
            <pubmed-id>19967009</pubmed-id>
            <citation>Nayak S, Acharjya B: Adverse cutaneous drug reaction. Indian J Dermatol. 2008 Jan;53(1):2-8. doi: 10.4103/0019-5154.39732.</citation>
          </article>
        </articles>
        <textbooks>
          <textbook>
            <ref-id>T803</ref-id>
            <isbn>978-1-4614-7261-2</isbn>
            <citation>Brian A. Baldo, Nghia H. Pham (2013). Drug Allergy: Clinical Aspects, Diagnosis, Mechanisms, Structure-Activity Relationships. Springer.</citation>
          </textbook>
        </textbooks>
        <links>
          <link>
            <ref-id>L14438</ref-id>
            <title>DermNet NZ: Exanthems</title>
            <url>https://dermnetnz.org/topics/exanthems/</url>
          </link>
          <link>
            <ref-id>L14477</ref-id>
            <title>DermNet NZ: Morbilliform drug reaction</title>
            <url>https://dermnetnz.org/topics/morbilliform-drug-reaction/</url>
          </link>
        </links>
        <attachments/>
      </references>
    </presentation>
    <presentation>
      <condition>
        <title>Bronchospasm</title>
        <drugbank-id primary="true">DBCOND0013567</drugbank-id>
        <meddra-id kind="low_level_term">10006443</meddra-id>
        <icd10-id kind="concept">J98.01</icd10-id>
        <synonyms>
          <synonym>(Bronchospasm) or (O/E - rhonchi (&amp; present))</synonym>
          <synonym>Bronchial Spasm</synonym>
          <synonym>Bronchospasm (finding)</synonym>
          <synonym>Bronchospasm (rare)</synonym>
          <synonym>Bronchospasm NOS</synonym>
          <synonym>Bronchospasms</synonym>
          <synonym>Spasm bronchial</synonym>
        </synonyms>
      </condition>
      <simple-description>Bronchospasm is a tightening of the airways that can cause cough, wheezing, chest tightness, and breathing difficulties. It is caused by various conditions, such as asthma, inflammation, or allergic reactions.</simple-description>
      <clinical-description>Bronchospasm is caused by the contraction of bronchial smooth muscle[A201872]  induced by asthma, irritation, inflammation, or allergies.  In the context of drug allergy, bronchospasm occurs rapidly following exposure to a culprit drug. It may be followed by airway edema and increased mucus secretion, impairing the ability of bronchodilators to reach their target sites.[A201872] Clinically, bronchospasm may present with cough, difficulty breathing, or wheezing.[L15138]</clinical-description>
      <management>Bronchospasm can be managed on a short-term basis with short-acting beta-2-selective adrenergic agonists.[A201872] Long-acting beta-2-selective agonists may be employed for the long-term management of bronchospasm.[A201872] If a drug-induced allergy is suspected or confirmed, the causative agent should be discontinued immediately. Supportive care measures and symptomatic treatment are the cornerstones of management and should be tailored to each individual’s clinical presentation.[A201914, A204257] When choosing an alternative agent for drug treatment, consider cross-sensitivity and avoid agents that are structurally related, if possible.[A201914, A204257]</management>
      <hypersensitivity-type>Type I</hypersensitivity-type>
      <references>
        <articles>
          <article>
            <ref-id>A201872</ref-id>
            <pubmed-id>20007991</pubmed-id>
            <citation>Woods BD, Sladen RN: Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009 Dec;103 Suppl 1:i57-65. doi: 10.1093/bja/aep271.</citation>
          </article>
          <article>
            <ref-id>A201914</ref-id>
            <pubmed-id>30135011</pubmed-id>
            <citation>Böhm R, Proksch E, Schwarz T, Cascorbi I: Drug Hypersensitivity Dtsch Arztebl Int. 2018 Jul 23;115(29-30):501-512. doi: 10.3238/arztebl.2018.0501.</citation>
          </article>
          <article>
            <ref-id>A204257</ref-id>
            <pubmed-id>30275849</pubmed-id>
            <citation>Warrington R, Silviu-Dan F, Wong T: Drug allergy. Allergy Asthma Clin Immunol. 2018 Sep 12;14(Suppl 2):60. doi: 10.1186/s13223-018-0289-y. eCollection 2018.</citation>
          </article>
        </articles>
        <textbooks/>
        <links>
          <link>
            <ref-id>L15138</ref-id>
            <title>NIH StatPearls: Bronchospasm</title>
            <url>https://www.statpearls.com/kb/viewarticle/18658</url>
          </link>
        </links>
        <attachments/>
      </references>
    </presentation>
    <references>
      <articles>
        <article>
          <ref-id>A221795</ref-id>
          <pubmed-id>23135806</pubmed-id>
          <citation>Hopps S, Medina P, Pant S, Webb R, Moorman M, Borders E: Cetuximab hypersensitivity infusion reactions: Incidence and risk factors. J Oncol Pharm Pract. 2013 Sep;19(3):222-7. doi: 10.1177/1078155212462440. Epub 2012 Nov 7.</citation>
        </article>
        <article>
          <ref-id>A221800</ref-id>
          <pubmed-id>20464886</pubmed-id>
          <citation>George TJ Jr, Laplant KD, Walden EO, Davis AB, Riggs CE, Close JL, George SN, Lynch JW: Managing cetuximab hypersensitivity-infusion reactions: incidence, risk factors, prevention, and retreatment. J Support Oncol. 2010 Mar-Apr;8(2):72-7.</citation>
        </article>
        <article>
          <ref-id>A221805</ref-id>
          <pubmed-id>18337601</pubmed-id>
          <citation>Chung CH, Mirakhur B, Chan E, Le QT, Berlin J, Morse M, Murphy BA, Satinover SM, Hosen J, Mauro D, Slebos RJ, Zhou Q, Gold D, Hatley T, Hicklin DJ, Platts-Mills TA: Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. N Engl J Med. 2008 Mar 13;358(11):1109-17. doi: 10.1056/NEJMoa074943.</citation>
        </article>
        <article>
          <ref-id>A216143</ref-id>
          <pubmed-id>25754718</pubmed-id>
          <citation>Galvao VR, Castells MC: Hypersensitivity to biological agents-updated diagnosis, management, and treatment. J Allergy Clin Immunol Pract. 2015 Mar-Apr;3(2):175-85; quiz 186. doi: 10.1016/j.jaip.2014.12.006.</citation>
        </article>
        <article>
          <ref-id>A216268</ref-id>
          <pubmed-id>25017680</pubmed-id>
          <citation>Vultaggio A, Castells MC: Hypersensitivity reactions to biologic agents. Immunol Allergy Clin North Am. 2014 Aug;34(3):615-32, ix. doi: 10.1016/j.iac.2014.04.008.</citation>
        </article>
      </articles>
      <textbooks/>
      <links/>
      <attachments/>
    </references>
  </allergy-detail>
</allergy-details>

