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英国临床药理学家 Herxheimer 指出,许多市售药品的推荐剂量比实际需要偏大,致使部分病人产生原可避免的不良反应。为了使新药能尽快地打入市场,它应在大部分病人中生效迅速,使用简便。为此,首次处方的剂量通常选定在大约 ED_(90)的水平。但在25％的病人中,较小的剂量(ED_(25))即有效,这意味着1/4的病人对这个药最敏感,如果按 ED(90)的剂量给予,远大于他们所需要的剂量。一个较好的方法是通过制作包括 ED_(20)、ED_(25)或ED_(30)及较大剂量的片剂,以适合最敏感的和相对有耐受的病人。然而,这对大多数病人意味着剂量必须经过调试。当对片剂的含量取整到最接近的合适的数值时,诸如10mg、50mg、100mg 等,即超过实际需要剂量的“偏爱数值”,作者认为,对大多数药来说,这个“偏爱数值”的副作用只影响到少数病人,但却可能发生在全部药品的一半以上,故涉及到的病人总数是庞大的。他列举了一些因片剂的作用较强而可能引起超过所需剂量的例子,包括氨酰心胺、卡托普利、依那普利、地高辛、氟氯可的松以及用于绝经症状的雌激素/孕激素。
Herxheimer, a British clinical pharmacologist, points out that the recommended doses for many marketed drugs are larger than they actually need, resulting in some avoidable adverse reactions in some patients. In order for new drugs to enter the market as soon as possible, it should become effective and effective in most patients and be easy to use. For this reason, the first-prescribed dose is usually selected at a level of approximately ED 90. However, in 25% of patients, the smaller dose (ED_ (25)) is valid, which means that one in four patients is the most sensitive to this drug and is much larger than what they need if administered at ED (90) Of the dose. A better method is to make tablets that include ED20, ED25 or ED30 and larger doses to suit the most sensitive and relatively tolerant patients. However, for most patients this means that the dose must be adjusted. When the tablet content is rounded to the nearest suitable value, such as 10 mg, 50 mg, 100 mg, etc., ie, “preference value” exceeding the actual required dose, the authors believe that for most drugs this “preference value ”The side effects only affect a small number of patients, but may occur in more than half of all drugs, so the total number of patients involved is huge. He cited some examples of the effects of tablets that may cause more than the required dose, including aramid, captopril, enalapril, digoxin, flucloxaclor, and menopause Symptoms of estrogen / progestin.