Thursday, November 19, 2009
Drug doses are not all the same

By Dr. Anthony Policastro

There are often misperceptions that patients have about medication that they take. One of those misperceptions is related to the dose of medication. When someone is on a medication, we usually ask what dose they are taking. The dose is often in milligrams (mg). Many patients think that the dose in mg is similar for all drugs. That is not true. The number of milligrams in a drug is related to the chemical composition of the drug. A smaller chemical will have a low mg dose. A larger chemical will have a higher mg dose. For example, I am on three different medications. One of them is for my thyroid condition. The dose of that is 0.125 mg. A second one is for my cholesterol. The dose of that is 40 mg. The third one is for my triglycerides. The dose on that is 1000 mg. It does not mean that the medication for my triglycerides is stronger than the medication for my thyroid. It just means that its chemical components are larger than the medication for my thyroid condition. Thus if a physician switches you from a low mg amount of one drug to a high mg amount of another drug, it may be exactly the same equivalent dose. I often use ADHD medication. The two most common medications are Ritalin and dextroamphetamine. Due to the difference in size, the dose of the Ritalin in mg is about twice the dose of the dextroamphetamine. When I change patients from one drug to another, the parents will often ask me why I am increasing or decreasing the dose with the change. It really is not an increase or decrease. It is just that when you use a different drug, the mg amount will be different because of the size of the chemical. It is important for you to know how many mg of a drug you are taking. The reason it is important is that the doctor needs to know what dose you are on. However, if you are on a higher mg dose of one medication than you are of another, it does not mean that the higher mg dose medication is stronger. It just means that it is different. The thing that is most important about mg doses is how what you are taking compares to other doses of that particular drug. For example, I will often ask parents how much Tylenol or Ibuprofen they are giving their child. Very often they give too little. So we increase the dose. When we used to use aspirin for fever a lot, it was easy to give a child too much aspirin. Thus it was important to know how much the patient was taken. When I took my oral board exams, the first patient they gave me was one who had aspirin overdose. The mother had been giving the usual dose of aspirin but the child was dehydrated. That made the dose relatively higher for the child. The bottom line is understanding the fact that medications should not be compared mg for mg. Trying to do that only causes confusion.

Blood Bank honored for program The Blood Bank of Delmarva was honored at the American Diabetes Associations (ADA) 20th Anniversary Diabetes Gala on Nov. 6 at the Deerfield Golf & Tennis Club for being the first blood bank in the country to offer diabetes screening to every blood donor. The ADA chooses an honoree based on their commitment to helping raise awareness about the seriousness of the diabetes epidemic in the community. The Blood Banks diabetes screening program recently passed the two year mark. During that time, more than 102,000 blood donations were screened. Of that number, 5,044 individuals were found to have elevated glucose levels, and 62 people were in the dangerous category of over 400. The non-fasting blood glucose test is voluntary and is offered to donors at no charge. "I am extremely proud that Blood Bank of Delmarva was first to institute this glucose screening for blood donors, said Blood Bank president and CEO, Robert L. Travis. "I am also pleased to say that other blood banks around the United States have followed us by instituting similar programs. Travis conceived the idea for a screening program after hearing a presentation on the diabetes problem. Travis formed a committee of experts from Christiana Care Health System, Blue Cross Blue Shield of Delaware, the ADA, and the Delaware Division of Public Health to help advance the project.

Safe Arms for Babies law In response to news reports about an alleged stillborn infant being disposed of in a dumpster, the Delaware Childrens Department is urging the public to be mindful of the Safe Arms for Babies law. The law, which allows any parent to go to any Delaware hospital emergency department and leave their newborn (14 days old or younger) with any emergency department staff or volunteer, provides immunity from criminal prosecution provided the baby is alive, unharmed and brought into a hospital emergency department. According to the law, the person surrendering the baby will not be asked for identification, will not be asked who they are, will not have their identity revealed and will not be contacted. The employee or volunteer of the hospital will make a reasonable attempt to provide the person surrendering the baby with the identification number of the baby, a mail-back medical questionnaire and information about the Safe Arms for Babies law that includes a list of phone numbers for public and private agencies that provide counseling and adoption services. Since the law was enacted in 2001, no child has been surrendered under the provisions. On any given day, the Delaware Childrens Department provides services to children who have been abused, neglected, abandoned, dependent, or have mental health or substance abuse problems, and/or have been adjudicated delinquent by the Courts. For more information, visit or

Coalition recognizes physicians The Delaware End-of-Life Coalition hosted its 2nd Annual Physician Excellence Award in End-of-Life Care Dinner on Nov. 3 at the Sheraton Dover Hotel. The focus of this years award was teaching about end-of-life at the local, state and national level. Ten physicians were nominated and received a certificate for involvement in end-of-life care in their respective specialty areas. The nominees were: Bayhealth Medical Center - Kathrina Chua, MD, John Fazekas, MD, Iftekhar Khan, MD, John Lahaniatis, MD, Rishi Sawhney, MD and Adity Sharma, MD; Stephanie Gilibert, MD - Christiana Care Health System; Misael Marquez, MD - Heartland Hospice Service; Robin Miller, MD - Nemours/Alfred. I. duPont Hospital for Children; and Yogish Patel, MD - Delaware Hospice. Dr. Robin Miller, pediatric oncologist at Nemours/Alfred I. DuPont Hospital for Children, was the recipient of this years Excellence in End-of-Life Care award. Barbara Plummer, MSN, RN and Dyane Bunnell, MSN, RN from AIDHC nominated Dr. Miller writing that Dr. Miller does an exemplary job of caring for children with cancer and their families. To learn more about the Coalition, visit

Monthly support group Compassionate Care Hospice, The Wellness Community-DE and Nanticoke Memorial Hospital will collaborate to present a monthly bereavement group, The Next Step. The group focuses on issues of loss that continue beyond the early stages of grief. Mary Van House, bereavement coordinator, will facilitate the group at 10 a.m. on the third Tuesday of each month, at the Nanticoke Cancer Care Center, second floor conference room. To register, call Lisa at 629-6611, ext. 2378.

Hospice offers Grief Support group Delaware Hospice is offering an eight-week group meeting for adults who have experienced the death of a loved one. The group will meet Wednesday afternoons from 5 to 6:30 p.m., until Dec. 2, at Nanticoke Memorial Hospital, 801 Middleford Road, Seaford. Find out what normal grief "looks like; learn about the "tasks of mourning; identify your coping style and develop coping skills that feel right for you; share as much or as little as you would like. This activity is provided free to the public by Delaware Hospice; however, registration is required. To register, call Paul Ganster at 302-357-7147.

Depression Support Group There is a free bimonthly Depression Support Group meeting in Laurel on the second and fourth Wednesday evenings from 7 to 8:30 p.m. Any person who has signs and symptoms of depression and is under the care of a professional counselor/MD is welcome to attend. To register, call Life Matters Counseling and Consulting at 302-465-6612.