Friday, April 26, 2013

Lowest effective dose is often much lower than the minimum dose

Common sense seems to be returning now that pharma is coming more and more under scrutiny. Keep in mind that lowest effective dose applies to psych drugs, too, and it may be more than half the minimum dose.

Here is an excerpt from The Globe and Mail.
Canadians overmedicated because MDs unaware of drug risks, experts say

ADRIANA BARTON The Globe and Mail
Published Thursday, Apr. 25 2013, 6:03 PM EDT
Last updated Thursday, Apr. 25 2013, 6:23 PM EDT

But more often than not, McCormack said, the dosage is too high. A phenomenon he calls the “unintentional medication overdosing” of Canadians is due to a systemic flaw in the drug regulatory process, he said. To prove that a medication works in clinical trials, drug companies select a dose high enough to generate a response in the majority of patients. The studied dose becomes the marketed dose – and the dose that most health professionals choose, he explained.

Studies to determine the lowest effective dose are rarely conducted. Nevertheless, many drugs work in much smaller doses, with fewer side effects, he said. For example, when the antidepressant Sinequan was introduced as a sleeping aid, the studied dose was 25 to 50 milligrams. Years later, however, a follow-up study found that 1 milligram of Sinequan “was effective for sleep,” McCormack said.

Unless a condition is severe or life-threatening, he said, patients should ask their doctor about starting with one-quarter to one-half of the marketed dose, and then increasing the dose as needed.

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