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Book Reviews



The Pharmaceutical Journal Vol 268 No 7192 p477
6 April 2002



Book Reviews


Applying pharmacokinetics

‘Clinical pharmacokinetics’ (2nd edition), edited by John E. Murphy. Pp xix+537. Price $52.50. Washington: American Society of Health-System Pharmacists; 2001. ISBN 1 879907 98 4

This book has been written for practitioners with experience in basic pharmacokinetics. It is intended to be used as a reference source to aid them in the initiation and monitoring of treatment in actual patients or to teach these principles to students. It is not intended for those interested in learning how to manipulate pharmacokinetic formulae in clinical practice as this knowledge is assumed.

Chapter authors have used the most recent literature to enable them to put forward methods they would use to initiate and monitor treatment. Readers may use different approaches based on their own evaluation of the literature. This is not unexpected since there is often more than one approach to caring for patients.

General pharmacokinetic principles are discussed in the introductory chapter including the reasons why some drug concentration measurements fall outside the expected range of population estimates. This chapter also includes a glossary of pharmacokinetic terms, selected pharmacokinetic symbols and a series of pharmacokinetic equations.

A new chapter on creatinine clearance estimations has been added to this edition largely because many dose predictions depend on creatinine clearance rather than body weight. A good example is how to predict a dose when a patient has had a limb amputated.

The main chapters, 19 in total, are devoted to those drugs that require careful monitoring such as the aminoglycosides, the newer antiepileptics (gabapentin, lamotrigine, tiagabine, topiramate), immunosuppressant agents (ciclosporin, tacrolimus), carbamazepine, antidepressants, digoxin, heparin, warfarin and others.

Typically, each chapter includes the usual dose range, the bioavailability of the dose forms, general pharmacokinetic information (absorption, distribution, elimination, metabolism, protein binding), clearance, volume of distribution, half-life and time to steady state, therapeutic range, dosing strategies, sampling times, pharmacodynamic monitoring, drug-drug interactions, pharmacodynamic interactions, drug-disease interactions and references.

The final three chapters deal with drug dosing in the neonate, drug dosing in paediatric patients and therapeutic drug monitoring in the geriatric patient.

A welcome addition is the inclusion of a table on international units for the drugs and laboratory tests. This will allow the wider use of the book around the world.

This useful book shows practitioners and students how to apply pharmacokinetic principles to drug therapy in day-to-day practice.

Laurence A. Goldberg

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Principles of clinical research

‘Principles of clinical research’, edited by Ignazio Di Giovanna and Gareth Hayes. Pp xv+558. Price £49.50. Hampshire: Wrighton Biomedical Publishing Ltd; 2001. ISBN 1 871816 45 9.

This is a multi-authored book published under the auspices of the Institute of Clinical Research. It is intended as both a training aid for those new to clinical research and as a reference source for those of longer experience. The primary readership will be researchers in the pharmaceutical industry, but the book will also be of value to those in hospital practice who become involved in the execution and management of clinical trials. This totally revised publication supersedes the ‘Handbook of clinical research’, last reprinted in 1997.

Comprising 24 chapters, ‘Principles of clinical research’ covers all aspects of the conduct of clinical trials. With almost all authors based in the United Kingdom, the coverage is largely eurocentric. However, the need for the industry to conform to international regulatory guidelines ensures that much of the content is relevant to clinical research carried out in most other parts of the world.

The content ranges from a general discussion of the drug development process, a history of drug regulatory affairs, and ethical issues, to highly detailed accounts of the statistical evaluation of clinical trials, the design of case record forms, and the processes for archiving clinical data for future reference. One imaginative inclusion is a chapter on the best ways in which to communicate the information that has been generated to those (eg, fellow researchers or assessors in regulatory authorities) who need to be aware of the data. As with most multi-authored books, there is a certain amount of duplication of information in different chapters, but the editors have succeeded in minimising this.

I am greatly impressed by the comprehensive coverage in this book, and believe it would be of interest to many pharmacists. It deserves to be read by a wider audience than just those intimately involved in clinical research.

Robin J. Harman

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Herbs and nutritional supplements

‘Herbal companion to AHFS DI’, edited by Lynn Forget. Pp x+178. Price $39.95. Washington: American Society of Health-System Pharmacists; 2001. ISBN 1 58528 017 8.

The ‘Herbal companion to AHFS DI (American Hospital Formulary Service Drug Information)’ is intended to provide essential, accurate, practical and referenced information about herbs and nutritional supplements. Each monograph is well researched, succinctly presented and formatted in a standard way. The monographs are reviewed by a panel of health professionals representing the intended readership, including pharmacists, doctors, nurses, nutritionists, dietitians, chiropractors, herbalists and naturopaths.

This book comprises 52 herbal monographs and 32 monographs on nutritional supplements.

Each herbal monograph starts with the names of the product: the English name, the botanical name, the plant family name and the pharmacopoeial name. This is followed by an overview of the herb, identifying its country of origin and any historical information that is relevant. The macro description offers details of the plant and when it is harvested. A further section describes the part of the plant used along with its constituents and composition. In the case of the bilberry fruit the active constituents are listed as catechins, invertose, flavonone glycosides and anthrocyanosides. The commercial preparations are also identified and again, in the case of the bilberry, fresh or dried berries, tea from the berries and an extract are listed. The other sections in the monograph describe medical uses (including the pharmacology), indications, dose ranges, duration of treatment, cautions (including toxicology, adverse effects, warnings, contraindications and precautions), interactions and regulatory status. Each monograph is well referenced. The nutritional supplements monographs follow a similar format.

A six-step methodology has been used in developing these monographs: data collection from over 3,000 industry standard sources, including over 500 medical journals; data assessment by research staff that employs scientific criteria; production of evidence-based documents and databases; peer review by an advisory board; rigorous checking by senior editors; and ongoing review and updating of the information. The result is a comprehensive, authoritative, science-based publication which can be used with confidence by health care professionals.

Laurence A. Goldberg

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