Normalization Guidelines

Medication Terms
DOMAIN OVERVIEW .............................................................................................................................................1
GUIDELINES AT A GLANCE ....................................................................................................................................1
DETAILED GUIDELINES ..........................................................................................................................................1
GENERAL PRINCIPLES ................................................................................................................................................... 1
SPECIFIC CASES – MULTIVITAMINS AND SUPPLEMENTS ......................................................................................................... 5
SPECIFIC CASES – BRANDS AND GENERICS .......................................................................................................................... 6
SPECIFIC CASES – DOSE FORMS ........................................................................................................................................ 7
SPECIFIC CASES – IV FLUIDS............................................................................................................................................. 9
SPECIFIC CASES ........................................................................................................................................................... 10

Domain Overview
An overview of the Medication element can be found here.

Guidelines at a Glance

Target Ontology RxNorm

1:N Mapping Yes

Detailed Guidelines
General Principles
1. Prioritize mapping to single code over multiple codes when possible
Prioritize one to one (1:1) mapping, when single code/concept can fully represent all clinical ideas from the
source term. If there is not a single code/concept that can be used to fully represent the source term, use
combination of multiple codes/concepts. Please also refer to later section for when choosing one to many (1:N)
mapping.

2. Map as specific as possible when source information is available

When information is provided by the source terms, map to the most specific concept. Semantic Branded Drug
and/or Brand Name Pack contains most specific information as they include Drug Ingredient, Strength, Dose
Form, and Brand name information. Thus, concepts in this type should be used when all these information exist
and match in the source term. Below is the mapping priority by RxNorm TermType (RXNCONSO.TTY) in
descending order:
Priority Name (TTY) Description
Ingredient + Strength + Dose Form + Brand
1 Branded Drug or Pack (SBD/BPCK)
Name
2 Clinical Drug or Pack (SCD/GPCK) Ingredient + Strength + Dose Form
3 Branded Drug Component (SBDC) Ingredient + Strength + Brand Name
4 Clinical Drug Component (SCDC) Ingredient + Strength
5 Semantic Branded Drug Group (SBDG) Brand Name + Dose Form Group
6 Clinical Dose Form Group (SCDG) Ingredient + Dose Form Group

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 A proprietary name for a family of products
7 Brand Name (BN)
containing a specific active ingredient.
8 Ingredient (IN/MIN) Ingredient

Do Not Map to:

Dose Form Group (DFG)

3. Multiple codes can be used together (1:N combination) when no single code can represent the meaning of the
source term
§ See Multivitamins and Supplements Specific Cases section below.
§ It is permissible to combine any of the permitted term types as listed above in 2 in a 1:N mapping.
§ If there is no single code for a medication containing multiple ingredients, map 1:N to individual SCDC
(Ingredient + Strength) or IN/MIN (Ingredient) codes, and do not include any term types with Dose
Form.

4. Retired codes
Active codes are preferred; however, it is okay to map to retired, obsolete, or noncurrent codes if they are an
exact match to the source term. When there is a new concept that replaces the retired concept (“Remapped”),
and it aligns with the health system term, do choose the new concept. Retired codes can be found in the
Concept Browser. To use a retired code, please ensure it has a relationship to another code. These
relationships ensure that concepts mapped to these codes can be captured appropriately in a study. If no
relationships are seen in Console, do not map to that code, instead map to the closest active code.

5. Normalized Strength Mapping

RxNorm normalizes medication strength, often to the lowest common denominator, so the exact healthy
system term strength may not be present in RxNav. If exact strength cannot be found, a multiple is acceptable.
Do not select a strength if the strength is not in the health system term.