Allergy detail data described below is available to subscribers to DrugBank+. See www.drugbank.com/data to learn more.

An allergy detail includes available information regarding hypersensitivity (allergic) reactions patients may experience following the administration of a drug. Allergy details may be specific to a drug or may be retrieved for a drug from an allergy category.

<drug> elements may have one or more <allergy-detail> elements as children of the <allergy-details> element.

Each <allergy-detail> element has the following elements.

Child Elements

Element Type Occurrences Description
summary string 0..1 An overview of the allergy information for the drug. It will contain whether or not this is a category-based detail as well as the list of ways it can present.
info string 0..1 A high level description of the allergy.
source-name string 0..1 Information on where the allergy detail came from including name and type of source.
source-type string 0..1 Either categorical or drug-specific
evidence-type string 0..* A list of evidence types (such as review or case reports) used to gather the allergy information for this drug. See possible values below.
presentation Presentation 0..* A list of conditions that a patient may present when they have an allergy to the drug.
references See references. 0..* References for allergy information.

Evidence Types

Possible values for evidence_type include:

Type Description
clinical_trial data is from a controlled clinical trial
post_marketing data comes from post-approval drug surveillance
uncontrolled_trial open study without a comparator/placebo
nonclinial_trial cohort study, retrospective medical records review, or case control
case_reports specific data from one or more cases
varying_reports anything that does not easily fit into another category
literature data comes from various sources within the literature
unclassified data comes from a source other than one of those listed
review general literature review, may cover data from any of the other types

