Incorrect Overdose Management Advice in the Physicians' Desk Reference

Byline: Walter H Mullen, Ilene B Anderson, Susan Y Kim, Paul D Blanc, Kent R Olson Abstract: Study hypothesis: Physicians may consult references such as Physicians' Desk Reference (PDR) for overdose management advice. Although PDR recommendations are approved by the US Food and Drug Administration (FDA), we hypothesized that they are often outdated and potentially hazardous. Methods: We surveyed physicians who consulted our poison center during a 1-month period with regard to their use of the PDR for overdose information and also compared PDR overdose treatment recommendations with those of five current major toxicology references. For the PDR overdose information review, we examined data from the American Association of Poison Control Centers to identify pharmaceutical categories with the largest number of deaths. We reviewed the four leading drugs with at least 1,000 reported exposures in each category and identified 20 PDR-listed brand-name products for analysis. We obtained the consensus from five current toxicology references on contraindicated treatments, ineffective treatments, and specific recommended treatments or antidotes. Finally, we compared the overdose management advice provided in the 1994 PDR with the toxicology reference consensus. Results: Forty of 80 of physicians surveyed (50%) reported use of the PDR for overdose information in the preceding 12 months. Of the 20 PDR entries, 16 (80%) had at least one deficiency, and 5 (25%) had two or more deficiencies. Thirteen (65%) omitted an indicated specific treatment, three (15%) recommended contraindicated treatments, and four (20%) advised ineffective treatments with potential for harm. Only four entries (20%) had no deficiencies by our survey criteria. Conclusion: We found serious discrepancies in overdose treatment advice in the PDR compared with a consensus of current toxicology references. Altogether, four of five PDR entries were deficient, and almost half advised ineffective or frankly contraindicated therapies. Despite FDA approval, the use of PDR overdose advice in a serious poisoning case could result in unnecessary morbidity or mortality. [Mullen WH, Anderson IB, Kim SY, Blanc PD, Olson KR: Incorrect overdose management advice in the Physicians' Desk Reference. Ann Emerg Med February 1997;29:255-261.] Article History: Received 30 January 1996; Revised 1 July 1996; Accepted 25 July 1996 Article Note: (footnote) [star] From the Schools of Pharmacy* and Medicinea and the Division of Occupational and Environmental Medicine, School of MedicineAs., University of California; and the San Francisco Bay Area Regional Poison Control Centera[yen], San Francisco, California., [star][star] Address for reprints: Walter H Mullen, PharmD, San Francisco Bay Area Regional Poison Control Center, San Francisco General Hospital, Room 1E86, 1001 Potrero Avenue, San Francisco, California 94110, 415-206-8058, Fax 415-821-8513, E-mail w@wtnx.com, a Reprint no. 47/1/77729