Stockley's Drug Research Articles

Potential drug-drug interactions in a multi-center study of death cases of COVID-19: The significance of appropriate drug choice.

The prevalence, types, severity, risk ratings, and common pairs of involved drugs, and the most important potential drug-drug interactions (pDDIs) in coronavirus disease 2019 (-COVID-19) deceased cases were evaluated. We reviewed the medical records of 157 confirmed COVID-19 deceased cases hospitalized in 27 province-wide hospitals. Patients' demographics and clinical data (including comorbidities, vital signs, length of in-hospital survival, electrocardiograms (ECGs), medications, and lab test results) were extracted. The online Lexi-interact database and Stockley's drug interactions reference were used to detect pDDIs retrospectively. The QTc interval and total Tisdale risk score were also calculated. Descriptive analysis, analysis of variance, Fisher exact test, and multivariate analysis were conducted for data analysis. Of 157 study cases, 63% were male, had a mean age of 68 years, and 55.7% had one or more underlying diseases. All patients had polypharmacy, with 69.2% having ≥15 drugs/day. We detected 2,416 pDDIs in patients' records, of which 658 (27.2%) were interactions with COVID drugs. Lopinavir/ritonavir among -COVID drugs and fentanyl among non-COVID drugs were commonly involved in the interactions. pDDIs was significantly higher in the polypharmacy group of ≥15 medications (p<0.001). A majority (83%) had received drug(s) with the QTc prolongation effect, of whom 67% had actual QTc prolongations in their ECGs. The regression analysis showed that by increasing 6.7% in polypharmacy, one day increase in-hospital survival can be expected. Moreover, an increase of 2.3% in white blood cells or 10.5% in serum potassium level decreased in-hospital survival by 1%. The findings underscored the importance of careful drug choice, especially in the hectic search for early treatments in pandemics of novel diseases. Close monitoring of patients' drug choice is warranted for reducing pDDIs and their adverse effects in any new disease outbreak.

Interaction alerts: A comparison of classifications and recommendations for clinical management between Janusmed and three other knowledge resources.

Classifications of drug interaction alerts differ between knowledge resources, but agreement regarding recommendations for clinical management is less explored. Starting from the medication lists of 274 older patients with ≥2 drugs, all unique drug pairs that triggered a clinically significant interaction alert in Janusmed were included: 100 Category C (manageable by, e.g. dose adjustment) and nine Category D interactions (should be avoided). Out of 109 C/D alerts in Janusmed, 89 (82%), 75 (69%) and 45 (41%) drug pairs triggered an alert of similar clinical significance in Lexicomp, Micromedex® and Stockley's Drug Interactions/Checker (Stockley), respectively. Eight (7%), 20 (18%) and 10 (9%) drug pairs did not trigger any alert in these resources. For 81 (74%), 81 (74%) and 94 (86%) drug pairs, Lexicomp, Micromedex and Stockley provided at least one recommendation for clinical management similar to those provided by Janusmed. For 16 (15%), 9 (8%) and 21 (19%) drug pairs, these resources provided recommendation(s) entirely in agreement with Janusmed. Although many drug pairs elicit alerts of similar significance, and partly concordant recommendations, a non-negligible proportion do not. The findings encourage medical/pharmaceutical reflection by prescribing clinicians and dispensing pharmacists; recommendations provided by knowledge resources vary considerably and cannot be considered definite.

Potential Interactions of Hypertension Drug in Medan City Pharmacy

Background: Hypertension is a disease that can cause complications without the patient realizing it. Therapeutic management needed to control the patient's blood pressure is complex enough to potentially lead to drug interactions. The purpose of this study was to analyze the interaction of hypertension drugs that occurred in a pharmacy in the city of Medan.&#x0D; Method: The study was conducted retrospectively involving 101 patient data in February-May 2022. Patient data was processed descriptively and potential drug interactions were analyzed using the Medscape Drug Interactions Checker, Stockley's Drug Interaction, and the drugs.com database&#x0D; Result: Based on the study results, it was found that from 101 patients, 57 patients had no drug interactions (56.4%), but 45 cases of drug interactions were found in 44 patients (43.6%). Drug interactions found in 27 cases occurred pharmacokinetically (60%) and 18 cases occurred pharmacodynamically (40%). The most frequent drug interactions are Amlodipine and Simvastatin.&#x0D; Conclusion: Based on this study, it can be concluded that most patients who have drug interactions occur through pharmacokinetic mechanisms.&#x0D;

