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Start Low, Go Slow, Is Not Always Best
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| Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. |
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In the article by Cohen1 about adverse
drug effects and compliance, the author appears to advocate a "start low,
go slow" approach. While this approach has merit, and may minimize adverse
effects, it has an important psychological flaw, which may diminish compliance.
It is hard enough for patients to begin long-term treatment for a chronic
disease. If they start a medication regimen, then undergo dose titrations
or medication changes, they may perceive such adjustments as failures, become
frustrated, and discontinue use. I agree with the author when he advocates
flexible, individualized prescribing.
Daniel Reinharth, MD
New Hyde Park, NY
1. Cohen JS. Adverse drug effects, compliance, and initial doses of antihypertensive
drugs recommended by the Joint National Committee vs the Physicians' Desk Reference. Arch Intern Med. 2001;161:880-885.
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In reply
As Dr Reinharth suggests, no one approach works for all patients. However,
in my practice, I found that compliance actually increased by using a "start
low, go slow" approach if patients were informed. When the standard and low-dose
approaches were explained to patients, the majority chose the latter. Many
. . . [Full Text of this Article]
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Adverse Drug Effects, Compliance, and Initial Doses of Antihypertensive Drugs Recommended by the Joint National Committee vs the Physicians' Desk Reference
Jay S. Cohen
Arch Intern Med. 2001;161(6):880-885.
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