Example (a):
Health System Term DEXAMETHASONE 0.5 MG/5ML PO ELIX
Map to:
309686 dexamethasone 0.1 MG/ML Oral Solution

Example (b):
Health System Term NaCl 0.9% in 25 ML injection
Map to:
1807630 25 ML sodium chloride 9 MG/ML injection

6. Quantified Versus Unquantified Concepts

Prioritize unquantified concepts over quantified concepts as dose is captured separately in the Medication
table. Below are the priorities:
a) Map to exact source term match, even if a retired code, as long as a relationship exists to the retired
code. Retired codes can be found in Console. These relationships ensure that concepts mapped to
these codes can be captured appropriately in a study. If no relationships are seen in Console, do not
map to that code.
b) Do not select quantified code if the quantification does not match the source term, in that case, map to
a wider code, even if that means an Ingredient code (IN/MIN).
c) Map 1:N, if needed.
d) In case of Emergency Use Authorization (EUA) combination drug, it is okay to map to available
quantified code.

Published 11.13.23
 Example (a):
Health System Term NITROGLYCERIN 0.4MG/ML IV SOLN
Map to
312006 Nitroglycerin 0.4 MG/ML Injectable Solution
Even though this is a retired code, it is an exact match.

Example (b):
Health System Term CASIRIVIMAB 60 MG-IMDEVIMAB 60 MG/mL INTRAVENOUS SOLUTION (EUA)
Map to
2557240 casirivimab 60 MG/ML / imdevimab 60 MG/ML Injection
Even though this is a retired code, it is an exact match.

Example (c):
Health System Term levothyroxine sodium 0.1 mg/ml Injectable solution
Options:
2166148 5 ML levothyroxine sodium 0.1 MG/ML Injection (SCD / active)
levothyroxine sodium 0.1 MG/ML Injection (SCD / unquantified /
2166149
inactive)
2166149 is preferred because it is unquantified, and the quantity in 2166148 (5 mL), is not seen in the
health system term.

Example (d):
Health System Term albumin human, 25% IV SOLN
Options:
1741380 100 ML albumin human, USP 250MG/ML Injection
1741375 50 ML albumin human, USP 250 MG/ML Injection
1741570 20 ML albumin human, USP 250 MG/ML Injection
1741378 albumin human, USP 250 MG/ML Injection (retired)*
329494 albumin human, USP 250 MG/ML (retired)
1741289 albumin human, USP Injection
*1741378 is preferred because it is unquantified and contains ingredient + strength + dose form in a
single term.

7. Dose Form
Health system terms include a wide variety of expressions that can be used to inform dose form selection,
including routes of administration and true dose forms. In some cases, the expression related to dose form
or route of administration cannot be perfectly represented by dose forms or dose form groups in RxNorm.
In those cases, the following rules will help capture as much data and stay as true to the input intention as
able.

Of note, we do capture route of administration separately in the MedicationAdministration,

MedicationRequest, and MedicationStatement tables, in the field DoseRoute.

The acceptable dose forms listed below are considered “equivalent,” when mapping. Preference is given to
active codes over the order of preference below if the active code contains one of the acceptable dose
forms. Definitions of the different types of dose forms can be found here.

Published 11.13.23
 Health System Term Acceptable Dose Forms (listed in order of preference)
[Suspensions or solutions] IV, IVPB, IV
a. Injectable solution (DF)
Solution, IV SUSP, IV SOLN, INJ SOLN,
b. Injection (DF)
SC/SQ SOLN, Infusion, SOLR (Solution
c. Injectable product (DFG)
Reconstituted)
a. Injection (DF)
[Injections] INJ, Injection, SC/SQ
b. Injectable solution (DF)
injection
c. Injectable product (DFG)
a. Injectable suspension (DF)
b. Injection (DF)
INJ SUSP
c. Injectable solution (DF)
d. Injectable product (DFG)
[Syringes] IV SOSY/SOSY (Solution
a. Prefilled syringe (DF)
Prefilled Syringe), PSKT (Prefilled Syringe
b. Injectable product (DFG)
Kit), IV syringe
a. Injection (DF) or Injectable solution (DF)
Flush, Lock
b. Injectable product (DFG)
a. Injection (DF) or Injectable solution (DF) or Auto-
Injector (DF) or Prefilled Syringe (DF) or Pen Injector
SC/SQ, IM, IO
(DF)
b. Injectable product (DFG)
[Pens] Pen, SOAJ (Solution Auto-
a. Auto-injector (DF) or Pen Injector (DF)
Injector), PNKT (Pen-Injector Kit),
b. Injectable product (DFG)
SUBQ INPN
PO a. Oral product (DFG)
a. Inhalation solution (DF)
NEB
b. Inhalant product (DFG)
a. Drug Implant (DF)
IMPLANT
b. Drug Implant Product (DFG)