Analisis Interaksi Obat Hiperlipidemia pada Pasien PT. Pertamina di Salah Satu Apotek Kimia Farma di Bandung

Hyperlipidemia is an abnormal condition of lipid metabolism which is characterized by an increase in lipid levels in the blood. Hyperlipidemia is often accompanied by other diseases. So the treatment of hyperlipidemia is often combined with other drugs and has the potential to increase the occurrence of drug interactions. Drug interaction is a condition in which a substance or drug activity can produce an increased or decreased effect or produce a new effect. This study aims to determine the presence of hyperlipidemic drug interactions in patients with diabetes mellitus Pertamina in one of the chemical pharmacies in Bandung based on the number of patients, number of cases, interaction mechanism and severity. This study uses a non-experimental research method with a descriptive approach and data collection is taken retrospectively based on prescription sheet data for the March 2021 period. The number of samples taken is 87 prescription sheets that meet the inclusion criteria. Data were analyzed descriptively usingliterature Stockley's Drug Interaction Handbook. Of the hyperlipidemic patients, who had the potential to experience drug interactions as many as 28 Prescriptions. Based on the results of the study, it was found that the severity of drug interaction cases which stated the severity level of major interactions was 1%, Moderate was 30% and minor was 1% while those that did not interact were 68%. Based on the results of the study above, the researchers concluded that there were 28 cases of prescription sheets containing hyperlipidemia drug interactions in March 2021 at Kimia Farma Pharmacy. The level of drug interactions consisted of major, moderate and minor categories with a severity level of 1% for the major category, 30% for the moderate category, 1% for the minor category, while 68% had no interactions.

Detect Drug Interactions with Metronidazole

Introduction: Metronidazole has been prescribed to treat infections for over a century and continues to be helpful in the therapy of amoebiasis, trichomoniasis, and giardiasis. Metronidazole is a cost-effective medication because of its low price, few adverse effects, and favorable pharmacokinetic and pharmacodynamic properties; nevertheless, it interacts with a wide variety of other medications. Some interactions with other medicines diminish its effectiveness, while others increase it.&#x0D; Aims: The study aims to detect and evaluate metronidazole interactions with other medicines at King Abdulaziz Specialist Hospital.&#x0D; Methodology: This retrospective study encompasses the review of 360 computerized prescriptions inside the outpatient clinic at King Abdulaziz Specialist Hospital in Saudi Arabia between March and September 2020 to detect and evaluate interactions among metronidazole and different medications.&#x0D; Results: Metronidazole interactions are mostly major or moderate. Metronidazole had the most common interactions with domperidone (15.83 %), famotidine (13.89 %), and ciprofloxacin (11.67 %). Metronidazole contains a nitroimidazole ring, which suppresses the metabolism in the liver of numerous medications, including those that may be metabolized by the CYP3A4 and/or CYP450 2C9 isoenzymes. The combination of metronidazole with phenytoin or phenobarbital can cause metronidazole elimination to be accelerated and phenytoin clearance to be reduced. Metronidazole may improve warfarin's anticoagulant effects, leading to a longer prothrombin time and a higher risk of bleeding. Concurrent use of metronidazole with alfuzosin, escitalopram, and ondansetron may raise the risks of QT-interval prolongation and arrhythmias.&#x0D; Conclusion: Most metronidazole drug interactions can be avoided by following excellent clinical care and clinical pharmacology concepts, such as avoiding complex treatment regimens, educating patients. and identifying patient risk factors. Furthermore, before prescribing and dispensing medicines, physicians and pharmacists should utilize drug-drug interactions checkers such as Micromedex and Lexicomp or a book such as Stockley's Drug Interactions.

