Thank you for publishing “New Drugs: How to Decide Which Ones to Prescribe” [June 2006] by Dr. Philip Mohler. I wish more physicians would give credence to the issues of cost and efficacy. Too many people don’t realize that they’re prescribing drugs incorrectly. Why are there so many prescriptions for bid dosing of Toprol XL? Isn’t the point of “XL” (aside from extra large windfall for the drug company) once a day administration?

In the ambulatory surgery center where I am the chief nurse anesthetist and responsible for ordering and maintaining the drug inventory, I know that at least one physician doesn’t believe that generic metoprolol works and insists that his patients take Toprol XL bid. Furthermore, he doesn’t believe Toprol XL tablets should be split despite the fact that they’re scored. The contract cost at my health care facility for 100 25 mg Toprol XL tablets is equivalent to 100 50 mg tablets, which is $74 to $78 at wholesale cost. Generic metoprolol is even cheaper than pill splitting. One hundred tablets cost $3. This is significant for someone without prescription coverage who must shoulder the entire cost.

It is useless to prescribe drugs that patients can’t afford. Doing so fails to keep the best interest of the patient in mind. Thank you, Dr. Mohler, for addressing a concern that is all too obvious to many of us as providers and health care recipients.