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The Pharmaceutical Journal
Vol 268 No 7193 p505
13 April 2002

This article



'Martindale — the complete drug reference' (33rd edition), edited by Sean C. Sweetman. Pp x+2483. Price £250 (£199 to members ordering before 1 May 2002). London: The Pharmaceutical Press; 2002. ISBN 0 85369 499 0

Samuel Johnson, the renowned lexicographer, once said: "Knowledge is of two kinds. We know a subject ourselves, or we know where we can find information upon it." 'Martindale' has been one of the sources that pharmacists have turned to, to find the second type of knowledge, and more often than not it provides an answer or a good starting place. After 119 years of evolution, 'Martindale' has reached its 33rd edition, which is published next week and is heralded by the publishers as the "foremost source for medicines information worldwide". However, just as a successful animal species may find its long-term survival put at risk due to a loss or change in habitat, could its continued existence in printed form be in danger due to the encroachment of electronic sources including its own CD-ROM version and the internet?

'Martindale' carries the clean modern look of the previous edition, and states boldly the claim to be "the complete drug reference". One can only be humbled by the challenging task of making 'Martindale' physically usable, without a degradation of key information. The temptation to publish 'Martindale' as a two-volume set has been resisted for the present. In a busy pharmacy dispensary, or if one is on-call in the early hours, a single volume reference text is perhaps more practical.

This edition contains over 5,300 monographs, 95,000 preparations, 32,000 cited references, and the details of over 7,800 manufacturers. A total of 160 monographs have been dropped and 175 drug monographs added. 'Martindale' maintains its existing structure: Part 1 holds monographs of drugs and groups of drugs with similar uses or actions in 51 chapters; Part 2 contains supplementary drugs and other substances; and Part 3 is an extensive listing of preparations. Some chapters have changed, lipid-regulating drugs have moved into the cardiovascular drugs section and a new chapter on neuromuscular blockers has been created. The layout, headings and text have been slightly modified and this does appear to improve readability. Thankfully, font size for the majority of text seems to be similar to the previous edition, although slightly narrower. The usual excellent index allows rapid information retrieval.

Following on a trend from the previous edition, recommended International Non-proprietary Names (rINNs) are given heightened prominence and are used preferentially instead of the British Approved Name (BAN). However, in contrast to the British National Formulary (BNF), preference continues to be given to the BAN, in both the general index and monographs, for those drugs such as frusemide/furosemide where both the BAN and rINN should be used. The BNF in these cases gives equal weighting to both the BAN and rINN in the titles of drug monographs, and it is arguable that some consistency in approach between the two texts would have been desirable.

A key strength of 'Martindale' is that it uses a skilful mix of evidence from multi-centre studies, meta-analyses and the single case report, and this depth of knowledge is perhaps what makes 'Martindale' the superb resource that it is. The disease treatment reviews in the chapters have undergone major revision, reflecting changes in clinical practice. There are over 634 disease treatment reviews (interestingly 10 fewer than the previous edition) and these are cross-referenced with the drug monographs. The reviews are a pleasure to read, being succinct, reasoned, well referenced and balanced in their views. As well as providing the evidence for efficacy of treatments, they also point out areas lacking clear evidence and important safety considerations. For example, while the heart failure treatment review now acknowledges the increased evidence for the role of beta adrenoreceptor antagonists and spironolactone, attention is also paid to the less clear role of beta adrenoreceptor antagonists in severe heart failure and the need for close monitoring of plasma potassium in those taking spironolactone.

The promotional material for 'Martindale' asks us "How up-to-date is your drug reference?", a question one might wish to ask two years down the road about this edition itself. Major changes in therapy rarely occur overnight, but three years between editions may be too long a period when electronic resources are under continual revision. Looking at recent issues, the voluntary withdrawal of cerivastatin following reports of increased rhabdomyolysis when used in combination with gemfibrozil is noted. Bupropion is given an even-handed monograph, with due attention given to risk factors for adverse events. A discussion on smoking cessation in another area states nicotine replacement therapy is the first line pharmacological therapy, and bupropion is advocated by "some, as a first line alternative". Advances in cardiovascular medicine are covered, although the CURE study of clopidogrel in acute coronary syndromes is absent, even though it was published at around the same time as the cerivastatin withdrawal.

Complementary medicine is taken into account, with 200 monographs and 5,000 preparations of herbal medicines. Although this is not an increase from the previous edition, the monographs appear more extensive reflecting the increase in evidence for their efficacy and/or increasing knowledge about their adverse effects or interactions with drugs. As an example, the St John's Wort monograph had no listed adverse effects or interactions in the 32nd edition; this has been extensively revised, and is cross-referenced to the drugs with which it may interact.

One of the more useful things about the 'Martindale' is its emphasis on older preparations and unlicensed drugs. Thalidomide is a good example, and the rehabilitation of this "pariah" drug into several specialised therapeutic areas, such as human immunodeficiency virus-associated complications and skin diseases is well described, although doses for these conditions are not listed.

The additional features of the CD-ROM, which has yearly updates and an archive of deleted monographs, acknowledge the limits of the printed 'Martindale'. However, the printed version will continue to be popular. Books are easier to use for shorter queries and are sometimes preferable to searching for information on a screen. The best solution of course is to have both versions to hand. 'Martindale' continues to be the superb reference book it has always been and is an essential tool for any practising pharmacist.

Anthony Cox

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Anthony Cox is the ADR pharmacist at the West Midlands Centre for Adverse Drug Reaction Reporting and a teaching fellow at the Pharmacy Practice Research Group, Aston University

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