Example (a):
Health System Term
INSULIN ASPART U-100 100 UNIT/ML insulin aspart, human 100 UNT/ML Injectable
SUBCUTANEOUS SOLUTION Solution [RxCUI 311040]
INSULIN ASPART U-100 100 UNIT/ML (3 ML) 3 ML insulin aspart, human 100 UNT/ML Pen Injector
SUBQ INPN [RxCUI 1653202]
INSULIN ASPART insulin aspart, human [RxCUI 51428]

Example (b):
Health System Term Enoxaparin 100mg/ml SC injection
Options
854255 enoxaparin sodium 100 MG/ML Injectable Solution
1360019 enoxaparin sodium 100 MG/ML Prefilled Syringe
854255 is the correct mapping because “SC injection” can be mapped to “injection” or “injectable
solution,” there is no “injection” option available, so “injectable solution” is acceptable.

Example (c):
Health System Term heparin flush 10UNITS/ML
Map to

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 1361029 heparin sodium, porcine 10 UNT/ML Injectable Solution
328869 heparin 10 unit/mL
1856274 heparin injectable product
1361029 is the correct mapping, “flush” can be mapped to “injectable solution.”

Example (d):
Health System Term HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML IV SYRINGE
Map to
1362058 Heparin sodium, porcine 100 unit/mL prefilled syringe
In this case, the term contains “flush” and “IV syringe,” so can be mapped to “injection,” “injectable
solution,” “prefilled syringe,” or “injectable product.”

Specific Cases – Multivitamins and Supplements

8. Multivitamins
Multivitamins come through as health system terms in a variety of ways. We see “multivitamin” or “prenatal
vitamin,” specific vitamin brands, and sometimes lists of vitamins strung together. In alignment with our general
principles, we should map as specifically as we can without making assumptions. If there is only a brand name
and there is no code for that brand name, map to the multivitamin code below, do not map to ingredients
identified elsewhere.

Health System Term “Multivitamin” or “Prenatal Vitamin”

Map to
89905 Multivitamin preparation
311810 Multivitamin preparation Oral Tablet
402792 Multivitamin preparation Oral Capsule
If “folate” is in the health
system term, add
62356 folate

Example (a):
Health System Term multivitamin with minerals||
Map to
89905 Multivitamin preparation

Example (b):
Health System Term multivitamin with folic acid 400 mcg tablet||
Map to
311810 Multivitamin preparation Oral Tablet
62356 folate

9. Supplements
Supplements often come through as lists of ingredients and often these ingredients do not have strength or
dose form. To simplify, map all lists of supplements 1:N to ingredient only.

Example (a):

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 FISH, BORAGE, FLAXSEED OILS-OMEGA 3,6,9 COMB NO.1 1,200
Health System Term
MG CAPSULE
Map to
4419 fish oils
68905 borage oil
6404 linseed oil

Specific Cases – Brands and Generics

10. Brand Names vs Generic Names

Map health system terms with Brand name concepts to RxCUI of Brand names, and generic name concepts to
RxCUI of generic names.

