Clinical prescribing guide
I enjoyed Dr. Henry A. Nasrallah’s editorial (“3 Types of ‘EBM’: Which do you practice?” Current Psychiatry, April 2007), which reminded me of a rough guide to clinical prescribing that I often refer to when teaching residents. According to a bell-shaped curve, approximately 80% of your patients should be on “normal” doses and medication combinations. However 10% should be on abnormally low or high doses, or an unusual combination of medications. If all your patients are on similar standard or FDA-approved doses, seek consultation.
Obviously, this guideline does not apply to clinicians working with atypical patient populations.
James H. Thomas, MD
Dr. Nasrallah responds
Dr. Thomas’ dose distribution guideline would also correlate with the slow, regular, and rapid cytochrome metabolism found in the general population.
Henry A. Nasrallah, MD
Professor of psychiatry, neurology,
University of Cincinnati College of Medicine