Adelaide: Australian Medicines Handbook Pty Ltd, 1998.
927 pp. $125.00
The Australian Medicines Handbook (AMH) provides general practitioners with concise, accessible, unbiased, current information about the medicines they prescribe. Doctors who have worked in the U.K. unanimously praise the British National Formulary which is similar to the AMH, so it should receive widespread acceptance in the medical community.
The information for the AMH has been assembled, reviewed and edited by an impressive group of doctors and pharmacists sponsored by the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists, the Pharmaceutical Society of Australia and the Royal Australian College of General Practitioners with, importantly, no input from the pharmaceutical industry.
As a practising rural general practitioner, I was invited to `test drive' the handbook in my daily routine practice. Given the difficulties that many rural general practitioners have in finding time and locum support for updating their knowledge, the AMH is a much better source of impartial information than is usually provided by industry representatives.
The medicines are listed according to systems. Some sections, e.g. immuno-modulating drugs, are not often relevant to general practice, but do provide interesting reading. To provide a complete list for all practitioners is very difficult and column space therefore is at a premium. With the rise and rise of generic and brand substitutions, it is useful to have access to the names of the myriad of different products that pharmacists may give our patients. However, I question the wisdom of dedicating a whole column of one page to every generic variety of captopril. I presume the pharmacists on the panels were responsible for this input. Similarly, the space occupied by the 13 presentations of temazepam or the 28 preparations of coal tar could have been better utilised. In this regard, the publication is more a pharmacopoeia than a medicines handbook.
Each group of drugs has an introduction which successfully details mode of action, indications, specific considerations, drug interactions, adverse effects and comparative details of the class of drug. This is probably the most important and valuable part of the publication for practising general practitioners. It is an excellent reminder of important information about each drug; in particular, an easy reference for potential drug interactions that can so easily occur in elderly patients on multiple drugs. The ACE inhibitor/NSAID interaction is a good example which was highlighted during my use of the book. Similarly, common adverse events are listed for easy access and I found this very useful to counsel patients starting on a new medication or for assessment of reported adverse symptoms.
Some of the `comparative information' presented is controversial e.g. the statement that `calcium channel blockers should only be used for hypertension when all other groups are contraindicated' is unfounded. The treatment end-point for hypertension of at least 140/90 mmHg may need to be revised in the light of the results of the Hypertension Optimum Treatment study.
I was disappointed not to see Pharmaceutical Benefits Scheme prescribing information, such as authority indications, listed with each drug. This would not only save time for busy general practitioners, but we could also scan the AMH prescribing information while waiting for the Health Insurance Commission to answer the telephone!
I believe the AMH at $125.00 is excellent value for money when compared to other sources of drug information such as the MIMS ($135.00) which is industry sponsored, cluttered with advertisements and contains less important impartial information. Professor Felix Bochner and his editorial advisory board are to be congratulated for creating such a valuable aid for busy general practitioners. The AMH will become a bible of drug prescription and foster the quality use of medicines in general practice.
2. Sebastian Barresi, Intern, Royal Melbourne Hospital, Melbourne, Vic.
As an intern, there are many situations where the finer points of clinical pharmacology may be required. The Australian Medicines Handbook (AMH) provides a comprehensive guide to the use of common pharmaceuticals in a well-organised format.
The text encapsulates an excellent summary and reference to rational prescribing in the young, elderly and pregnant patients; a setting that is not too often encountered in the first year out of university. This part of the book provides a logical framework on the principles of using pharmaceuticals in each of these different settings.
The majority of the AMH covers each of the medical specialties and the products often used within them e.g. cardiovascular and respiratory medicines. Many of these areas are especially relevant to the intern, given the prevalence of these illnesses. This book gives the intern great perspective about the products used, and not only on when to prescribe, but most importantly, when not to prescribe.
Such is the content of the publication, its spectrum varies in application from general and specialised medical disciplines, to the use of medications in an emergency, to prescribing antibiotics and analgesics in surgical settings. Each of the major groups of drugs described allows the reader to bear in mind the mechanism of action, dose and a well-balanced perspective on adverse reactions ranging from the common to the very rare. Much of the content, I feel, is not only relevant to that covered in the intern year, but can prepare the young clinician beyond the first year of hospital work.
While the AMH provides an excellent resource when required, its only deficiency is its lack of a clinical approach. As an intern, there are often clinical situations where a guideline of which drug to use, rather than a detailed profile, is required. The publication can be used in this setting; however, it is not as efficient. The focus of this text is largely as a resource, but it would extend its appeal to the average intern with more emphasis placed upon clinical settings. Despite this, the principles outlined in the AMH are most helpful, and would assist the intern to prescribe safely and sensibly.