Allergy Presentations

<allergy-detail>
  <presentation>
    <condition>
      <title>Cutaneous Manifestations of Drug Allergy</title>
      <drugbank-id primary="true">DBCOND0131308</drugbank-id>
    </condition>
    <simple-description>A cutaneous manifestation is a skin condition or rash that can occur due to infections, medical conditions, or a drug allergy. It is sometimes accompanied by a fever, feeling generally unwell, a headache, or other symptoms.</simple-description>
    <clinical-description>Cutaneous manifestations of drug allergy normally result in a rash with or without systemic symptoms such as fever, headache, or malaise. The skin eruption can have various clinical presentations and can change or progress over time. Examples include but are not limited to maculopapular rash, morbilliform rash, fixed drug eruption, and more serious conditions such as Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN).</clinical-description>
    <management>If a drug-induced allergy is suspected or confirmed, the causative agent should be discontinued immediately. Supportive care measures and symptomatic treatment are the cornerstones of management and should be tailored to each individual’s clinical presentation. When choosing an alternative agent, consider cross-sensitivity and avoid agents that are structurally related, if possible.[A201914, A204257]</management>
    <hypersensitivity-type>Unclassified</hypersensitivity-type>
    <references>
      <articles>
        <article>
          <ref-id>A201914</ref-id>
          <pubmed-id>30135011</pubmed-id>
          <citation>Böhm R, Proksch E, Schwarz T, Cascorbi I: Drug Hypersensitivity Dtsch Arztebl Int. 2018 Jul 23;115(29-30):501-512. doi: 10.3238/arztebl.2018.0501.</citation>
        </article>
        <article>
          <ref-id>A204257</ref-id>
          <pubmed-id>30275849</pubmed-id>
          <citation>Warrington R, Silviu-Dan F, Wong T: Drug allergy. Allergy Asthma Clin Immunol. 2018 Sep 12;14(Suppl 2):60. doi: 10.1186/s13223-018-0289-y. eCollection 2018.</citation>
        </article>
      </articles>
      <textbooks/>
      <links/>
      <attachments/>
    </references>
  </presentation>
  <presentation>
    <condition>
      <title>Stevens-Johnson Syndrome Toxic Epidermal Necrolysis Spectrum</title>
      <drugbank-id primary="true">DBCOND0117748</drugbank-id>
      <synonyms>
        <synonym>Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis</synonym>
        <synonym>Stevens-Johnson syndrome/ toxic epidermal necrolysis</synonym>
      </synonyms>
    </condition>
    <simple-description>Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, potentially life-threatening reactions to medications. At first, patients with these reactions feel like they have the flu. Sores develop on the skin and sometimes the eyes, mouth, and genitals. The skin may eventually begin to peel off. This type of reaction is called Stevens-Johnson Syndrome (SJS) if less skin is involved, and Toxic Epidermal Necrolysis (TEN) when more skin is involved.</simple-description>
    <clinical-description>Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) are reactions that occur following exposure to a culprit medication that elicit a hypersensitivity response. Initially, the reaction presents with flu-like symptoms (fever, sore throat, and fatigue), and can progress to include ocular involvement, ulcers, and mucous membrane lesions.[A189309,A201965] These ulcers and lesions are most common on the lips and mouth, but may also appear on the eyes, trunk, and genitals.[A189309,A201965] SJS and TEN skin reactions cause blistering, a positive Nikolsky’s sign, skin detachment, and erythema.[A204254] Histological examination reveals keratinocyte necrosis, full-thickness epidermal necrosis, and mild inflammation (often with lymphocytic infiltrate). The diagnosis for SJS/TEN requires a negative direct immunofluorescence test to rule out other conditions characterized by antibody deposition in the skin.[A204254] This cutaneous reaction is classified as SJS when less than 10% of the skin's surface area is involved; it is classified as TEN when greater than 30% of the skin's surface area is involved.[A201965,A189309] TEN generally presents within 1 to 60 days of initial drug exposure and within 5 half-lives of stopping the drug.[A201965] SJS/TEN severity is correlated with levels of both granulysin and IL-15.[A204254] </clinical-description>
    <management>In the case of SJS/TEN  immediately withdraw the causative drug and admit the patient to a specialized unit with adequate monitoring and supportive care, such as a burn unit or the intensive care unit.[A201965] Drugs with long half-lives are associated with a higher mortality rate.[A201965] Some patients may require non-adhesive dressings over the affected areas and air fluidized beds to promote skin regrowth.[A201965] Pain management is an important part of therapy for SJS/TEN.[L15032]&#13;
&#13;
The use of antibiotics in patients with SJS/TEN has not been thoroughly investigated, however, they may be administered if an infection is suspected.[A201965,L15032] Evidence regarding the benefit of glucocorticoids, intravenous immunoglobulins, or cyclosporin A treatment is conflicting, although they have been beneficial in some cases.[A201965] Cyclophosphamide and thalidomide are no longer used as therapies for SJS/TEN, as they have not been determined to be efficacious during  clinical studies.[A201965]&#13;
