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October 5, 1984

Excessive Doses of Drugs

Author Affiliations

West Virginia University Medical Center Morgantown

JAMA. 1984;252(13):1685. doi:10.1001/jama.1984.03350130017023

To the Editor.—  Baum et al1 describe an increase in "overall drug use" as a result of both increasing numbers of prescriptions and increasing prescription size (number of tablets, capsules, or other units).We wish to point out another dimension of "overall use" and to suggest that the prescribed dosage of drug, when inappropriately high, may entail unnecessary morbidity.Hydrochlorothiazide is noted by the authors to be the most prescribed drug substance in the United States. The November 1983 FDA Drug Bulletin recommends 50 mg of hydrochlorothiazide or its equivalent as the maximum dose of diuretic for treatment of hypertension.Blaschke and Melvin2 state that "small doses of thiazide (eg, 25 mg of hydrochlorothiazide or its equivalent) will produce little change in plasma electrolytes but have about as much anti-hypertensive action as do much larger doses." Kaplan3 emphasizes the dangers of hypokalemia and recommends the equivalent of