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Miles Weinberger, MD
University of Iowa Hospitals and Clinics Iowa City

JAMA. 1978;239(5):401.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The report by Zaske et al (237:1453-1455, 1977) results in average dosages quite similar to those recently reported by Wyatt et al.¹ I think it needs to be strongly emphasized, however, that the average dosage requirements place up to 20% of patients at risk for serum concentrations in excess of 20 µg/ml, thus exposing the patients to potential toxicity.²I would therefore recommend that initial therapy be begun at lower dosages and that the average dosage requirements in the publication by Zaske et al be used as upper limits for dosage when serum concentrations are not monitored.

The potential risk of using trough serum concentrations was also not mentioned by the authors. Particularly among children, peak serum concentrations estimated at two hours after a dose have been demonstrated to exceed predose trough levels by 9 ±3 µg/ml (mean ± 1 SD).³

Appreciation of these . . . [Full Text PDF of this Article]

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