</management>
    <hypersensitivity-type>Type IV</hypersensitivity-type>
    <references>
      <articles>
        <article>
          <ref-id>A189309</ref-id>
          <pubmed-id>22165859</pubmed-id>
          <citation>Warrington R, Silviu-Dan F: Drug allergy. Allergy Asthma Clin Immunol. 2011 Nov 10;7 Suppl 1:S10. doi: 10.1186/1710-1492-7-S1-S10.</citation>
        </article>
        <article>
          <ref-id>A201965</ref-id>
          <pubmed-id>29188475</pubmed-id>
          <citation>Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T: Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Clin Rev Allergy Immunol. 2018 Feb;54(1):147-176. doi: 10.1007/s12016-017-8654-z.</citation>
        </article>
        <article>
          <ref-id>A204254</ref-id>
          <pubmed-id>28476287</pubmed-id>
          <citation>Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O: Severe cutaneous adverse reactions to drugs. Lancet. 2017 Oct 28;390(10106):1996-2011. doi: 10.1016/S0140-6736(16)30378-6. Epub 2017 May 2.</citation>
        </article>
      </articles>
      <textbooks/>
      <links>
        <link>
          <ref-id>L15032</ref-id>
          <title>Merk Manual: Consumer Version: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)</title>
          <url>https://www.merckmanuals.com/home/skin-disorders/hypersensitivity-and-inflammatory-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten</url>
        </link>
      </links>
      <attachments/>
    </references>
  </presentation>
  <presentation>
    <condition>
      <title>Anaphylaxis</title>
      <drugbank-id primary="true">DBCOND0001820</drugbank-id>
      <meddra-id kind="high_level_term">10002220</meddra-id>
      <icd10-id kind="concept">T78.2</icd10-id>
      <synonyms>
        <synonym>Allergic shock</synonym>
        <synonym>Anaphylactic</synonym>
        <synonym>Anaphylactic Reaction</synonym>
        <synonym>Anaphylactic reactions</synonym>
        <synonym>Anaphylactic responses</synonym>
        <synonym>Anaphylactic shock</synonym>
        <synonym>Anaphylactic symptoms</synonym>
        <synonym>Anaphylactic-type reactions</synonym>
        <synonym>Anaphylaxis reaction</synonym>
        <synonym>Anaphylaxis reactions</synonym>
        <synonym>Systemic anaphylactic reaction</synonym>
        <synonym>Systemic anaphylaxis</synonym>
      </synonyms>
    </condition>
    <simple-description>Anaphylaxis is a life-threatening allergic reaction that can cause low blood pressure, difficulty breathing, and a skin rash.</simple-description>
    <clinical-description>Anaphylaxis is an allergic reaction that causes urticaria, dyspnea, wheezing, nausea, vomiting, syncope, and hypotension. It typically manifests seconds to minutes following exposure to a drug or other allergen. Rarely, it may be delayed by several hours after exposure. Protracted anaphylaxis may last for hours to days.[A214499] Anaphylaxis is caused by activation of the immune system, causing the release of IgG, IgE, and the formation of immune complexes that lead to various symptoms.[L14378] Cardiovascular, cutaneous, and respiratory symptoms are the most frequently reported clinical manifestations of anaphylaxis, and may result in fatal outcomes.[A199128,A214499]</clinical-description>
    <management>Anaphylaxis is a life-threatening condition and is generally treated with prompt withdrawal of the offending medication, early intramuscular or subcutaneous epinephrine, and intravenous fluids.[A199128,A214499] The patient should be monitored closely. Adjunctive treatment options include antihistamines, beta agonists, and corticosteroids. In some cases, ventilatory support may be required. Patients with anaphylaxis should be monitored for protracted anaphylaxis, which may persist for hours or days without resolution of symptoms.[A214499,A215392]</management>
    <hypersensitivity-type>Type I</hypersensitivity-type>
    <references>
      <articles>
        <article>
          <ref-id>A199128</ref-id>
          <pubmed-id>29103454</pubmed-id>
          <citation>Lee SE: Management of Anaphylaxis. Otolaryngol Clin North Am. 2017 Dec;50(6):1175-1184. doi: 10.1016/j.otc.2017.08.013.</citation>
        </article>
        <article>
          <ref-id>A214499</ref-id>
          <pubmed-id/>
          <citation>Tang, Angela W.: A Practical Guide to Anaphylaxis American Family Physician.</citation>
        </article>
        <article>
          <ref-id>A215392</ref-id>
          <pubmed-id/>
          <citation>M. Winikor, J. Xu, J. Stoll, W. Khan: Protracted Anaphylaxis and Treatment Resistant Angioedema: Looking Beyond Ingestions and Skin American Journal of Respiratory Critical Care Medicine.</citation>
        </article>
      </articles>
      <textbooks/>
      <links>
        <link>
          <ref-id>L14378</ref-id>
          <title>World Allergy Organization: Anaphylaxis vs. Anaphylactoid reactions</title>
          <url>https://www.worldallergy.org/ask-the-expert/questions/anaphylaxis-vs-anaphylactoid-reactions</url>
        </link>
      </links>
      <attachments/>
    </references>
  </presentation>
</allergy-detail>

