Martindale: The Complete Drug Reference

Abstract

There can be few readers of this Journal to whom Martindale, the ultimate reference for drug information, needs introduction, so I will concentrate on what is new. The 32nd edition differs from earlier ones not only by its title—it is no longer ‘The Extra Pharmacopoiea’ but ‘The Complete Drug Reference’. Each of its 5000 monographs now incorporates a section on Interactions, ensuring this information is readily accessible. Certain chapters have been amalgamated: for example, all drugs used in the treatment of asthma have been combined into a single chapter to reflect therapeutic practice more closely. The authors consider extending this approach. For instance, should not the treatment of ballism, chorea and tics be found with drugs used in the treatment of Parkinson’s disease, rather than the chapter with anxiolytics, sedatives, hypnotics and antipsychotics? Martindale has always been a stickler for alphabetical order, and old habits die hard. Even within each chapter, the order of categories starts with Adverse effects and their management, followed by Interactions and Pharmacokinetics, and ends with Uses. To a clinician this seems back to front—it conveys the impression that the benefits of using a medicine are the least important of its characteristics and that safety must always come first—but this may have been deliberate. After all, the book is compiled chiefly for pharmacists, who turn to it more for information on unwanted effects and precautionary advice rather than to find out how to treat a patient. All of which make me wonder—where do clinical pharmacologists go for information on choosing and using medicines, not so much in their specialist area of clinical activity, but as generalist? Some may avoid textbooks completely, in the belief that their content must be out of date. But textbooks do have the advantage of being comprehensive, and can be recommended to others as a convenient starting point for postgraduate or continuing education. Some may turn to Dollery [1] for details on individual drugs, or to Meyler [2] for help with the diagnosis of adverse reactions, but neither of these can be approached without a very specific question in mind; they do not help when we are required to treat, or to teach about treatment of a condition we do not deal with every week. What we need is a source of guidance we can trust, with enough supporting evidence on the relevant drugs to make us confident that our advice is sound. Avery [3] is thorough and has a generous section on Clinical Pharmacology as well as its broad coverage of Therapeutics. But whereas Avery’s 4th edition was published in 1997, 10 years after the 3rd, Martindale’s 32nd is up to date and will be revised every 3 years. Martindale is, for all those unfamiliar with it, the most reliable and complete source of guidance on all areas of drug use. Its chief drawback for the reader in search of knowledge, as opposed to information, is the sheer mass of detail. But then it is ‘The Complete Drug Reference’.