A Prospective Study on Impact of Anemia and Iron Supplementation in Pregnancy, Baptist Hospital, Bangalore, India

Aim: A prospective study on Impact of Anemia and Iron Supplementation in Pregnancy, Baptist Hospital, Bangalore, India Methodology: the prospective observational study was conducted for 6 months from September 2016_Febrry to 2017. All inpatients women who are pregnant and anemic. The patient data collection was used to collect all the details like inpatient number, age, sex, social history, history, laboratory data, diagnosis, therapeutic management. All inpatients diagnosed anemia in pregnancy and pregnant women without anemia. Fulfilling the inclusion criteria will be enrolled into the study and their prescriptions will be analyzed on daily basis. The prescription guidelines, Micromedex, interaction checker, drug interaction database, and Stockley's drug interaction book 8 edition. The drug interaction in prescription was collected and then compare with guidelines. When the analysis of prescription was completed then all data entered into the appropriate software and the results were gained. Results: The present study was focused to find out the presence of anemia in 110 pregnant women who were admitted to gynecology and OBG wards of BBH (Bangalore Baptist Hospital). Presence study showed that anemia was Confirmed in 50 patients. Of these 28(25.4%) of them diagnosed as mild anemic, 20 (18.1%) Of them with Moderate and 2(1.8%) of them as severe anemic patients. The result of this study showed that LBW is higher in anemic women 19(25%) compared to non-anemic 17(21%). Conclusion: The present study showed from a total of 110 patients were included in this study, anemia was confirmed in 50 patients. Of these 28(25.4%) of them diagnosed as mild anemic, 20(18.1%) Of them with Moderate and 2(1.8%) of them as severe anemic patients. More low-birth-weight (LBW) babies were born to anemic mothers. Anemia in pregnancy may be reduced by proper Iron and folic acid supplementation which can be improved through providing proper ANC services. Has also a recognizable association with fetal outcome. Keywords: Anemia, Iron, anemia, iron supplementation, pregnancy, low birth weight.

The prevalence of potential drug-drug interactions in adults with intellectual disability.

There is a high use of medications in adults with intellectual disability (ID). One implication of taking multiple medications is the potential for drug-drug interactions (DDIs). However, despite this being well highlighted in the mainstream literature, little is known about the incidence or associations of DDIs in the ID population. This study describes the prevalence, patterns and associations of potential DDIs in a total administrative sample of adults with ID known to services in Jersey. Demographic, health-related and medication data were collected from 217 adults known to ID services. Data were collected using a face-to-face survey. The Anatomical Therapeutic Chemical classification system was used to categorise medications, and Stockley's Drug Interaction Checker was used to classify potential DDIs. Drug-drug pairings were considered to be of clinical significance if they were to be 'avoided, adjusted, monitored or required further information'. Potential DDIs of clinical significance were common. Exposure to potential DDIs of clinical significance was associated with being female, taking more than five medications (polypharmacy), living in residential care and having more health conditions. A simple regression was used to understand the effect of number of prescribed medications on potential DDIs of clinical significance. Every prescribed drug led to a 0.87 (95% confidence interval: 0.72-1.00) increase in having a potential DDI of clinical significance. Adults with ID who live in residential care, who are female, exposed to polypharmacy and have more health conditions may be more likely to have potential DDIs of clinical significance. Urgent consideration needs to be given to the potential of DDIs in this population given their exposure to high levels of medication.

Evaluation of the Prescribed Drugs to Elderly in a Tertiary Healthcare Center for Possible Drug Interactions with Investigational Drugs for COVID-19 Treatment.

Objective:Earlier identifying drug interactions may help in risk reduction in elderly patients.Methods:Drug prescription data of 212 elderly patients of tertiary health care center had been analyzed for possible drug interactions with investigational drugs for COVID-19 treatment. Drug interaction had been checked from Stockley's Drug Interaction 2019 and Martindale the Complete Drug Reference 2017 and standard reference books of Pharmacology.Findings:Different types of drugs prescribed in the elderly were 260 and out of which 68 (26.36%) were in the category of fixed-dose combinations. Around 150 (70.75%) elderly patients were having one or more associated comorbidities. Thirty-five drugs prescribed to elderly had been found to cause drug interaction with investigational drugs for COVID-19. Possible drug interactions are mediated through CYP3A4 (eighteen patients), CYP2D6 (seven patients) isoenzymes, or P glycoproteins transporters (three patients).Conclusion:Possible drug interactions predicted in this study suggested need for modification of dose of drug or watchfulness for adverse effects. If these drug interactions are considered beforehand, complications can be prevented on account of these drug interactions in elderly who are suffering from COVID-19.

A qualitative evaluation of a prescribing e-learning package for general practice.