Exceptions
a) If a brand name does not exist in RxNorm but the generic counterpart does, map to the generic name
(wider).
Example (a):
Health System Term Levall
Map to
284629 carbetapentane / guaiFENesin / phenylephrine (wider)

Example (b):
Health System Term Septra
Map to
10831 sulfamethoxazole / trimethoprim (wider)

b) If a brand name and its generic counterpart both do not exist in RxNorm, map to NullFlavor No Code
Available (NO).
Example (c):
Health System Term Osmolite
Map to
NullFlavor No Code Available

c) If a brand name and a generic name given together in a health system term is conflicting and cannot
be found in RxNorm, map wide to the generic name (+ strength and DF/DFG if applicable).
Example (d):
Health System Term Dexamethasone (Decadron) IVPB
Map to
1812073 dexamethasone Injection (wider)

11. Brand Name with Only One Formulation

If a specific brand name exists only as one formulation, map to this SBD even if not explicitly indicated in the
source term.
Example (a):
Health System Term Atrovent HFA MDI 2 puffs, every 6 hours as needed for S.O.B.
Map to

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 Atrovent 0.017 MG/ACTUAT Metered Dose Inhaler, 200
836368
ACTUAT

Example (b):
Health System Term ACTEMRA ACTPEN SUBCUTANEOUS
Map to
2106075 0.9 ML Actemra 180 MG/ML Auto-Injector

Example (c):
Health System Term Claritin-D 12 HOUR PO
Map to
Claritin-D (loratadine 5 MG / pseudoephedrine sulfate 120 MG)
1242406
12 HR Extended-Release Oral Tablet

12. Generics with Only One Dose Form

For generic drugs, we cannot assume the DF even if there's only DF available for the given drug name and
strength, because a new dose form may be added in the future.
Example (a):
Health System Term Dexamethasone 4 mg PO
Map to
315778 Dexamethasone 4 MG
1154535 Dexamethasone Oral Product

Example (b):
Health System Term Colchicine 0.6 mg PO daily
Map to
315714 colchicine 0.6 MG
1155484 colchicine Oral Product

Specific Cases – Dose Forms

13. Avoid Mapping to a DF/DFG

Avoid mapping to a dose form (DF)/dose form group (DFG) for 1:N, preference is given to the DF/DFG with the
ingredient for source terms showing only an individual drug.
Example (a):
Health System Term Daptomycin 50mg/ml IV syringe
Map to
405886 daptomycin 50mg/ml
1152143 DAPTOmycin Injectable Product
NOT
405886 daptomycin 50mg/ml
1649574 Injection

14. Map to Combined Ingredient and DF/DFG

Published 11.13.23
For source terms containing a combination of ingredients, preference is to map to a code with both ingredients,
strength, and the DF/DFG. If an RxCUI for this does not exist, map to the separate ingredients (with the strength
if given) but leave out the DF/DFG.
Example (a):
Health System Term GNP Calcium Citrate + D3 315-250 MG-UNIT Oral Tablet
Map to
375480 calcium citrate / cholecalciferol Oral Tablet

Example (b):
CALCIUM CARB-CHOLECALCIFEROL 600-800 MG-UNIT PO TABS
Health System Term
Tab 600-800 MG-UNIT
Map to
375477 calcium citrate / cholecalciferol Oral Tablet
1099860 cholecalciferol 800 UNT
315519 calcium carbonate 600 MG
1099860 + 315519 preferred 1:N combo over 375477

i. Even if certain combinations of ingredients exist with the DF/DFG but not all together, still map to
separate ingredients without the DF/DFG.
Example (c):
BUPIVACAINE 0.5% WITH LIDOCAINE 1%-EPI 1:100000
Health System Term
INJECTION MIXTURE INTRAPROCEDURE
Map to
1012383 bupivacaine hydrochloride 5 MG/ML
328866 lidocaine 10 MG/ML
3992 EPINEPHrine
NOT
2178760 5 ML bupivacaine hydrochloride 5 MG/ML Injection
1163887 EPINEPHrine Injectable Product

Example (d)
BUPIVACAINE 0.5% WITH LIDOCAINE 1% INJECTION MIXTURE
Health System Term
INTRAPROCEDURE
Map to
1012383 bupivacaine hydrochloride 5 MG/ML
328866 lidocaine 10 MG/ML

