Our function is unbiased review and dissemination of therapeutic evidence. We are committed to evaluate the effectiveness of our educational activities using the Pharmacare database without identifying individual physicians, pharmacies or patients. There are numerous examples of recommended introductory doses which are larger than those eventually needed. We know now that 6.25 mg BID is a good starting dose and doses greater than 25 mg TID are seldom needed. In recognition of the need for lower doses it has just been approved in the USA as a 25 and a 50 mg tablet.
Several factors appear to influence initial drug dosage recommendations.
The way to show that a drug has a significant effect in the smallest number of study patients is to use doses of the drug that will work in most study patients. Study patients are highly selected and often include only middle-aged, Caucasian males, who are receiving no other drugs and have no concomitant disease. Once approved, the company must base dosing recommendations on the available study data. Unfortunately, these study patients may have little in common with your patients, particularly the elderly who are more likely to have altered drug handling and responses. It is clear that different patients have similar therapeutic responses to very different drug doses.