The GMC PRACtiCe study identified a 1 in 20 error rate in prescriptions issued in general practice and identified a need for further training in prescribing. As a result, an e-Learning prescribing package was designed and launched to healthcare professionals through the Royal College of General Practitioners in January 2014. This part of the study explored the longer-term impact on prescribing knowledge, attitudes and behaviours of practitioners completing the eLearning prescribing package. On completion of the e-Learning package, participants were asked to indicate their willingness to be contacted for a telephone interview. Semi-structured interviews were conducted which were audio recorded, transcribed verbatim and analysed using thematic analysis, aided by NVivo. Interviewees were invited to enter a prize draw to win Stockley's Drug Interaction textbook (provided courtesy of the Royal Pharmaceutical Society). Of the 120 participants who expressed an interest in being followed up for interview, seven prescribers were interviewed in 2014 and 2015. Reasons for completing the course were explored, and interviewees gave examples of changes made to their prescribing practice as a result of completing the e-Learning. This included the adoption of specific strategies to enhance safe practice, and enacting enhanced vigilance in key areas such as renal function monitoring. Some changes to the course content and presentation were also recommended. These interviews have highlighted the potential for using e-Learning for prescribing training and to achieve long-term changes in prescribing practice. However, further work is needed to generate substantive evidence of its impact on prescribing.

Book review: Stockley's drug interactions. 11th ed.

Book review: Stockley's drug interactions. 11th ed.

A comparison of five common drug-drug interaction software programs regarding accuracy and comprehensiveness.

Objective:Drug–drug interactions (DDIs) can cause failure in treatment and adverse events. DDIs screening software is an important tool to aid clinicians in the detection and management of DDIs. However, clinicians should be aware of the advantages and limitations of these programs. We compared the ability of five common DDI programs to detect clinically important DDIs.Methods:Lexi-Interact, Micromedex Drug Interactions, iFacts, Medscape, and Epocrates were evaluated. The programs' sensitivity, specificity, and positive and negative predictive values were determined to assess their accuracy in detecting DDIs. The accuracy of each program was identified using 360 unknown pair interactions, taken randomly from prescriptions, and forty pairs of clinically important ones. The major reference was a clinical pharmacist alongside the Stockley's Drug Interaction and databases including PubMed, Scopus, and Google Scholar. Comprehensiveness of each program was determined by the number of components in the drug interaction monograph. The aggregate score for accuracy and comprehensiveness was calculated.Findings:Scoring 250 out of possible 400 points, Lexi-Interact and Epocrates, provided the most accurate software programs. Micromedex, Medscape, and iFacts ranked third, fourth, and fifth, scoring 236, 202, and 191, respectively. In comprehensiveness test, iFacts showed the highest score, 134 out of possible 134 points, whereas Lexi-Interact rated second, with a score of 120. Scoring 370 and 330 out of possible 534 points, Lexi-Interact and Micromedex, respectively, provided the most competent, complete, and user-friendly applications.Conclusion:Lexi-Interact and Micromedex showed the best performances. An increase in sensitivity is possible by the combination of more than one programs and expert pharmacist intervention.

Clinical Weighting of Drug-Drug Interactions in Hospitalized Elderly.

Adverse drug reactions impact on patient health, effectiveness of pharmacological therapy and increased health care costs. This investigation intended to detect the most critical drug-drug interactions in hospitalized elderly patients, weighting clinical risk. We conducted a cross-sectional study between January and April 2014; all patients 70years or older, hospitalized for >24hr and prescribed at least one medication were included in the study. Drug-drug interactions were estimated by combining Stockley's, Hansten and Tatro drug interactions. Drug-drug interactions were weighted using a risk-analysis method based on failure modes, effects and criticality analysis. We calculated a criticality index for each drug involved in the drug-drug interactions based on the severity of the interaction mechanism, the frequency the drug was involved in drug-drug interactions and the risk of drug-drug interactions in patients with impaired renal function. The average number of drugs consumed in the hospital was 6±2.69, involving 160 active ingredients. The most frequent were as follows: Furosemide, followed by Enalapril. Of drug-drug interactions, 2% were classified as contraindicated, 14% advised against and 83% advised caution during the hospital stay. Thirty-four drug-drug interactions were assessed, of which 23 were pharmacodynamic drug-drug interactions and 12 were pharmacokinetic drug-drug interactions (1 was both). The clinical risk calculated for each drug-drug interaction included heparins+non-steroidal anti-inflammatory drugs (NSAIDs) or Digoxin+Calcium Gluconate, cases which are pharmacodynamic drug-drug interactions with agonist effect and clinical risk of bleeding, one of the most common clinical risks in the hospital. An index of clinical risk for drug-drug interactions can be calculated based on severity by the interaction mechanism, the frequency that the drug is involved in drug-drug interactions and the risk of drug-drug interactions in an elderly patient with impaired renal function.