Example (e)
Health System Term CEFTRIAXONE 1G IM WITH LIDOCAINE SYRINGE
Map to
1665021 cefTRIAXone 1000 MG
727604 lidocaine

Example (f)
FISH, BORAGE, FLAXSEED OILS-OMEGA 3,6,9 COMB NO.1 1,200
Health System Term
MG CAPSULE

Published 11.13.23
 Map to
4419 fish oils
68905 borage oil
6404 linseed oil

Specific Cases – IV Fluids

15. Ignore Intravenous (IV) Fluids

If a concept contains an IV fluid, ignore and map only the active ingredient in the source term.
Example (a)
Health System Term CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE
Map to
309335 50 ML clindamycin 12 MG/ML Injection
Do Not Need to Add
309778 glucose 50 MG/ML Injectable Solution

Example (b)
Health System Term HEPARIN (PORCINE) IN 0.9% NaCl 25000 UNIT/250 ML IV SOLP
Map to
1658717 250 ML heparin sodium, porcine 100 UNT/ML Injection

Example (c)
HEPARIN (PORCINE) IN NaCl (PF) 1,000 UNIT/500 ML
Health System Term
INTRAVENOUS SOLP
Map to
1658692 500 ML heparin sodium, porcine 2 UNT/ML injection (wider)

Example (d)
Health System Term Norepinephrine 8mg/NS 500ml
Map to
2475336 norepinephrine 0.016 MG/ML

16. Total Volume

Consider the total volume listed in the health system term to calculate the appropriate concentration.
Example (a)
Health System Term Vancomycin HCL in NACL 1.25-0.9 gm\\/250ml
Calculation Vancomycin 1250mg/250ml = 5mg/ml
Map to
2387078 250 ML vancomycin 5 MG/ML Injection

Example (b)
Health System Term Vancomycin 750 mg in Dextrose 5% 250ML IVPB
Calculation Vancomycin 750mg/250ml = 3mg/ml
Map to
415868 Vancomycin 3 MG/ML Injectable Solution

Published 11.13.23
17. Irrigation Solution
Heparin in Sodium Chloride Irrigation Solution
a. Source concepts that contain heparin in sodium chloride irrigation solution map accordingly:
RxNav (nih.gov)
b. 0.9 % Sodim Chloride Irrigation USP provides an isotonic saline irrigation identical in composition
with 0.9 % Sodium Chloride Injection USP (normal saline) 0.9% Sodium Chloride Irrigation USP
(nih.gov)
c. Note: For these cases map to ingredient + irrigation solution
Example (a)
HEPARIN 30000 UNITS IN NS 1000 ML IRRIGATION MIXTURE
Health System Term
INTRAPROCEDURE (ADS LOCKED)
Map to
379429 Heparin Irrigation Solution
486515 sodium chloride 0.154 MEQ/ML Irrigation Solution

Specific Cases

18. Medical Devices and Supplies

If a health system term lists medical devices or supplies, map to NullFlavor Invalid (INV).
Example:
Health System Term LUMBOSACRAL SUPP LIGHTWEIGHT S MISC
abac10S
EYE-SCRUB EX PADS
FUTURO PANTYHOSE MISC
Map all to
NullFlavor Invalid

19. Medication with Dosing Instructions

Medications with instructions on dosing should be mapped to the strength as indicated in the health
system term. If that strength does not exist in RxNorm, map to the SCDG (ingredient + DF/DFG).

