The Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists
Recommendations from the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists on polypharmacy and harm reduction in prescribing policy. ASCEPT is the professional and independent Society in Australia and New Zealand with expertise in the use and toxicity of medicines and chemicals. Established in 1966, ASCEPT is affiliated with the International Union of Basic and Clinical Pharmacology (IUPHAR) and the International Union of Toxicology (IUTOX).
3.
Avoid using a higher or lower dose than is necessary for the patient to optimise the ‘benefit-to-risk’ ratio and achieve the patient’s therapeutic goals.
Therapeutic dosage should be adjusted to optimise the benefit-to-risk ratio of the treatment. Dosage should be no higher or lower than needed to achieve the patient’s therapeutic goals. As patients become more frail, potential harms usually increase and potential benefits usually decrease for a given dosage of pharmacological treatment. For example, carefully assessing the risk and benefits when initiating non-steroidal inflammatory drugs in elderly patients is important, because of the increased risk of stroke associated with NSAID therapy; and use of proton pump inhibitors in the elderly should be stepped down after an initial course of therapy. Related to this, high drug doses are not necessarily more effective than low doses. An example of this is the relationship between doses of a selective serotonin re-uptake inhibitor for patients with major depressive disorder and useful clinical improvements.
Supporting evidence
- Caughey GE, Roughead EE, Pratt N, et al. Stroke risk and NSAIDs: an Australian population-based study. Med J Aust 2011;195(9):525-9.
- Dimmitt SB, Stampfer HG. Low drug doses may improve outcomes in chronic disease. Med J Aust 2009;191(9):511-3.
- Raghunath AS, O'Morain C, McLoughlin RC. Review article: the long-term use of proton-pump inhibitors. Aliment Pharmacol Ther 2005;22:55–63.
How this list was made
A working party of members of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) was established to propose an initial list of recommendations. ASCEPT’s membership was then invited to participate in an online survey to comment on the appropriateness of the proposed recommendations and suggest additional items for consideration.
Based on the survey responses, six recommendations were shortlisted. Following an evidence review the top 5 list items were selected. The final list was signed off by the ASCEPT President in April 2016.
Related recommendations
- 1 Recognise and stop the prescribing cascade.
- 2 Reduce the use of medicines when there is a safer or more effective non-pharmacological management strategy.
- 3 Avoid using a higher or lower dose than is necessary for the patient to optimise the ‘benefit-to-risk’ ratio and achieve the patient’s therapeutic goals.
- 4 Stop medicines when no further benefit will be achieved or the potential harms outweigh the potential benefits for the individual patient.
- 5 Reduce use of multiple concurrent therapeutics (hyper-polypharmacy).