E-DRUG: Industry Control over Information (4)
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Drug compendia in developed countries like Canada have a couple of serious
deficiencies one of which was mentioned by Rizwan in his commentary at the
end of Catherine Hodgkin's posting. These compendia are sent free to
doctors by virtue of payments made by the drug companies for listings. It
may not be considered worthwhile to list older products with low sales
volumes. A second problem is that the information in the compendia is only
updated when there are changes made to the approved drug information for
the product. Therefore the information for older products may be seriously
out-of-date or important information may be missing. For example in the
Canadian compendium, the Compendium of Pharmaceuticals and Specialties
(CPS), the recommended treatment for an overdose of amitriptyline (a
tricyclic antidepressant) includes inducing vomiting and using a drug
called physostigmine. Neither of these methods of treatment are recommended
in modern toxicology books. Another example is digoxin. Although it is
well known that dosing of this drug needs to be modified in the elderly
there is no mention of that in the CPS. Another problem is that monographs
for very similar drugs don't necessarily contain the same information,
because the drugs were approved at different times. For example in the
monograph for maprotiline, another tricyclic antidepressant, states that
physostigmine should not be used. Out-dated information and inconsistencies
in information may have potentially serious consequences. One survey of
Canadian family physicians in the late 1970s found that 90% relied on
information in the CPS for treating drug overdoses. A 1994 survey of
doctors and residents in a family practice teaching clinic found that for
drug information questions arising in the course of day-to-day practice,
staff and residents in a family practice unit first consulted the CPS
because it was felt to be the most available resource and the easiest to
use.
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: (416)-964-7186
Fax: (416)-923-9515
email: joel.lexchin@utoronto.ca
[Note from the co-moderator: Joel has raised an important point about
the presence of outdated information in the officially approved compendia.
A study published last year found that the U.S. PDR also has incomplete
and out-of-date information on the management of certain drug overdoses
(Mullen WH, Anderson IB, Kim SY, et al. Incorrect overdose management
advice in the Physicians' Desk Reference. Annals of Emergency Medicine
1997;29:255-61.). Syed Rizwanuddin Ahmad]
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