Example (a):
Health System Term GLIPIZIDE 2.5 MG ORAL HALF TAB
Map to
379804 glipizide 2.5 MG Oral Tablet

Example (b):
Health System Term AZITHROMYCIN 300 MG ORAL HALF TAB
Map to
370976 azithromycin Oral Tablet

Example (c):
Health System Term Aspirin 81 mg 2 tabs
Map to
243670 aspirin 81 MG Oral Tablet

Published 11.13.23
20. Drugs with Multiple Precise Ingredients (PINs)
In cases where the drug exists with multiple precise ingredients/salts, capture the PIN and DF separately by
using 1:N with PIN + SCDF/SCDG. (Note: If the drug is available with only one salt, we don't need to capture it
separately.)
Example (a):
Health System Term METHYLPREDNISOLONE SOD SUCC (ALL) SOLUTION
Map to
203189 methylPREDNISolone sodium succinate
376656 methylPREDNISolone Injectable solution

Example (b):
Health System Term DEXAMETHASONE ACETATE IJ
Map to
22690 dexamethasone acetate
1812073 dexamethasone Injection

21. NDC Codes

NDC codes provided as health system codes should not be used to aid in mapping.

22. GPI Codes

GPI codes cannot be used to aid in mapping because this is proprietary information that Truveta does not
currently have a subscription to.

23. Qualitative Distinction

If the health system term contains a Qualitative Distinction (QD), but no RxCUI can be found that contains the
QD, map to the RxCUI that contains the same ingredient/DF/strength as health system term with specificity of
wider.

Fluoxetine Example
313990 Fluoxetine 10 MG Oral Tablet
2532159 PMDD Fluoxetine 10 MG Oral Tablet
These drugs have the same ingredient, strength, and dose form but one has the QD of PMDD
(premenstrual dysphoric disorder) which changes the RxCUI.

Example (a):
Health System Term FLUOXETINE HCL (PMDD) 20 MG CAPS
Map to
310385 Fluoxetine 20 MG Oral Capsule

a. More information on the QD concept: RxNorm Technical Documentation, RxNorm Release

Notes (nih.gov), What is Qualitative Distinction in RxNorm? - HDD Access
b. Other QDs we frequently run into include:
i. Preservative Free (PF), see below example HEPARIN (PORCINE) IN NaCl (PF), for the
reason RxNorm does not have heparin porcine concept that has the QD (PF), we need
to map as a 'Wider' concept
ii. Sugar free

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24. Converting Between Units
Converting between units is allowed.
a) Percent to mg/ml
Example (a):
Health System Term Sodium chloride 0.9%
Map to
1661411 sodium chloride 9 MG/ML

b) Percent to mg/mg
Example (b):
Health System Term Miconazole powder 2%
Map to
998461 miconazole nitrate 0.02 MG/MG Topical Powder

25. Submicronized
Medications listed as "submicronized" should be mapped as such. If none exists in RxNorm, map to the wider
concept.
Example (a):
Health System Term ABIRATERONE, SUBMICRONIZED 125 MG ORAL TAB
Map to
2046579 abiraterone acetate 125 MG Oral Tablet (wide)

26. SSRR
SSRR indicates an extended-release suspension formulation. Map to the drug's RxCUI that indicates extended-
release suspension version. If none exists, pick the wider code.
Example (a):
Health System Term AZITHROMYCIN 2 GRAM/60 ML ORAL SSRR
Map to
577378 azithromycin 33.3 MG/ML Extended-Release Suspension

Example (b):
Health System Term METFORMIN 500 MG/5 ML ORAL SSRR
Map to
metFORMIN hydrochloride 100 MG/ML Extended-Release
2200518
Suspension

Example (c):
Health System Term ARIPIPRAZOLE 300 MG IM SSRR
Map to
1659816 ARIPiprazole 300 MG Injection (wide)

27. Placebo
Medications that include “placebo” within the health system term should be mapped to NullFlavor II (Insufficient
Information).
Example (a):
Health System Term Famotidine vs placebo IVPB (20-0268)

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 Map to
NullFlavor Insufficient Information

28. Vaccines
Vaccines under the medication domain should be mapped to the appropriate RxCUI.
Example (a):
Health System Term Influenza Vaccine (HIGH DOSE)
Map to
5806 Influenza virus vaccine

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