A presentation includes available information for a specific set of symptoms relating to an allergic reaction.

<allergy-detail> elements may have one or more <presentation> elements.

Each <presentation> element has the following attributes and elements.

Child Elements

Property Type Occurrences Description
condition Condition 0..1 Related condition for this presentation
simple-description string 0..1 Concise overview of the condition in plain language suitable for non-clinical users.
clinical-description string 0..1 Concise overview of the condition in technical language suitable for healthcare professionals.
management string 0..1 Guidance on how to potentially manage this drug allergy presentation.
hypersensitivity-type string 0..* The levels of allergic reactions to this condition, such as Type I (onset is within an hour), Type II (onset is within a few hours to a few days); health professionals are usually familiar with these terms.
references See references. 0..* References for presentation details.

Hypersensitivity Types

Possible values for hypersensitivity_types include one or more of the following:

Type Description
Type I onset within 1 hour. Examples include anaphylaxis, urticaria, angioedema, bronchospasm, etc.
Type II onset between a few hours to a few days. Examples include anemia, cytopenia, thrombocytopenia, etc.
Type III onset between 1-3 weeks. Examples include serum sickness, vasculitis, fever, rash, arthralgia, etc.
Type IV onset of several days to several weeks. Examples include contact sensitivity, skin rashes, organ-tissue damage, etc.
Unclassified We do not yet have a well-understood mechanism to fit into one of the above types.

Cross-sensitivities

If you know that a patient is allergic to one drug, there’s a chance that they are also allergic to other drugs that are known to be cross-sensitive with it.

