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Why maximum tolerated dose?
Author(s) -
Stampfer Hans G.,
Gabb Genevieve M.,
Dimmitt Simon B.
Publication year - 2019
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.14032
Subject(s) - medicine , maximum tolerated dose , intensive care medicine , disease , effective dose (radiation) , pharmacology , adverse effect , radiology
A long‐established approach to the pharmacological treatment of disease has been to start low and go slow . However, clinicians often prescribe up to maximum tolerated dose (MTD), especially when treating acute and more severe disease, without evidence to show that MTD is more likely to improve outcomes. Cardiovascular guidelines for some indications advocate MTD even in prevention, for example hypercholesterolaemia, without compelling evidence of better outcomes. This review explores the origins and potential problems of prescribing medications at MTD. Oral effective dose 50 (ED50) may be a useful guide for balancing efficacy and safety.