Doctors may lack current drug prescribing info

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Doctors may lack current drug prescribing info

 

By Keith Mulvihill

 

NEW YORK, Apr 12 (Reuters Health) - Doctors may not be

prescribing medication based on the most up-to-date

dosing information, which could lead to adverse side

effects in some patients, a new report warns.

 

" A gap exists in the availability of current and

comprehensive dose information for physicians, "

according to Dr. Jay S. Cohen of the University of

California-San Diego in La Jolla. His findings are

published in the April 9th issue of the Archives of

Internal Medicine.

 

In his study, Cohen evaluated 48 commonly prescribed

drugs and compared the initial dose recommendations

that are listed in the reference book, Physicians'

Desk Reference (PDR), to lower effective doses sited

in the medical literature.

 

The PDR, a comprehensive book that includes

prescribing information approved by the Food and Drug

Administration (FDA), is " the leading source of drug

information for physicians, " the report indicates.

 

The bottom line, Cohen told Reuters Health in an

interview, is that " initial recommended doses of drugs

that appear in the PDR often prove to be higher than

many patients require. "

 

When it comes to prescribing drugs, Cohen notes that

" for many types of medications, physicians are

frequently advised to use the lowest effective doses

of drugs, especially initially. Yet effective low

doses [that may be determined in other aspects of the

drug testing process] are often omitted from the PDR,

even when they have been recommended by expert

panels. "

 

As an example, Cohen sites dosage recommendations for

estrogen, which was prescribed to roughly 48 million

women in 1998.

 

" Estrogen therapy causes a significant [number] of

dose-related adverse drug events...and estrogens may

promote uterine and, possibly, breast cancer, " the

author writes.

 

While " respected drug references and multiple studies

indicate as little as 0.3 milligrams per day (mg/d) of

estrogens...is adequate for many women, " from 1964

until 1999 the PDR listed the recommended dose as 1.25

mg/d, the researcher points out.

 

" In 2000, the PDR recommendation was finally reduced

to 0.625 mg/d, which may still be excessive for many

women, " Cohen writes.

 

The company that publishes the reference book notes

that the PDR is only allowed to print FDA-approved

prescribing information and relies solely on the drug

manufacturers to submit updated information, according

to Mukesh Mehta, vice president and spokesperson for

Medical Economics Company located in Montvale, New

Jersey.

 

" The PDR is published once each year and has two

updated supplements in June and September. The online

version of the PDR--which is identical to the print

version--is updated each month, " Mehta told Reuters

Health.

 

But if drug manufacturers choose not to send the

information to the PDR or doctors do not continually

educate themselves about new dosage information,

patients may not be receiving optimal care, Cohen

explained.

 

SOURCE: Archives of Internal Medicine

2001;161:957-964.

 

 

 

 

 

 

 

 

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