Systematic comparison of four sources of drug information regarding adjustment of dose for renal functionBMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38476.471088.3A (Published 28 July 2005) Cite this as: BMJ 2005;331:263
Posted as supplied by authors.
List of 100 drugs most commonly used (by defined daily doses) during 2003 at Rabin Medical Center
Angiotensin converting enzyme inhibitors
captopril, cilazapril, enalapril, ramipril
Angiotensin-II receptor antagonists
acetylcysteine, diclofenac, dipyrone, fentanyl, morphine, naproxen, paracetamol
amoxicillin, ampicillin, cefazolin, cefonicid, cefuroxime, ceftriaxone, co-amoxiclav, cloxacillin, doxycycline, gentamicin, metronidazole, ofloxacin, roxithromycin
enoxaparin, heparin, warfarin
insulin human, metformin, glibenclamide
famotidine, omeprazole, ranitidine
bro= tizolam, diazepam, lorazepam, midazolam, oxazepam
atenolol, carvedilol, metoprolol, timolol
Bronchodilators - selective beta2 agonists
amlodipine, felodipine, lercanidipine, nifedipine, verapa= mil
budesonide, dexamethasone, hydrocortisone, methylpredniso= lone, prednisone
furosemide, hydrochlorthiazide, spironolactone
magnesium sulfate, potassium salts
bisacodyl, lactulose, paraffin liquid
isosorbide dinitrate, isosorbide mononitrate
atorvastatin, pravastatin, simvastatin
Sympathomimetics and parasympathomimetics
ephedrine, epinephrine, phenylephrine, neostigmine
ascorbic acid, cyanocobalamine, folic acid, folinate, thiamine, tocopheryl
amiodarone, B.C.G. vaccine, bromhexine, digoxin, graniset= ron, infliximab, metoclopramide, papaverine, paroxetine, phenytoin
Descriptions of the process and use of sources to reach recommendations
British National Formulary (BNF)
http://bnf.org/bnf/extra/current/openat/450015.htm (last accessed 17.2.05):
“The Joint Formulary Committee is responsible for the content of the BNF. Doctors and pharmacists on the Committee decide on matters of policy and review amendments to the BNF in the light of new evidence and expert advice.
BNF staff editors are pharmacists with a sound understanding of how drugs are used in clinical practice. Each staff editor is responsible for editing, maintaining and updating specific chapters of the BNF.
Amendments to the text are drafted when the staff editors (together with the executive editor) are satisfied that any new information is reliable and relevant. The draft amendments are passed to expert advisers for comment and then presented to the Joint Formulary Committee for approval.
The BNF uses over fifty expert clinical advisers throughout the UK to help with the production of each edition. The role of these expert advisers is to review existing text and to comment on amendments drafted by the staff editors. These clinical experts help to ensure that the BNF remains reliable providing expert opinion in areas of controversy or where reliable evidence is lacking, advising on areas where the BNF diverges from product data sheets or summaries of product characteristics, providing independent advice on drug interactions, prescribing in hepatic impairment, renal impairment, pregnancy, breast-feeding, children, elderly, palliative care, and the emergency treatment of poisoning.
Basic information about drugs is drawn from the manufacturers’ product literature, medical and pharmaceutical literature, regulatory and professional authorities, and data used for pricing prescriptions. Advice on the choice and use of medicines is constructed from clinical literature and reflects, as far as possible, an evaluation of the evidence from diverse sources. The advice also takes account of authoritative national guidelines. In addition, the Joint Formulary Committee receives expert clinical advice on all therapeutic areas in tune with current best evidence; this ensures that the BNF’s recommendations are relevant to practice.
The BNF uses a variety of sources for its information; the main ones are:
Summaries of product characteristics -The SPCs are the principal source of product information and are carefully processed.
Staff editors monitor core medical and pharmaceutical journals. Research papers and reviews relating to drug therapy are carefully processed. Where a difference between the advice in the BNF and the paper is noted, the new information is assessed for reliability and relevance to UK clinical practice. If necessary, new text is drafted and discussed with expert advisers and the Joint Formulary Committee.
