How to Write a Good Clinical Indication

How long should an indication be?

Ideally three or four words, such as “to lower blood pressure” (FAQ 3). Some entries in the Sample Directory are longer, because they carry a warning message as well.

How should it be worded?

As the effect of the medicine on the patient: the home page says an indication describes “the effect on the patient of a particular drug”. In the directory, most entries begin with “to” or “for”, for example amlodipine “to lower blood pressure”, allopurinol “to prevent gout” and cetirizine “for hayfever”.

The 2015 BJGP letter joins the indication to the instruction: allopurinol “Take one daily to prevent gout”. Adding it to the drug instructions, the letter says, “firmly links the drug with its clinical indication”.

FAQ 7 adds that careful wording may enhance drug performance, giving “to promote positive mood” as an example, and that this “needs careful evaluation”.

Should practices use standard phrases?

Yes, as far as possible. FAQ 7 says indications “should be standardised as much as possible”, while individual ones should continue, and FAQ 5 says “the use of standard phrases would enhance safety”.

Standard does not mean automatic. In a 2004 onmedica.net survey of 360 GPs, 70% favoured adding indications automatically to all repeat prescriptions. The developer disagrees: he “believes that prescribers should pick recommended phrases from lists and does not recommend automatic use of standard phrases”, and the prescriber “should remain medicolegally responsible” for the wording (FAQ 7).

The directory is a starting list, and an example rather than a working directory. It is the 02/02/06 version, with spelling corrections and two entries removed in 2026 (a misplaced insulin glargine row and co-proxamol, withdrawn from the UK market). Some entries may have dated, so check each phrase before you use it. FAQ 8 says it “will require refinement and adaptation over time”.

When should a safety message be added?

When the drug needs one. The About page says “key safety messages can be added to the specific prescription”, and the directory includes warning messages because indications were designed “to help health staff and patients get the best from their medicines”. Examples from FAQ 5 and the directory:

• a check: the contraceptive pill “yearly blood pressure check required”;
• monitoring: “regular three monthly blood tests required”;
• a stop date for time-limited treatment, such as warfarin for deep vein thrombosis;
• an action: clindamycin “for infection (IF DIARRHOEA OCCURS STOP TAKING MEDICINE)”;
• a colour to tell inhalers apart, such as “(blue inhaler)” or “(brown inhaler)”.

For dosing and interaction warnings, see prescribing errors.

What did patients ask for?

An expert cardiac patient group discussed the cardiology phrases on 18 October 2005 (the focus group). It asked for:

• on amiodarone, “check blood regularly”, not “bloods” plural;
• on aspirin and simvastatin, “may” or “will” prevent heart attacks and strokes, rather than “to prevent heart attacks and strokes”;
• on aspirin, a warning: “do not take with warfarin”.

The page concludes that “an expert patient group may be helpful in the discussion of appropriate phrases”, and FAQ 14 expected the requested changes to be taken up. Dr Masters has kept the directory’s aspirin, simvastatin and warfarin entries as they are.

See also wording for sensitive conditions and for prescribers.