Drug Interactions Casebook: The Cytochrome P450 Systemand Beyond, 2nd ed. By Neil B. Sandson. Washington, DC,American Psychiatric Press, 2003 ($35.50, paperback ed.),334 pp.

As a frequent lecturer and consultant for interactions in-volving the dreaded P450 Isoenzyme system, I have overthe years accumulated a group of references that are invalu-able. I have just added to my top shelf Dr. Neil Sandson’sbook, Drug Interactions Casebook: The Cytochrome P450System and Beyond. Though the title may appear somewhatintimidating, this work is written in a “user-friendly” formatthat accommodates the novice or even the senior expert indrug metabolism. The author takes a keen approach, whichavoids “ losing” the reader in the first chapter. This is an everso important task in educating clinicians about this dauntingsubject. Readers should not pick up this reference with theassumption that they will be omniscient about the P450system. Rather, clinicians should address this book as afantastic reference for possible metabolic interactions withthe various enzymes discussed.

The term Cytochrome P450 Isoenzyme System in itself isquite threatening. The name is derived from the chromepigment (P) color the isoenzymes display in a hollow testtube (Cyto). The number 450 is the speed (in nanometersper second), measured by spectrophotometry, at which thesystem absorbs a beam of light. The isoenzymes are sepa-rated by family, subfamily, and then the individual gene(e.g. 1A2) [1]. The author organizes the book in a unique,and well welcomed, approach by segregating each chapterby the individual isoenzymes. The sections include a varietyof case vignettes that give extraordinary examples of pos-sible drug–drug interactions. The cases are enticing andleave the reader eager to read the next. Though some of theexamples are a little extreme and leave one wondering if theinteraction could lead to such consequences, the point ofdriving home the possible outcomes are acknowledged. Inaddition, all of the cases are referenced immediately afterthe citation instead of at the end of the chapter. I found thisto be extremely helpful and saved me the burden of fum-bling through pages if I questioned the possibility of such aninteraction. What make the cases more memorable are thecreative titles Dr. Sandson gives each of them. My favoritewas the “Drowsy Dog Trainer,” in which a woman whoworked as a dog trainer experienced excessive sedationsecondary to an interaction between alprazolam (Xanax)and ritonovir (Norvir). The end result led to disgruntledcustomers as the woman slept through the time in which sheshould have been walking the canines. Cases also includevarious herbal medications and the popular grape fruit juiceinteractions.

For the seasoned veteran, the text concludes with onechapter that tests one’s knowledge of complex vignettes andanother with interactions not necessarily related to the P450system. Such interactions included involve the less recog-nized P-glycoproteins (PGPs) and the Phase II reaction of

glucuronidation. This portion of the book adds a nice tie into the P-450 system. Many times clinicians identify aCytochrome interaction, but in actuality it is secondary to anon-P450 pathway.

After a very complex, but real, Test Case, 31 pages oftables are reprinted with permission from Dr. Kelly Cozza’sbook Concise Guide to Drug Interaction Principles forMedical Practice: Cytochrome P450s, UGTs, P-Glyco-proteins and Drs. Oesterheld and Osser’s website www.mhc.com. The tables from Dr. Cozza identify P450 interactions,while the latter reviews possible Phase II complications.Though no one should have to reinvent the wheel, I am onewho is always open to “new” approaches in simplifying thismaterial. The tables are well-written and well-documented,but in a book that is very user friendly, I expected somethingdifferent. A more concise representation of these tables atthe end of each chapter may be an idea for the secondedition.

As more drugs gain the Food and Drug Administration’sapproval, clinicians must recognize the importance of pos-sible drug–drug interactions. Educating novice and experi-enced medical professionals is a must. Dr. Sandson does agreat job of this in his text. Seven chapters are included andorganized in a concise way that allows this reference to beread with ease and interest. This text is a must for anypractitioner prescribing, administering, and/or monitoringmedications.

Donald Rogers, Pharm.D., B.C.P.S.Tewksbury, MA

doi:10.1016/j.genhosppsych.2003.12.003

Reference

[1] Jefferson JW. Drug interactions—friend or foe? J Clin Psychiatry1998;59(Suppl 4):37–47.

Medical Complications of Psychiatric Illness. By ClairePomeroy, James E. Mitchell, James Roerig, and Scott Crow.Washington, DC, American Psychiatric Publishing, Inc.,2002 (paperback edition, $33.00), 288 pp.

It is each psychiatrist’s responsibility to either assumeprimary medical care responsibility or ensure that anexpert consulting medical physician is involved in thepatient’s care. (p. 19)

How strongly do you agree or disagree with this state-ment? If you find yourself at the “disagree” end of thespectrum, the small but informative book, Medical Compli-cations of Psychiatric Illness, may convince you otherwise.Pomeroy, Mitchell, Roerig and Crow are clear on the role ofpsychiatrists, first and foremost, as medical doctors withresponsibility for either providing or ensuring the medicalcare of their patients.

The medical status of psychiatric patients is the new hot

249Book Reviews / General Hospital Psychiatry 26 (2004) 248–251