Overdose advice

We agree that the product monographs provided by manufacturers are not good sources of poison management information and that physicians managing unfamiliar poisonings should make use of the many resources available to them, including poison control centres, electronic databases and numerous excellent texts. Nevertheless, some physicians and other medical professionals do consult the CPS when managing poisoned patients, and it is clearly in no one's best interest if the product monographs contain misinformation.

Pharmaceutical companies are responsible for keeping their monographs up to date, and we find it unfortunate that in many cases they have failed to do so. Health Canada has the authority to require companies to update the information in these monographs, but it appears that there is no regular review mechanism in place. Johnson states that the CPhA has no authority to change the content of the monographs. This may be true, but the association is in a position to review the monographs regularly and could inform Health Canada and the pharmaceutical manufacturers of obvious errors. This would require additional resources, but even reviewing the monographs every 5 years could result in significant improvements.

In addition to the product monographs written by pharmaceutical companies, the CPS contains general monographs prepared by CPS staff. Johnson states that these general monographs are evidence based and that they are regularly reviewed and updated. To investigate the accuracy of poison control information in the general monographs, we reviewed the data collected for our study1 (from the 2001 CPS2), focusing specifically on the general monographs, which accounted for 7 of the 119 monographs that we analyzed. We found that the poison management information in these monographs did not agree with recommendations in current toxicology textbooks and databases. Specifically, of the 7 general monographs for the classes of medications that we reviewed in our study, 4 contained misleading or dangerous advice, and only 2 contained sufficient information for a physician to manage an overdose.

It is our understanding that the CPS editorial staff is in the process of extensively revising and updating the general monographs to correct some of the deficits that we have identified. We applaud these efforts. However, we do not think it is safe to correct the general monographs and not address the deficiencies in the product monographs. It is unrealistic to ask practitioners to consult certain monographs and ignore others. As long as the manufacturers' product monographs are included in the CPS, they are likely to be consulted for poison management advice. We believe that until the deficiencies in all of the monographs are addressed, physicians and other practitioners should be advised not to consult any of the CPS monographs for poison management advice.

Jeff Brubacher Roy Purssell Debra A. Kent British Columbia Drug and Poison Information Centre Vancouver General Hospital Vancouver, BC