dosereduction

Dosereduction refers to the intentional lowering of the amount of a drug given to a patient. It is used to tailor therapy to individual factors, minimize adverse effects, improve tolerability, and manage potential drug interactions while aiming to preserve therapeutic benefit. Dose reduction can be temporary or permanent and may occur during initial titration or as an ongoing adjustment after a period of stable dosing. It is distinct from tapering, which is the gradual reduction required to discontinue a medication after long-term use.

Triggers for dose reduction include reduced organ function (notably renal or hepatic impairment), advanced age, low body weight, pregnancy or breastfeeding, significant drug interactions, intolerance, or changes in comorbid conditions. Clinicians also adjust doses in response to toxicity, poor tolerability, or changes in concomitant therapies.

Implementation typically follows a start-low, go-slow approach, with stepwise decreases (for example, 25% reductions) and close monitoring of efficacy and safety. Therapeutic drug monitoring or pharmacokinetic/pharmacodynamic considerations may guide adjustments, particularly for drugs with narrow therapeutic indices. Documentation of the rationale, target ranges, and monitoring plan is essential.

Considerations and risks include potential underdosing and treatment failure, withdrawal or rebound symptoms for certain medications, and the need for careful monitoring to balance efficacy against adverse effects. Patient adherence and the practicality of the dosing regimen also influence success.

Applications span across medical domains, including antidepressants and other psychotropics, cardiovascular agents, chemotherapy, anticoagulants, and immunosuppressants, where organ function or tolerability necessitates dose changes. Dosereduction is a common, evidence-informed part of individualized pharmacotherapy aimed at optimizing outcomes.