Analysis of drug interactions at the end of life

BackgroundAs death approaches, patients are at their most frail, but an increasing symptom burden often necessitates an increase in medications, putting them at higher risk for drug–drug interactions.ObjectivesTo assess the...

Stockley’s Drug Interactions, Pocket Companion

This pocket companion is published annually. It is based on the monographs in Stockley's Drug Interactions, which are fully referenced and derived from clinical studies, case reports and systematic reviews.

Stockley's Drug Interactions. Tenth edition, Stockley's Drug Interactions Pocket Companion 2013

Stockley's Drug Interactions, 10th edition, is the most recent publication of this pharmaceutical reference text. With close to 4,200 monographs included in this edition, it is quite comprehensive in its scope. Almost all of the editorial staff are pharmacists, which is an important consideration in such a reference text. It includes interactions for not only other drugs, but also herbs, supplements, foods, and other substances such as tobacco and alcohol. The text itself is organized into thirty-nine chapters. The first chapter presents a thorough overview of the varied possible drug interactions that exist, including a number of data tables and illustrations. After the first chapter, the remaining chapters are presented alphabetically by type of drug class or substance (such as alcohol). Each chapter includes an introduction with a short overview of the drug type and, if it lends itself to the topic at hand, discussions of common interactions, mode of action, and specific information for drug subclasses. Each interaction is then listed alphabetically by specific drug and secondary interacting agent. The text is organized with a bolded, short-paragraph, bottom-line determination as the first note under each topic heading. Below that, the more detailed clinical evidence, mechanisms of action, importance, management, and reference sections are included. Most references originate from primary sources, although there are some unpublished drug company documents and personal correspondence cited as well. The index includes both drug types and specific drug names. The editors include an advisement for readers to look up both the drug type and drug name in order to access all of the relevant information available in the edition. Stockley's Drug Interactions Pocket Companion 2013 is designed to be a quick-reference text for clinicians. Its diminutive size compared to the larger edition makes it more convenient for mobile clinicians. The pocket edition includes approximately half of the drug interactions that the full text includes (over 2,000) and is organized alphabetically by substance. There are no chapters in the companion edition; nor are the reference lists included. There is an index available for quick page identification of a substance. Information is condensed into short paragraph form; most entries include 1 or 2 paragraphs. The streamlined edition means that no graphics or tables are included. There is a page that defines 39 abbreviations utilized throughout the book (the more comprehensive edition includes 100), along with a short preface that discusses the organization, inclusions, and severity ratings. The pocket guide uses four symbols to alert the reader to the severity of the interaction. “X” alerts to a life-threatening interaction or one that is contraindicated by the manufacturers. “!” delineates that there is a significant hazard, and dose adjustment and close monitoring are indicated. “?” means there is doubt about the interaction, and patient advisement, along with possible monitoring, is recommended. A checkmark notes that there is no interaction or none of clinical significance. Pharmaceutical data, including drug interactions, change often. The editors publish any new updates to the topics at MedicinesComplete . Access for one year is included with purchase, but only on an individual basis as it is a single-use code. This creates a significant barrier for libraries or institutional pharmacies to be assured of the most current information. However, the scope of both books is quite broad and offers a well-organized reference text in general.

Drug-drug interactions and their predictors: results from Indian elderly inpatients