<cross-sensitivities>
  <cross-sensitivity>
    <summary>As a Monoclonal Antibodies From The Murine (Sp2/0) Cell Line, Cetuximab is known to be cross-sensitive with Monoclonal Antibodies From The Murine (Sp2/0) Cell Line</summary>
    <description>There is limited clinical information on cross-sensitivity amongst monoclonal antibodies (mABs), although several factors are mentioned in the literature that may result in a cross-sensitivity reaction. Drug-related risk factors for hypersensitivity reactions include the degree of humanization, the glycosylation pattern, the cell line of origin from which it was obtained, the dosing interval, and excipients with allergenic potential.[A36676] Cross-sensitivity may occur from two mABs if they share a common structural feature, such as specific glycosylation patterns of the Fc portion of the molecule, that causes a hypersensitivity reaction.[A216098] &#13;
&#13;
The drug’s cell line of origin can contribute to specific structural differences or glycosylation patterns because different cell lines produce cell-derived enzymes that give rise to varying glycosylation patterns.[A36676] If the hypersensitivity reaction against a given mAB involves the recognition of a structural feature, such as specific glycosylation of the Fc portion of the mAB, then cross-sensitivity may occur with other mABs if they share that structural feature.[A216098] mABs that are derived from the SP2/O murine cell line have a distinct glycosylation pattern due to the presence of galactose-α1,3-galactose (α-gal), which is an enzyme found in nonhuman sources, such as ticks. As hypersensitivity to α-gal has been demonstrated in the literature, cross-sensitivity among drugs derived from this cell line may be theoretically possible. During clinical trials, patients who developed hypersensitivity reactions to cetuximab had pre-existing IgE antibodies against α-gal.[A216098, A216298] It is not known whether the target specificity of mABs is of significance in determining cross-sensitivity: it is unclear whether two mABs binding to the same antigen leads to similar hypersensitivity reactions to a cross-sensitivity reaction.[A216098]&#13;
</description>
    <incidence>Theoretical</incidence>
    <evidence-type>review</evidence-type>
    <cross-sensitive-drug>
      <name>Abciximab</name>
      <drugbank-id>DB00054</drugbank-id>
    </cross-sensitive-drug>
    <cross-sensitive-drug>
      <name>Basiliximab</name>
      <drugbank-id>DB00074</drugbank-id>
    </cross-sensitive-drug>
    <cross-sensitive-drug>
      <name>Canakinumab</name>
      <drugbank-id>DB06168</drugbank-id>
    </cross-sensitive-drug>
    <cross-sensitive-drug>
      <name>Golimumab</name>
      <drugbank-id>DB06674</drugbank-id>
    </cross-sensitive-drug>
    <cross-sensitive-drug>
      <name>Infliximab</name>
      <drugbank-id>DB00065</drugbank-id>
    </cross-sensitive-drug>
    <cross-sensitive-drug>
      <name>Ustekinumab</name>
      <drugbank-id>DB05679</drugbank-id>
    </cross-sensitive-drug>
    <references>
      <articles>
        <article>
          <ref-id>A216098</ref-id>
          <pubmed-id>31028896</pubmed-id>
          <citation>Hong D, Sloane DE: Hypersensitivity to monoclonal antibodies used for cancer and inflammatory or connective tissue diseases. Ann Allergy Asthma Immunol. 2019 Jul;123(1):35-41. doi: 10.1016/j.anai.2019.04.015. Epub 2019 Apr 25.</citation>
        </article>
        <article>
          <ref-id>A36676</ref-id>
          <pubmed-id>25219103</pubmed-id>
          <citation>Corominas M, Gastaminza G, Lobera T: Hypersensitivity reactions to biological drugs. J Investig Allergol Clin Immunol. 2014;24(4):212-25; quiz 1p following 225.</citation>
        </article>
        <article>
          <ref-id>A216298</ref-id>
          <pubmed-id>26383226</pubmed-id>
          <citation>Dumont J, Euwart D, Mei B, Estes S, Kshirsagar R: Human cell lines for biopharmaceutical manufacturing: history, status, and future perspectives. Crit Rev Biotechnol. 2016 Dec;36(6):1110-1122. doi: 10.3109/07388551.2015.1084266. Epub 2015 Sep 18.</citation>
        </article>
      </articles>
      <textbooks/>
      <links/>
      <attachments/>
    </references>
  </cross-sensitivity>
</cross-sensitivities>

Cross-sensitivity data described below is available to subscribers to DrugBank+. See www.drugbank.com/data to learn more.

The term cross-sensitivity refers to an increased likelihood of a patient experiencing an allergic reaction to a given drug or drug allergy category based on a pre-existing allergy to a separate drug or category. Each cross-sensitivity entry provides information on known associations between drugs/categories that result in an increased risk of allergic reactions.

<drug> elements may have one or more <cross-sensitivity> elements as children of the <cross-sensitivities> element.

Each <cross-sensitivity> element has the following elements.

Child Elements

Element Type Occurrences Description
summary string 0..1 An overview of the cross-sensitivity information for the drug. It will contain whether or not this is a category-based cross-sensitivity.
description string 0..1 More details on the cross-sensitivity such as supporting evidence, underlying mechanisms, risks, and management guidelines, if known.
incidence string 0..1 Text describing the incidence of the cross-sensitivity. Note that this is not a structured field at this point. Some values may be percentages. Others may be just a general description or indication that it’s a theoretical cross-sensitivity only.
evidence-type string 0..* A list of evidence types (such as review or case reports) used to gather the cross-sensitivity information for this drug. See possible values below.
cross-sensitive-drug Drug 0..* Drugs considered cross-sensitive.
references See references. 0..* References for cross-sensitivity information.

Evidence Types

Possible values for evidence_type include:

Type Description
clinical_trial data is from a controlled clinical trial
post_marketing data comes from post-approval drug surveillance
uncontrolled_trial open study without a comparator/placebo
nonclinial_trial cohort study, retrospective medical records review, or case control
case_reports specific data from one or more cases
varying_reports anything that does not easily fit into another category
literature data comes from various sources within the literature
unclassified data comes from a source other than one of those listed
review general literature review, may cover data from any of the other types