Book Review

Therapeutic Drugs

N Engl J Med 1993; 328:1651June 3, 1993

Article

Therapeutic Drugs
Edited by Sir Colin Dollery. Approximately 2500 pp. in two volumes. New York, Churchill Livingstone, 1991. $450. ISBN: 0-443-02846-X

This is a massive work, with monographs written by more than 500 contributors from all over the world. About 40 percent of the contributors are from the United Kingdom, and the remainder are from the United States, most of the European countries, the Caribbean, Africa, Australia, and the Far East. Despite the number and diversity of the contributors, the format of the monographs is remarkably uniform and clear. For each drug, the features of its chemistry, pharmacology, toxicology, pharmacokinetics, therapeutic use, contraindications, adverse reactions, and interactions with other drugs are described. There is an excellent bibliography at the end of each monograph. The index is in three parts, listing generic names, therapeutic uses, and pharmacologic actions. This format makes finding the “right” drug very easy. The first monograph is about acarbose (Glucobay), which was the first α-glycoside hydrolase inhibitor to be used therapeutically in regulating the intestinal digestion and absorption of carbohydrates. The last monograph is about zuclopenthixol (Clopixol, Clopenthixol, or Cisordinol), “the second thioxanthine antipsychotic drug to achieve wide therapeutic use.” Neither of these drugs is listed in the 1992 Physicians' Desk Reference (Montvale, N.J.: Medical Economics Data).

I assessed the usefulness of this book in a general medical clinical setting by making it available to several physician staff members and nurse practitioners for several months. All the users found the therapeutic-use index and the pharmacologic-action index especially helpful. They compared Therapeutic Drugs with the Physicians' Desk Reference when specific problems arose about drug use, drug interactions, unusual drug toxicity, and unusual side effects. One of the questions of interest to clinicians is whether the absence of discussion of a side effect in a monograph is adequate evidence that the side effect has not occurred. According to this criterion, some of the monographs were found wanting. For example, there is no specific mention of fever as an adverse effect of phenytoin (Dilantin), although it certainly has been known to occur. In an attempt to learn about valproic acid, one user did not find it in the index, but finally found it listed under sodium valproate. The monograph did not mention any effect of sodium valproate on thyroid-function tests, although such an effect is mentioned in the Physicians' Desk Reference and had been seen in one case by one of the clinic physicians. Leg pain, which had been reported by one patient taking acyclovir, is mentioned in the Physicians' Desk Reference but not in Therapeutic Drugs.

An inevitable problem with any book about drugs is that by the time it is published, new drugs and new information have appeared. For example, although cardiac ventricular dysrhythmias are mentioned under adverse reactions to terfenadine, there is no mention of the risk of ventricular arrhythmias in patients taking both terfenadine and fluconazole. The only macrolide antibiotic discussed in the book is erythromycin.

The authors, of course, recognize the need for frequent updates with a book of this sort, and the book comes with an order sheet for an update. This is now available in the United States, at an additional cost of $225. The price of the book itself plus that of the supplement puts it out of the reach of the individual reader. The purchase should be considered by libraries and medical practice groups, which are sufficiently large to make it affordable and usable by a number of medical care providers. In these difficult economic times, however, $675 for a book about drugs is a major expenditure. The book would perhaps be valuable in clinics where medical residents and students are trained and taught. The importance of such a book in the training of medical students and house officers has perhaps been summed up best by Dr. Daniel D. Federman (“Relation of the Internal Medicine Residency and the Medical School Curriculum,” Annals of Internal Medicine 1992;116:1061-4):

The principal beneficial application of modern biomedical science is arguably in the creation of new drugs. Although new diagnostic tests, a better understanding of disease are important, all medical students like to perceive themselves as “making a difference.” For the internist, that desire is often attained through effective pharmacotherapy.

Julius Kritzman, M.D.
New England Medical Center, Boston, MA 02111