Format

Send to

Choose Destination
Br J Clin Pharmacol. 2019 Jun 20. doi: 10.1111/bcp.14032. [Epub ahead of print]

Why maximum tolerated dose?

Author information

1
Division of Psychiatry, Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia.
2
Department of General Medicine, Royal Adelaide Hospital, Adelaide, South Australia.
3
Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia.
4
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.

Abstract

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.

KEYWORDS:

clinical pharmacology; dosing outcomes; effective dose 50; maximum tolerated dose

PMID:
31219196
DOI:
10.1111/bcp.14032

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center