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by James J. Rybacki
Collins, 2006
Review by Christian Perring, Ph.D. on Jun 13th 2006

The Essential Guide to Prescription Drugs 2006

The Essential Guide to Prescription Drugs 2006 is one of the physically larger drug guides available on the market.  It is hardcover book with about 1380 pages, and will take up about 3 inches of your bookshelf space.  It has six main sections: first an explanation of the main ways to be a smart user of the book; the main section of information about drugs (about 1126 pages); a list of different families of drugs; a glossary of medicine-related terms, and finally a longish section (about 94 pages) on special issues, such as using drugs with a newborn baby, the connection between different drugs and bodily organs, using the Internet, home test kits, and herbal interactions.  There is a useful index, which include both USA and Canada brand names for all drugs.  As with most other such books, there are several pages of color photographs of some of the main pills available in their different dosages.  Valium still comes in tablets with a V-shaped donut hole, Haldol still has a hollow bat-shaped H in the middle, and Prozac still comes in green and white capsules. 

The entries for the drugs vary in length from a short paragraph to several pages.  Some are short entries because the drugs are old and not used very often: for example, the antihypertensive hydralazine has very little information about it: it was introduced in 1950, it is a prescription medication in the USA, it is not a controlled substance in the USA or Canada, and it is available as a generic.  There's a guide to the pronunciation of the name and a list of the brand names it is available under.  The entry for the antidepressant imipramine is only a little longer, with similar information, adding a list of possible benefits and risks from taking the drug, and its three principle uses -- antidepressant, preventing childhood bed-wetting, and treating delusion.  But the mood stabilizer lamotrigine, branded as Lamictal in the USA, has nearly four pages of information.  In addition to the categories also mentioned, the entry also explains what is known about how the drug works, available dosage forms and strengths, recommended dosage ranges, conditions requiring dosing adjustments, dosing instructions, usual duration of use, conditions proscribing use of the drug, conditions your physician should know about if you are taking this drug, possible side and adverse affects, possible effects on sexual function, possible effects on laboratory tests, cautions about dangers associated with the drug (e.g., seizures may occur if you stop taking it without tapering the amounts), precautions for use, advisability of use during pregnancy or if breast feeding, habit forming potential, effects of overdose, possible effects of long-term use, restrictions of diet and other activities when taking the drug, such as the effects of exposure to sun and heat when taking it. 

I am not in a position to assess the accuracy of the information in the book, but given that Rybacki has been writing such a guide for nearly 30 years and he has a doctorate in pharmacology, it is likely to be as reliable as any other guide.  Some of the short entries are rather puzzling: for example, the central nervous system stimulant modafinil, sold under the brand name Provigil, was introced in 1998, but very little information is included, and the author's note merely says that the profile will be broadened in subsequent editions "if warranted."  Another short entry is for eszopiclone, marketed as the anti-insomnia drug Lunesta, which was introduced in 2005 and is currently being heavily marketed in direct-to-consumer advertising in magazines and on television.  It is listed as a "First Look Drug Nook" and the author writes, "Information in this first look profile will be broadened as more safety data and comparative research becomes available."  This is a little unnerving: presumably millions of people are taking this drug already, so one would hope that there is already good data available about its safety.  Another sort of case comes with the antidepressant nefazadone, marketed as Serzone.  Accompanying the exceedingly short entry for this drug is the rather cryptic note: "Revisions have been made to the label for this medicine noting a thorough benefit-to-risk analysis when deciding between this medicine and other antidepressants."  It would be helpful for people taking the drug to know what those risks are and whether the information that had been previously given was false. 

Rybacki takes a judicious stance on including controversial claims about medications.  He does include reports of dangers even when the FDA has not taken action to stop prescription of a drug.  For example, in the case of paroxetine, known as Paxil in the USA, he highlights the possible association with increased risk of suicidal thinking or attempts in children and perhaps some adults, and he also mentions later on in the 6-page entry that the British regulatory agency has ordered physicians to stop prescribing the medicine to children because of the risk of suicidal behavior.  In the case of another antidepressant, fluoxetine, marketed as Prozac and Sarafem, Rybacki lists suicidality and conversion of depression to mania in manic-depressive disorders as risks right at the start of the 7-page entry.  Interestingly, he has more than usual to say about the habit-forming potential of the drug.  In cases of the other SSRI antidepressants, he generally mentions the discomforts of sudden withdrawal from the drug, but here he says that "Reports of patients using excess doses of fluoxetine or combining the drug with alcohol has surfaced.  It appears possible that a euphoric effect and abuse potential exists."  The drug manufacturer never mentioned that when they introduced the drug, and presumably other pharmaceutical companies are hoping that there are no similar reports with other SSRI antidepressants.  It is to Rybacki's credit that he included this information. 

Another striking editorial decision by Rybacki is his inclusion of non-prescription ethanol in the book.  He has a little fun with the reader when listing the nonprescription brand names "Robert Alison Chardonnay (12% by volume), Bud Dry, Glenlivet, Smirnoff (40% by volume), Cabernet, others."  He lists as one of the possible benefits of light to moderate use the decreased risk of stroke, but most of the entry details the many dangers associated with alcohol.  Clearly, his decision to include ethanol in the book is a wise one, given the many possible interactions with other drugs and the dangers of excessive use. 

The Essential Guide to Prescription Drugs 2006 is a very helpful guide to drugs.  Those wanting more quantitative information may want to go directly to the Physicians' Desk Reference, and those who are looking only for information on psychotropic drugs may prefer a more specialized guide (such as FAST FACTS (LINK)), but those wanting a broad readable guide should be pleased with this book.  Its large format makes it much easier to use than the dense paperbacks one often see on racks in pharmacies.  The only weakness of the book lies in the final section with Tables of Medicine Information, which is hard to browse efficiently.  I would also have liked more systematic information about herbal medicines and their comparative value compared to prescription medicines.  

 

© 2006 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.