What's my dose?

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The dose of a medication or supplement can be as important as or more important than the actual ingredients. However, in both conventional and integrative healthcare, dosing far too often is an afterthought. There are many factors that play a role in deciding on what dose to recommend to a patient. Some of these factors are evidence-based and most doctors stay close to the evidence. But, many factors are actually based on judgement and experience because of a lack of evidence-based information. In this week’s article we will discuss some of the factors that help guide doctors to answer the question, “What’s my dose”?

The majority of the most common medications and supplements have published guidelines for recommended dosage range. The average person likely thinks these ranges are specific for certain demographics and purposes of usage. However, most medications don’t have guidelines based on sex, age, ethnicity, metabolic rate, or any other individual factor. This lack of detailed information leaves the decision of dosage in the hands of the doctors making the recommendation.

The new buzz term for dosage recommendations in healthcare is “lowest effective dose”. I am a big fan of this term. This term acknowledges that people have individual characteristics that can affect the way they process and utilize medications and supplements. It also acknowledges the risks of using a dose higher than is really needed. It’s easy to overlook these risks but they are real and meaningful. These risks include increased side effects, dependency, the need for other medications, and the potential for the medication to eventually stop working as intended.

I see at least a few patients each week (if not each day) who are taking dosages that prove to be too high or even unnecessary. There is sometimes a question of whether they ever needed to medication to begin with. However, often it’s more of a problem of continuing longer than needed at a dose that was initially appropriate but has lost its effectiveness. I spend a lot of time every day in practice helping patients figure out what meds or supplements are actually needed and what their lowest effective dose is.

Last year 60 Minutes did a very interesting segment on dosage discrepancies with the most commonly prescribed sleep medication in the United States. The research they highlighted has shown a 40% difference between men and women in how they metabolize this class of sleep medication. This means that a female who is taking the same milligrams of the medication could actually be receiving 40% more than the doctor intended.

In next week’s column, we will continue our discussion on the factors that come into play when trying to find the right dose for medication and supplements.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.