Choosing the best medications

Physicians can create their own personal formulary by rigorously selecting and regularly using one or two drugs for each clinical condition they commonly encounter. The primary and secondary medical literature provides the necessary information to create this formulary. Primary literature sources include peer-reviewed articles of randomized, double-blind clinical trials that compare medications. Secondary information sources include Physicians' Desk Reference and Drug Facts and Comparisons, which summarize but do not recommend particular drugs. Other secondary sources, such as The Medical Letter on Drugs and Therapeutics and review articles in peer-reviewed journals, compare drug classes and make recommendations about the drug of choice. The main medication characteristics to compare are efficacy, safety, patient acceptability and cost. The most objective information on efficacy is obtained through large, methodologically sound clinical trials that evaluate meaningful clinical outcomes. Three safety criteria to review include adverse drug effects, interactions with other drugs and the extent of clinical experience with the medication. Factors that contribute to patient acceptability should also be taken into consideration.