In view of the multiple co-morbidities, the elderly patients receiving drugs are prone to suffer with drug interactions since they receive a greater number of drugs. The study was undertaken to determine the prevalence of drug interactions, as well as their predictors. The prescriptions of a total of 1510 inpatients were collected prospectively for 1.5 years from inpatients wards of public tertiary care teaching hospital. All the prescriptions were checked for drug interactions using the Micromedex® Drug-Reax database-2010 and Stockley's Drug Interactions. Regression analyses sought to determine predictors for the drug interaction. The patients, with the average age of 67.2 ±0.2 years, were prescribed an average of 9.15 ±0.03 medications. It was found that out of 1510 prescriptions of inpatients, 126 (8.3%) prescriptions had one or more than one drug interaction. All the identified interactions were severe in nature. The top most interacting drugs were acetylsalicylic acid and anticoagulant (n=59). The second top most interacting drug combination was clopidogrel and proton pump inhibitors (n=51). The most commonly involved drugs in interactions were C (cardiovascular system) and A (alimentary tract and metabolism). Using multivariate binary logistic regression, multiple drugs (Odds Ratio=4.5; 95% Confidence Interval: - 2.38 -9.47) and multiple diagnoses (Odds Ratio=2.6; 95%CI: -1.40 -5.57) were found to be significant predictors for drug interaction. The results of this study substantiate the occurrence of severe drug interactions among Indian elderly inpatients. In order to provide safer pharmaceutical care, the active involvement of clinical pharmacists is a potential option.

Stockley's Drug Interactions - Pocket companion(Editor) edited by KarenBaxter. Published by Pharmaceutical Press, London. 2012. 603 pp, price £25.99. ISBN: 9780857110251

Stockley's Drug Interacions – Pocket companion 2012 has summarized the reference work Stockley's Drug Interactions which provides concise, accurate and clinically relevant information to health care professionals on this important topic. It provides a portable quick reference guide to clinically relevant evaluated and evidence-based information about drug interactions. As with the full reference work, this pocket companion attempts to answer the following questions; Are the drugs or substances in question known to interact or is the interaction only theoretical and speculative? How serious is the interaction? How common is this interaction? What proportion of patients is affected by the interaction? Should some drug combinations be avoided altogether or can the interaction be accommodated in some way? What alternative and safer drugs can be used instead to avoid an interaction? Evidence-based guidance is provided on the management of common drug–drug, drug–herb and drug–food interactions. Each monograph in Stockley's Drug Interactions was assessed by practising clinical pharmacists for inclusion in the Pocket companion. However interactions involving anaesthesia, the specialist use of multiple antiretrovirals, the specialist use of multiple antineoplastics or intravenous interactions, and non-interactions were omitted although exceptions were made where controversy exists over whether or not a drug interacts. The quick reference format helps summarize the interaction and management advice. Easy to use severity ratings provide guidance on the clinical significance of a particular interaction. These ratings are combined to produce one of four symbols for interactions which have a life-threatening outcome, for interactions where concurrent use may result in a significant hazard to the patient requiring dose adjustment/close monitoring, for interactions where there is some doubt about the outcome of concurrent use and for interactions which are not considered to be of clinical significance or where no interaction occurs. Over 1900 interaction monographs (including 200 new monographs) are included in this edition. The particular monographs are structured alphabetically for ease of searching with International Non-proprietary Names (INNs) to identify drug names with cross references to US Approved Names (USANs) also included where drug names differ significantly and a comprehensive back of book reference is provided. The information is based on the most recent quarterly update of Stockley's Drug Interactions at the time of going to press with the data being fully referenced and available at http://www.medicinescomplete.com. This pocket companion, in summary, provides a quick reference guide for physicians, pharmacists, nurses and other health care professionals.

