Principles of Clinical Pharmacology

Abstract

Editors A. J. Atkinson, C. E. Daniels, R. L. Dedrick, C. V. Grudzinskas, S. P. Markey. Academic Press, San Diego, 2001 460 pages, price £53.95, ISBN 0120660601 This is a somewhat unusual book. While there are a number of texts on clinical pharmacology and therapeutics for undergraduates, this aims at a different audience, postgraduates with an academic or more likely an industrial interest in the principles of clinical pharmacology. The book arose from a course run for some years by the National Institutes of Health and which they have made largely accessible on the Internet without charge (http:www.cc.nih.govcccprinciples). The book deals with the same topics in much greater depth and detail. After an introductory chapter it is divided into five parts: pharmacokinetics; drug metabolism and transport; assessment of drug effects; optimizing and evaluating patient therapy; and drug discovery and development. The section on pharmacokinetics provides a very thorough comprehensive account of the general principles of the subject, including a detailed description of compartmental and noncompartmental models. It also discusses the alterations in pharmacokinetics seen in liver and renal disease. Some of the material requires more than elementary mathematics, but overall it provides an excellent overview of the subject even for the mathematically naive. The second section describes drug metabolism and some of the mechanisms of drug interactions and toxicity, as well as outlines of analytical methods for assaying drugs. Pharmacogenetics is also discussed in a pharmacokinetics context. Next, several chapters in section three deal with qualitative and quantitative aspects of the assessment of drug effects, including an introduction to pharmacodynamic and pharmacokinetic modelling. The fourth part of the book discusses special issues concerning gender differences in drug therapy, as well as the use of medication in children, the elderly and in pregnant and nursing women. There are also chapters on the clinical analysis of adverse drug reactions and on quality assessment in drug therapy. Finally, the last section describes the processes of drug development from discovery to clinical trials, with the regulatory aspects obviously having an almost exclusively US perspective. This is then a comprehensive book, and also a very well-produced (and probably expensive) one, as one might expect from its publishers. It assembles a huge amount of information difficult to find elsewhere in a single source at this level. The main drawback of the book is a certain lack of coherence in approach and style that is inevitable with five co-editors and more authors. On the whole this does not detract from its usefulness for specialist registrars in clinical pharmacology and those in training in pharmaceutical medicine in industry, perhaps also for the shrinking band who teach clinical pharmacology in medical schools. Compared with a book with its main focus on therapeutics, it should have a relatively long life, since it deals with largely unchanging principles.