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Doody's Review ServiceReviewer: Dennis K Constan, PharmD (Temple University Health System - Northeastern Hospital)
Description: Updated from the 2004 edition, the PDR for Herbal Medicines 2007 is a compendium of general botanical and clinical knowledge of herbal medicine. Structured in a format that is part textbook and part clinical reference, it provides literature-supported identification, safety, efficacy, and therapeutics information with cross-referencing ability by therapeutic category, indication, side effects, and drug interactions.
Purpose: The intent is to provide a thorough, inclusive compilation of herbal information derived from the literature, with a focus on additional research data, drug interaction information, and ease of use, so that healthcare professionals may apply the information to make informed judgments about herbal use by their patients. The objectives are worthy, since in this era of medication reconciliation, herbal medications are an often overlooked and less understood part of the medication reconciliation process. Given the level of base knowledge of herbal medications among healthcare professionals, the book meets its objectives for ease of use and the provision of general information across categories.
Audience: It is clear from the "How to Use This Book" section that the intended audience is healthcare providers who have patients that possibly use herbal medications, but the textbook structure of the book appears to address students or those requiring generalized knowledge. One might expect a tool to be used by clinicians to present information in a tabular format when possible.
Features: The book provides a general description, pharmacology, relevant literature, and clinical uses/dosages for an inclusive array of herbal medications. Unique features include cross-referenced indexes to permit searches alphabetically, by therapeutic category, and by indications for use, in addition to drug-herbal interactions. A full-color herbal identification chart accompanies the text. What is best about the book is that it is a comprehensive reference on an important, yet less studied subject that may impact the safety of patients taking medications. Its best features include the search indexes, especially a drug-herbal interaction index. Full literature references at the end of each monograph are also valuable to the reader. There may be areas of opportunity for the book. The identification, illustrative portion of the book does not add the same value that a drug identification illustration does, since viewing a plant obviously does not aid in identifying a tablet or capsule. Since the book is text-heavy, one might consider just adding the illustration to the beginning of the monograph. Esthetically, it will help break up the dense text. If the book's intention is to serve as a clinical "go-to" reference, some of the information might be more accessible and valuable if presented in a different format. Presenting information in a table format, when possible, would add interest to the text, as well as permit easier access (i.e., drug-herbal interaction table). The drug-herbal interaction section potentially possesses the greatest value in the book, but it appears incomplete at times. For example, under horse chestnut, it indicates an interaction with warfarin, but under warfarin, there is no mention of horse chestnut, even though it is described as a coumarin derivative. Another example of a lack of comprehensiveness is red sandalwood is listed as a treatment for diabetes and gallbladder complaints, but it is not listed under these topics in the indications index. There is some confusing, seemingly contradictory information. Under the Indications Index for Hyperthyroidism, it lists bladderwrack, but in the bladderwrack monograph, use in hyperthyroid patients is contraindicated. Minor shortcomings for a clinical text include a lack of continuity for abbreviations. Grams are abbreviated "g" and "gm" throughout the text. Milliliters are abbreviated "ml" and "mL" in the text. "Goiter" is spelled in the also correct British English "goitre" for no apparent reason. Some references are dated, perhaps due to a lack of recent studies. However, using cornflower as an example, the literature dates back to 1985 even though a PubMed search revealed a 1999 reference that would be relevant for its listed indications (LinksGarbacki N, Gloaguen V, Damas J, Bodart P, Tits M, Angenot L.Anti-inflammatory and immunological effects of Centaurea cyanus flower-heads.J Ethnopharmacol. 1999 Dec 15;68(1-3):235-41. PMID: 10624883 [PubMed - indexed for MEDLINE]).
Assessment: The book is of high quality and it compares favorably with the Natural Medicines: Comprehensive Database, 9th edition (Therapeutic Research Faculty, 2006). The challenge for a subsequent edition is to enhance the usefulness of the indexes with reformatting and enhanced explanations. (Pygeum is listed in the drug-herbal interaction guide with hormones, but what is the nature of the interaction? If you need to go to the monograph for the information, then the interaction guide is less helpful.) There is a huge opportunity to develop a significant section of the text devoted to a comprehensive interactions matrix. One consideration might be to add a patient education section to the monographs, as appropriate, when information is available. Given the paucity of information on herbal products, the book does serve as a good reference for those interested in enhancing their herbal medication knowledge base.