Identifying the need for a reference source on drugs which extended beyond those agents included in the British Pharmacopoeia, William Martindale set about producing the Extra Pharmacopoeia (Martindale). In 1883 he published the first edition — a sizable book of 313 pages. He went on to produce a further nine editions up until his death in 1902 at which point his son, also a pharmacist, took on the task of regularly updating the book every two or three years. When he died, the Pharmaceutical Society had the foresight to purchase all the rights of producing and selling the book with a view to perpetuating what had by then become a comprehensive book on drugs and their use. Today, Martindale enjoys the status of a highly prestigious publication, regarded as a valuable resource world-wide. Sean Sweetman (the editor) and his team have ably delivered a new, 134th edition. Martindale is now of course much bigger (2,784 large pages of small print) and these days is also available in electronic form.
At first, the task of reviewing the new edition seemed as challenging to me as Sean Sweetman’s must have been to produce it. After much thought I decided to adopt two approaches. First, I focused on the format, style, presentation and overall content, assessed by browsing through its numerous pages. Secondly, I subjected the book to a number of “tests” designed to mimic how it would be used in practice — as a reference source.
The format is little changed from previous editions. This is pleasing since, like others who have regularly used the book for some years, I have got used to its layout and the format of monographs. I have always thought it a little strange that the various uses of a drug are detailed half way through a monograph rather than at the beginning. But I, and probably other seasoned users, have become used to the adverse effects appearing first followed by the clinical indications for the drug. The content for each of the 5,300 monographs has been completely revised and updated. This is apparent from browsing through and was also proved by the more objective tests which I subjected the book to (see later). I particularly like the introductions to each therapeutic area. These provide a well researched and well written overview of the disease and the role of drug therapy. These, too, are up to date and reflect current opinion and practice. Clearly, thorough evaluations of recently published studies, guidelines and reviews have been carried out in the preparation of this information.
For the second part of my review I used Martindale to provide answers or information on 60 questions spanning various aspects of drugs and their use. These included adverse effects, dosages for specific indications, drug stability, herbal remedies, outlines of disease management, intravenous drug compatibilities and composition of foreign products. The book performed well. It was rare that little or no information was found relevant to the question. In the vast majority of cases the necessary details were found quickly and were judged to be accurate; during the exercise I found no errors at all.
On two occasions I failed to find the information I was looking for. The first, surprisingly, was the composition of Hartmann’s solution; no entry was found in the extensive index under “H” or under “C” for compound sodium lactate infusion. I did locate brief information on sodium lactate (under the subheading for sodium bicarbonate) but no mention of Hartmann’s or its administration as an intravenous infusion.
The only other occasion where I did not immediately find the information I wanted was when looking up Antegren; there is no entry in the index. The name has been in widespread use for a couple of years now (49,000 hits on Google) and to date has been used rather than the drug’s other name, natalizumab. The information I sought is in Martindale (under natalizumab), but I had to use another reference source first to ascertain this alternative name for the drug.
Despite these two examples, I hold the view that Martindale is comprehensive and I rapidly found the information needed for the other 58 questions. In all cases the information was correct and up to date. The book’s coverage of non-UK products is superb with information from more than 30 countries included. Previous editions have rarely let me down when trying to ascertain the constituents of medicines that a patient has acquired abroad. All of the foreign products used to test the new edition were traced.
Martindale is an immensely valuable book; the new edition lives up to expectations and reinforces its widely acclaimed reputation. All pharmacists should have access to this valuable resource, either in book form or electronically.