The dose of a drug

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        Dr. Gold: The discussion in the conference this afternoon centered on problems of dosage. The principles were explored and illustrated by examples from a wide variety of drugs. There are two systems of dosage by which drugs are administered, the cumulative and the non-cumulative systems, and for their most effective application, use must be made of pharmacologic facts relating to speed of absorption and elimination. The mechanisms of these systems were described. The significance of the “average dose” was discussed, and a method for establishing the “average dose” in humans was outlined. The “average dose” of digitalis received special attention. It was stated by one participant that the “average dose” with respect to the effect of digitalis on the T-waves of the electrocardiogram bears no relation to the average therapeutic dose of the drug, while others presented evidence indicating a close correlation between the two types of endpoints.
        It was stated that the position of the “average dose” is not known in the case of most drugs, and that the term “average dose” is incorrectly applied to the dose which the “average physician” prescribes. The application of the principles of dosage was considered in relation to such common therapeutic agents as digitalis, epinephrine, neostigmine, phenobarbital, picrotoxin, morphine, quinidine, mercurial diuretics and estrogenic hormones. It was pointed out that if physicians were to make more systematic use of the basic principles of dosage plans, the efficacy of drug therapy would greatly increase.
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