Concise Guide to the Cytochrome P450 System: Drug Interaction Guidelines for Medical Practice [Paperback]

Kelly L. Cozza MD (Author), Scott C. Armstrong MD (Author), MD Jessica R. Oesterheld (Author), MD Michael A Cole (Author)

Book Description

Publication Date: March 15, 2001 | ISBN-10: 1585620009 | ISBN-13: 978-1585620005 | Edition: 4th

Adverse medication reactions account for up to 7,000 deaths annually in the United States. In today's era of polypharmacy, busy clinicians - especially those who practice in medical/surgical settings - must be able to quickly find and even anticipate psychiatric drug interactions. This book is divided into three parts. Part 1 defines the P450 human oxidase system and its critical importance in metabolizing both endogenous and exogenous compounds, thereby rendering them less active. It also presents an in-depth discussion, tailored for psychiatrists, of pharmacology. Part 2 discusses - complete with case studies and tables - each of the six enzymes (2D6, 3A4, 1A2, 2C9, 2C19 and 2E1) that account for 90% of human drug oxidation. Unique to this guide, part 3 arranges the drugs commonly used in nonpsychiatric medicine that have clinically significant P450 drug interactions by specialty and lists them in tables, with pertinent clinical and research data to support and clarify the issues. Concluding with appendices that offer suggestions about how to prescribe in a polypharmacy environment and monitor for drug interactions and tips on how to sort through the enormous amount of information available in this area, this concise "how-to" guide should prove valuable to students and practitioners in psychiatric (in complicated medical/surgical settings, such as geriatrics) and nonpsychiatric (primary care, family practice, internal medicine and obstetrics/gynaecology) specialties alike.

Product Details

• Paperback: 272 pages
• Publisher: American Psychiatric Association; 4th edition (March 15, 2001)
• Language: English
• ISBN-10: 1585620009
• ISBN-13: 978-1585620005
• Product Dimensions: 6.4 x 4.3 x 1.8 inches
• Shipping Weight: 9.6 ounces
• Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #227,851 in Books (See Top 100 in Books)
  • #75 in Books > Medical Books > Pharmacology > Pain Medicine

Customer Reviews

Most Helpful Customer Reviews

12 of 15 people found the following review helpful:

5.0 out of 5 stars A great concise book., December 5, 2001

By 

George Dawson (St. Paul, MN USA) - See all my reviews
(REAL NAME)   

This review is from: Concise Guide to the Cytochrome P450 System: Drug Interaction Guidelines for Medical Practice (Paperback)

This is a technical book written by psychiatrists for physicians interested in Cytochrome P450 (CYP) enzymes and how these systems affect the metabolism of commonly prescribed drugs. Interest in these enzymes was heightened by problematic drug-drug interactions that lead to several fatalities and the removal of some prescription drugs from the market. Since then, there has been a heightened awareness by physicians, especially when prescribing drugs that inhibit one of these enzymes. From a clinical perspective, several questions are difficult to answer. For example, referring to commonly used tables or references it may be difficult to figure out why a particular drug has accumulated. It is also difficult at times to figure out a specific time course of action. When a drug is discontinued - how long does it have an effect on CYP systems? How immediate is the effect when it is started? Which drug-drug interactions are significant and which are not? This book provides a good deal of information in all of these areas.

The layout of the book is interesting and practical. The authors start out with a review of the 6 CYP systems as separate chapters. They start out with the most well characterized systems. They look at enzyme locations, metabolic activity, polymorphisms, inducers and inhibitors. They also provide vignettes of typical problems at the end of each chapter. A good example of the level of analysis in this book is contained in the brief vignette at the end of the 2C9 chapter. They describe a case of phenytoin toxicity that occurs when fluoxetine is added to phenytoin maintenance therapy. Their comment is: "Phenytoin is metabolized by 2C9, 2C19, and phase II conjugation systems. Although not a potent inhibitor of 2C9 and 2C19, fluoxetine does inhibit these enzymes and most certainly was the cause of this woman's increase in phenytoin levels". Comparison with other methods of checking these interaction usually does not provide this level of detail. Commonly used drug interaction programs may attribute the accumulation of phenytoin to "decreased metabolism" and point out that other compounds also have this effect. Drug interaction cards or charts might count on you being able to see both phenytoin and fluoxetine in two different columns and making the connection. The authors' analysis pulls all the relevant facts together in one place.

Chapters specific to Gynecology, Internal Medicine, Infectious Diseases, Neurology, Oncology and Surgery follow the initial chapters on CYP enzymes. Specific clinical examples of relevant drug- drug interactions are given in each chapter. As an example, the Gynecology chapter discusses the issue of contraceptive failure due to enzyme induction. Specific prescription drugs and a potential problem with St. John's wort are discussed. These chapters are all clinically relevant and well referenced.

The book concludes with two appendices - one about how to search the literature and very well written Appendix A. Guidelines for Prescribing in a Polypharmacy Environment. Polypharmacy has become the rule rather than the exception these days as more therapeutic agents are added to treat multiple illnesses in the same patient. In fact, in some situations multiple agents from the same therapeutic class are being used to treat refractory problems. The authors suggest five principles for physicians to use that decrease the likelihood of drug-drug interactions. These guidelines are adaptable to individual practices and allow the clinician to choose a profile of medications with the greatest level of safety. The book also contains a pocket guide called "P450 Tables" that summarizes the interactions listed on specific chapters.

My particular bias as a practicing physician is that I need to know the information in this book. After attending seminars on the topic, reading journal articles and pharmacology texts, and using several computer programs on drug interactions the information presented in this book is comprehensive and unique. As a paperback book it is also inexpensive. It is a book that should be read by psychiatrists and other physicians who prescribe medications to patients using other prescription or over the counter medications.

George Dawson, MD

5.0 out of 5 stars A good little book to have around, April 9, 2009

By 

Jack Irons "JB" - See all my reviews

This review is from: Concise Guide to the Cytochrome P450 System: Drug Interaction Guidelines for Medical Practice (Paperback)

A good little book to have around. Comes with a nifty 36-page pocket guide of tables. Worth the $$$.