Why maximum tolerated dose?

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 outco...

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Bibliographic Details
Published inBritish journal of clinical pharmacology Vol. 85; no. 10; pp. 2213 - 2217
Main Authors Stampfer, Hans G., Gabb, Genevieve M., Dimmitt, Simon B.
Format Journal Article
LanguageEnglish
Published England John Wiley and Sons Inc 01.10.2019
Subjects
Animals
clinical pharmacology
Dose-Response Relationship, Drug
dosing outcomes
Drug-Related Side Effects and Adverse Reactions - prevention & control
effective dose 50
Humans
Maximum Tolerated Dose
Pharmaceutical Preparations - administration & dosage
Practice Guidelines as Topic
Practice Patterns, Physicians
Reviews‐themed Issue
Review‐themed Issue
clinical pharmacology
maximum tolerated dose
dosing outcomes
effective dose 50
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Summary: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.
ISSN:0306-5251
1365-2125
DOI:10.1111/bcp.14032