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Book Review: Pharmacokinetic Principles of Dosing Adjustments: Understanding the Basics

If you are an instructor for pharmacokinetics, there does not seem to be a shortage of books from which to choose. The author’s purpose in writing this book was to provide useful concepts for dosing adjustments. However, I am not sure that this book is actually all that different from any other pharmacokinetic book available. I think the author did not achieve this goal because of the lack of actual clinical examples. Of course, no other pharmacokinetic book available has been able to achieve this goal, either. Although the idea of providing the concepts that would be useful in making dosage adjustments in actual practice sounds appealing, it seems to go against the evidence provided by a rather large body of accumulating educational research literature that theory first is not only a failure, but an abysmal one at that.1,2 Perhaps instructors cling to this style because, as professionals with advanced degrees, this is how we think we learn best. Research has shown that people learn by doing and then pick up the concepts rather than the reverse. We can continue to teach concepts first, but even the most adept of us have trouble applying them to actual problems we encounter, whether in the clinic or in our everyday decision making. Given the above, one might have hoped for a book that gives the student real clinical examples and the mechanisms to actually make adjustments based on these real patients. That is not what we have here. Indeed, in his preface, Schoenwald states that the book was not intended to be a clinical guide to dosing adjustments. But in his next paragraph, he states that the book was written for students and practitioners. Hence, a paradox seems to exist. Presumably, the intent is for practitioners to better understand what they are actually doing, but students unfortunately will not. The book has 4 sections: Basic Concepts, Parenteral Dosing Adjustments, Oral Dosing, and Advanced Considerations. Section I has 4 chapters, the first of which is titled Pharmacokinetic Processes. The chapter gives a short introduction to the processes in pharmacokinetics, mainly absorption, distribution, metabolism, and excretion (ADME). It always disappoints me to see abbreviations before they are defined, and that is what Schoenwald does in the very first sentence of Chapter 1. Abbreviations are best kept to a minimum so that beginning students are not presented with an alphabet soup to contend with besides the sea of deltas they will encounter and become lost in soon enough. The chapter does give an interesting example on the use of bicarbonate for a phenobarbital overdose, but ends citing only a single reference. Chapter 2, Kinetic Processes Applied to the Whole Body, is an introduction to Flick’s First Law and has an error in equation 2.3 on page 19. The author is giving a somewhat intuitive derivation as to the units of the elimination rate constant, but has distance3 distance2 time distance distance2