Is bigger better? An argument for very low starting doses

CMAJ. Canadian Medical Association Journal

Volumn 183, Issue 1, 2011, Pages 65-69

  McCormack, James P ^a   Allan, G Michael ^b,c   Virani, Adil S ^a,d  

^a UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^b UNIVERSITY OF ALBERTA   (Canada)

^c Towards Optimized Practice   (Canada)

^d FRASER HEALTH AUTHORITY   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

AMFEBUTAMONE; ATORVASTATIN; CAPTOPRIL; COLCHICINE; EZETIMIBE; FLUOXETINE; HYDROCHLOROTHIAZIDE; IBUPROFEN; IRON; RANITIDINE; SILDENAFIL; SUMATRIPTAN; VARENICLINE;

DIARRHEA; DOSE RESPONSE; DRUG COST; DRUG DOSE COMPARISON; DRUG EFFICACY; DRUG MARKETING; EVIDENCE BASED PRACTICE; FOOD AND DRUG ADMINISTRATION; HUMAN; LOW DRUG DOSE; NONHUMAN; PATIENT COMPLIANCE; PATIENT PARTICIPATION; PLACEBO EFFECT; RECOMMENDED DRUG DOSE; REVIEW; SIDE EFFECT;

EID: 78651428691     PISSN: 08203946     EISSN: 14882329     Source Type: Journal    
DOI: 10.1503/cmaj.091481     Document Type: Article

References (30)

1. Therapeutics Initiative. Dose titration: minimize to maximize. Therapeutics Letter 1995; 10. Available: www.ti.ubc.ca/node/90 (accessed 2010 Sept. 3).
2. Cohen JS. Over dose: the case against the drug companies. New York (NY): Tarcher/Putnam; 2001.
3. Cross J, Lee H, Westenlinck A, et al. Postmarketing drug dosage changes of 499 FDA-approved new molecular entities, 1980-1999. Pharmacoepidemiol Drug Saf 2002;11:439-46.
4. Hrobjartsson A, G0tzsche PC. Placebo interventions for all clinical conditions [review]. Cochrane Database Syst Rev 2004;(3): CD003974.
5. Pittrof R, Rubenstein I. The thinking doctor's guide to placebos. BMJ 2008;336:1020.
6. Levy G. Predicting effective drug concentrations for individual patients. Determinants of pharmacodynamic variability. Clin Pharmacokinet 1998;34:323-33.
7. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200-5.
8. Terkeltaub RA, Furst DE, Bennett K, et al. High versus low dosing of oral colchicine for early acute gout flare: twenty-four- hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum 2010;62:1060-8.
9. Tseng CW, Brook RH, Keeler E, et al. Cost-lowering strategies used by Medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage. JAMA 2004;292:952-60.
10. Craig CR, Shideman FE. Metabolism and anticonvulsant properties of mephobarbital and phenobarbital in rats. J Pharmacol Exp Ther 1971;176:35-41.
11. Cohen JS. Dose discrepancies between the physicians' desk reference and the medical literature, and their possible role in the high incidence of dose-related adverse drug events. Arch Intern Med 2001;161:957-64.
12. Sheiner LB. The intellectual health of clinical drug evaluation. Clin Pharmacol Ther 1991;50:4-9.
13. Statistical review and evaluation: clinical studies - Chantix (varenicline tartrate). Rockville (MD): Center for Drug Evaluation and Research, Department of Health and Human Services, US Food and Drug Administration; 2005.
14. Frishman WH, Bryzinski BS, Coulson LR, et al. A multifactorial trial design to assess combination therapy in hypertension. Treatment with bisoprolol and hydrochlorothiazide. Arch Intern Med 1994;154:1461-8.
15. Thind GS, Mahapatra RK, Johnson A, et al. Low-dose captopril titration in patients with moderate-to-severe hypertension treated with diuretics. Circulation 1983;67:1340-6.
16. Goldstein I, Lue TF, Padma-Nathan H, et al.; Sildenafil Study Group. Oral sildenafil in the treatment of erectile dysfunction. N Engl JMed 1998;338:1397-404.
17. Ferrari MD, Goadsby PJ, Roon KI, et al. Triptans (serotonin, 5-HT1B/1D agonists) in migraine: detailed results and methods of a meta-analysis of 53 trials. Cephalalgia 2002;22:633-58.
18. Gram L. Fluoxetine. N Engl J Med 1994;331:13 54-61.
19. Bays HE, Moore PB, Drehobl MA, et al. Effectiveness and tol- erability of ezetimibe in patients with primary hypercholes- terolemia: pooled analysis of two phase II studies. Clin Ther 2001;23:1209-30.
20. Rimon E, Kagansky N, Kagansky M, et al. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J Med 2005;118:1142-7.
21. Hurt RD, Sachs DP, Glover ED, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997;337:1195-202.
22. Nicholls SJ, Brandrup-Wognsen G, Palmer M, et al. Meta-analy- sis of comparative efficacy of increasing dose of atorvastatin versus rosuvastatin versus simvastatin on lowering levels of athero- genic lipids (from VOYAGER). Am J Cardiol 2010;105:69-76.
23. Codispoti JR, Prior MJ, Fu M, et al. Efficacy of nonprescription doses of ibuprofen for treating migraine headache. A randomized controlled trial. Headache 2001;41:665-79.
24. Pappa KA, Buaron K, Payne JE, et al. An evaluation of increasing doses of ranitidine for treatment of heartburn. Aliment Pharmacol Ther 1999; 13:475-81.
25. Pappa KA, Gooch WM, Buaron K, et al. Low-dose ranitidine for the relief of heartburn. Aliment Pharmacol Ther 1999; 13: 459-65.
26. Kaptchuk TJ, Kelley JM, Conboy LA, et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ 2008;336:999-1003.
27. Heisler M, Bouknight RR, Hayward RA, et al. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med 2002 ;17:243-5 2.
28. Stafford RS, Radley DC. The potential of pill splitting to achieve cost savings. Am J Manag Care 2002;8:706-12.
29. Packer M, Poole-Wilson PA, Armstrong PW, et al. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. Circulation 1999; 100:2312-8.
30. Teng J, Song CK, Williams RL, et al. Lack of medication dose uniformity in commonly split tablets. J Am Pharm Assoc (Wash) 2002;42:195-9.