To the Editor.—
The article by Weintraub et al (242:445, 1979) on digoxinprescribing was, indeed, "mostly good news," providing reassuring evidence of thoughtful therapeutics on the part of physicians who use this important but toxic drug. One bit of bad news, however, is a dismaying consequence of their commendable individualization of digoxin dosage using tablets.It is confusing, especially to elderly patients (and, I suspect, also to nursing home personnel, helpful family, and even to the physician), to deal with regimens that attempt to achieve a target digoxin serum concentration or a clinical therapeutic endpoint by alternating days of different-strength tablets, by varying permutations of "days on" and "days off," by taking different numbers of tablets on different days, or by taking several tablets of different strengths in daily combination.Weintraub et al describe the "large number of dosing programs, particularly for elderly patients"; there were "15 separate mean daily