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One dosage doesn't fit all

Life would be simpler for a shirt manufacturer if everybody wore the same size. All shirts could be made exactly alike, with no adjustments for sleeve length or collar size.

But any clothing maker who tried to follow this approach would also find business much simpler: There wouldn't be much business, so there would be no question of how to invest profits or expand production. So, to prevent that, even the most relaxed styles generally come in a range of small, medium or large sizes, at the very least.

Why, then, do drug companies expect all patients to take the same dose of so many medicines? You'd hardly expect a scrawny 6-year-old to wear the same size jeans as his 6-foot father, but the manufacturer recommends 10 mg of the allergy medicine Claritin (loratadine) for both of them.

Jay Cohen, M.D., suggests in an electronic commentary on Medscape (http://www.medscape.com/medscape /pharmacology/journal/1999/ v01.n12/mp1 213.01/ pnt-mp1213.01.html) that the pharmaceutical industry is putting patients at risk of side effects by relying up on one-size-fits-all doses. In many cases, the company's own research shows that lower doses work well for many people, and that certain patients may be especially susceptible to adverse effects. Yet these data are not readily reflected in the information provided to doctors.

More than 2-million serious drug reactions occur each year, with as many as 100,000 people dying as a result of medicines prescribed for them in the hospital alone. If you include medication mistakes and problems outside the hospital, prescription drugs are the third- or fourth-leading cause of death in the United States. Dr. Cohen suspects that many tragedies could be prevented by using a lower dose.

Even though you know your shoe size and what size pants fit most comfortably, you might not know what dose of medicine will lower your blood pressure or cholesterol with the fewest side effects. And although your age, your size and even your gender or your racial background may provide some clues, your doctor can't necessarily tell the best dose for you at a glance.

How much medicine you might need is determined by invisible factors such as enzyme activity. Although pharmaceutical companies are now developing tests that indicate how a person will handle a medication, they are not yet available _ and might prove pricey when they are marketed. For the time being, doctors and patients have to work harder to avoid drug disasters.

If you experience side effects, let your doctor know. Be sure to mention if you are especially sensitive to medicines and usually need a lower dose. Your willingness to start at a low dose and adjust it gradually might encourage the physician to tackle the extra work to individualize your dose.

Low doses are not appropriate for emergencies or infections. But for many conditions that require medication day in and day out for years, it makes sense for each person to take the lowest dose effective for him or her. This approach means more work for both you and your doctor, but it just might save your life.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. They can be reached by e-mail at PHARMACYmindspring.com or in care of the Times, P.O. Box 1121, St. Petersburg, FL 33731.

Read the Graedons' column "The Herbal Pharmacy" Wednesdays in Floridian.

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