Handbook of Drug Interactions: a Clinical and Forensic Guide

Interactions are tricky. They are easy to miss as you add another line to the prescription chart. They multiply promiscuously, if not quite exponentially. Their clinical effects go from the unobservable, through the uncertain, to the actionable. Thus, guidance is certainly needed, and Mozayani & Raymon have assembled a work by nearly 40 contributors, which they hope will prove useful to ‘health and forensic professionals’. This is quite a gap to bridge. Clinical pharmacologists will forgive Welner and Opler's explanation that ‘antipsychotics are able to exert their effects by influencing how specific chemicals, known as neurotransmitters, move through the brain’. Lawyers may need a tranquillizer before approaching Moody's description of ‘… flunitrazepam 3-hydroxylation and N-demethylation, brotizolam 1′- and 4-hydroxylation, the oxazolo-ring cleavage of mexazolam, the N-demethylation of clobazam …’ and much more. The title fails to give an idea of the true scope of the work. The chapter on cardiovascular drugs, for example, discusses adverse drug reactions in considerable depth; the chapter on antipsychotics covers several forensic aspects. The discussion of anabolic doping agents includes sections on β-agonists, erythropoietin and insulin-like growth factor-1. This chapter includes the disturbing notion of ‘pharmacologically enhanced troops’ and the uncomfortable fact that scrotal skin is fivefold more permeable than other skin to testosterone from patches. The information content is not uniform. Moody's chapter on benzodiazepines (435 references) and Wayne Jones's on ethanol (617 references) stand out. The rather complex interactions between phenytoin and other compounds are summarized in tables, as are the interactions with warfarin, but the tables are unreferenced, which is a pity. There are also gaps in the treatment of some important interactions. There is nothing on lithium, and no mention of transport proteins such as ABCB1 (p-glycoprotein) whose involvement in drug–drug interactions with amiodarone and verapamil, for example, is increasingly recognized. ABCB1 is also important when considering cancer chemotherapy, another subject that is omitted. The forensic discussions are interesting for clinical pharmacologists. The vexed question of pharmacogenetic influences on morphine and codeine is covered, although there is still some doubt as to whether postmortem concentrations of opioids in breast-fed neonates can really be used to demonstrate intentional administration. The rules of the International Olympic Committee, laid out in the anabolic steroid chapter, are in good time for this summer's festivities in London. The contribution by Brunette, a partner in a law firm, gives a fascinating insight into US legal processes, although it does not quite mesh with the pharmacology. For example, Brunette, in describing the case of Whittle vs. United States explains the interaction between Nardil® (phenelzine) and Fiorinal® (butalbital, acetaminophen and caffeine), but it is not described elsewhere in the text. Stockley's Drug Interactions says: ‘The evidence for an interaction between the MAOIs and the barbiturates seems to be confined to a few unconfirmed anecdotal reports with amobarbital.’ Thus, the Handbook is not what I was expecting, that is to say, a competitor for Stockley or for Hansten and Horn's Drug Interaction Analysis and Management, but a fascinating collection of monographs, some of which are outstanding.

Stockley's Drug Interactions Pocket Companion 2011

Stockley's Drug Interactions Pocket Companion 2011 is the abridged partner to the sizable Stockley's Drug Interactions. This pocket edition is a quick, convenient reference text with the same information in abbreviated form. This information is fully referenced and based on clinical studies, case reports, systematic reviews, and evidence-based practice, but the bibliographic data are not found in the pocket edition. It is only available in the larger text or online . The pocket companion contains more than 1,500 examples of interactions between drugs and drug groups, foods, supplements, and herbal preparations. Take for example, aspirin. Aspirin is listed as potentially reducing the effect of some diuretics; increasing coagulation time if taken with heparin or ginkgo biloba; increasing the risk of upper gastrointestinal bleeding if taken with selective serotonin reuptake inhibitors (SSRIs); decreasing the absorption of vitamin C; and if taken with food, aspirin's analgesic effect is delayed, though not reduced. Even with this effect, it is still recommended to take aspirin with food to minimize the drug's gastric irritability property. Found only in the pocket edition are unique symbolic tags following a drug name. These are meant to give a “heads-up” to the clinician. “X” indicates a drug interaction that could be life threatening; “!” means a potential hazard requiring close monitoring; “?” means there is some doubt as to an interaction, therefore it would be advisable to make patients aware of the possible side effects that would need to be reported; and a plain checkmark means there are no significant interactions noted. Stockley's Pocket Companion has a list of 39 abbreviations used in the text, a 71-page index, and no table of contents or introductory explanations regarding drug interactions. Drugs are listed alphabetically starting with ACE inhibitors and 8 pages of possible interactions with other drugs or substances. There are no interactions included for drugs beginning with the letters X, Y, and Z. The pocket edition contains no pictures, tables, or graphics. This differs from Stockley's regular-sized edition, which has a list of nearly 100 abbreviations used in the text, a 213-page detailed index, a table of contents, and occasional graphs and charts. This volume also has a detailed introduction summarizing drug categories and an explanation of the mechanisms of drug interaction including physiological details. Stockley's Drug Interactions Pocket Companion 2011 is an annual update of the less-frequently published Stockley's Drug Interactions. The companion information is compiled from the most recently available online quarterly updates of Stockley's. While the pocket edition does not have the scope or the depth of the full-sized monograph, it has the benefit of being up-to-date, accurate, brief, portable, and economical.

Book Review: Stockley's Drug Interactions Pocket Companion 2012

Book Review: Stockley's Drug Interactions Pocket Companion 2012