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Pdr Drug Reference

Regional poison control centers currently serve only one half of the U.S. population. Many physicians who are not within regional poison control center areas may consult references such as the Physicians' Desk Reference (PDR) for poison management information. The U.S. Food and Drug Administration requires drug manufacturers to provide overdose information in the labeling of new drugs. However, once a guideline is approved, the FDA does not require that it be updated. These overdose management guidelines are included in the PDR. Overdose management has changed significantly within the past 25 years. Mullen and associates surveyed physicians who used the PDR as a toxicology resource to assess its accuracy and compared overdose treatment recommendations in the PDR with those of current toxicology textbooks.

All physicians who consulted the San Francisco Bay Area Regional Poison Control Center on a drug overdose case during a one-month period in 1996 were asked about their use of the PDR for overdose information. In addition, a structured evaluation of the 1994 PDR drug overdose management advice was performed for 20 drugs from different classes that were commonly implicated in accidental or purposeful drug overdoses. Information in the PDR was compared with information included in five current toxicology references.

Of the 80 physicians surveyed, 47 percent had used the PDR for overdose information within the preceding 12 months. Of the entries for 20 drugs reviewed by the authors, 16 (80 percent) had at least one deficiency and 13 (65 percent) omitted an indicated specific treatment. Four entries (20 percent) included potentially harmful recommendations including use of physo-stigmine for overdose of tricyclic antidepressants, hemodialysis for phenytoin, forced diuresis for lithium, and procainamide for digoxin. Less effective procedures were occasionally recommended instead of similar but more effective procedures, and potentially life-saving specific treatments or antidotes, such as sodium bicarbonate for toxicity caused by tricyclic antidepressants and glucagon for propranolol toxicity, were omitted.

The authors conclude that physicians' frequent use of the PDR for overdose information may result in unnecessary morbidity and mortality because of serious discrepancies between overdose management recommendations in the PDR and recommendations in current toxicology references. At least one deficiency was present in 80 percent of the entries surveyed. The PDR entries for the tricyclic antidepressants appear to be the most problem-ridden since the advice is clearly outdated.

Mullen WH, et al. Incorrect overdose management advice in the Physicians' Desk Reference. Ann Emerg Med 1997; 29:255-61.

EDITOR'S NOTE: Physicians' reliance on the PDR for up-to-date drug information can have serious negative effects. There is inadequate incentive for manufacturers to periodically update overdose management guidelines. This lack of updating may extend to other parts of the PDR entry, including information about dosing and side effects. Physicians need to recognize the limitations as well as the usefulness of information found in the PDR and consult other resources when important information is needed. Supplementing knowledge with current publications such as the Medical Letter on Drugs and Therapeutics can help fill the information gap. However, in cases of serious drug overdoses, it is imperative to reach the regional poison control center or some other resource that will provide the latest toxicology management information.

COPYRIGHT 1997 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group