The BNF has access to various databases of systematic reviews (including the Cochrane Library and various web-based resources). These are used for answering specific queries, for reviewing existing text and for constructing new text. Staff editors receive training in critical appraisal, literature evaluation and search skills. Reviews published in Clinical Evidence are used to validate BNF advice.
The BNF’s advice is checked against consensus guidelines produced by expert bodies. The BNF routinely processes guidelines from the National Institute for Clinical Excellence (NICE), the Scottish Medicines Consortium and the Scottish Intercollegiate Guidelines Network (SIGN)
Textbooks and reference sources are used to provide background information for the review of existing text or for the construction of new text.
The BNF team works very closely with the Martindale editorial team.
Readers of the BNF are invited to send in comments.
Each manufacturer is provided with a complimentary copy of the BNF and invited to comment on it.
Our aim is to evaluate the literature, covering important studies, guidelines, and useful reviews and placing them in context. Multicentre studies, meta-analyses, and systematic reviews play an important role in the study of drug treatment, and their findings and conclusions are considered in many of our chapters. However, there is also a place for the anecdotal report and the small study, and information from such sources is included where appropriate. A clearer acknowledgement is now also given to information referenced from a number of authoritative sources including the British National Formulary, the British Pharmacopoeia, the European Pharmacopoeia, the United States National Formulary, and the United States Pharmacopeia
Martindale is prepared by the editorial staff at the Royal Pharmaceutical Society of Great Britain. The editorial team, most of whom are pharmacists, draw on a wealth of experience in clinical and academic pharmacy to provide practising pharmacists and clinicians with a global summary of unbiased, independent, and evaluated information on drugs and medicines in use around the world. The team uses extensive literature surveillance and modern information retrieval techniques to review existing text and identify new areas of interest for inclusion. Given the increasing importance of evidence-based medicine, particular care is taken to identify, and where possible include as references, systematic reviews and meta-analyses or evidence-based guidelines. Intensive checking procedures built into the editorial process are supplemented by clinical advisers who validate the clinical relevance of the text.
AHFS Drug Information 2004
McEvoy GK, Miller J, Snow EK, Welsh OH, Litvak K. AHFS Drug Information 2004. Bethesda: American Society of Health-System Pharmacists, 2004; page v.
Drug monographs are prepared by a professional editorial and analytical staff, who critically evaluate published evidence on the drug. The monographs incorporate the expert advice of leading medical scientists, physicians, pharmacists, pharmacologists, and other clinicians and professionally qualified individuals. Reviewers provide a full disclosure of interest, including any affiliation with or financial involvement in the manufacturer of the drug(s) under consideration in a given review as well as for competitive products. The monographs are reviewed by many consultants in the specific field of therapy under consideration, including experts from major research and clinical institutions as well as public bodies such as the NIH – national institutes of health and CDC – us centers for disease control and prevention and professional associations with therapeutic authority.
Using an independent, evidence-based, evaluative process the monographs incorporate information from pertinent references in the literature and expert therapeutic guidelines.
Drug Prescribing In Renal Failure
We found no reference as to their work process or use of primary sources.
- This Week In The BMJ Published: 28 July 2005; BMJ 331 doi:10.1136/bmj.331.7511.0-a
- Editorial Published: 28 July 2005; BMJ 331 doi:10.1136/bmj.331.7511.247
- Letter Published: 28 July 2005; BMJ 331 doi:10.1136/bmj.331.7511.292
- Letter Published: 28 July 2005; BMJ 331 doi:10.1136/bmj.331.7511.292-a
- Letter Published: 28 July 2005; BMJ 331 doi:10.1136/bmj.331.7511.293
- Letter Published: 28 July 2005; BMJ 331 doi:10.1136/bmj.331.7511.293-a
- Education And Debate Published: 21 July 2001; BMJ 323 doi:10.1136/bmj.323.7305.157
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- Potentially inappropriate medication in elderly patients with chronic renal disease--is it a problem?
- A pharmacy medication alert system based on renal function in older patients
- Dose adjustment in renal impairment: Response from Martindale: the Complete Drug Reference
- Evidence based prescribing
- Dose adjustment in renal impairment: Response from AHFS Drug Information
- Dose adjustment in renal impairment: Response from Drug Prescribing in Renal Failure
- Dose adjustment in renal impairment: Response from the British National Formulary