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Rx for Action

A blog devoted to helping people find local medicine take-back programs and highlighting current research findings and pending legislation.

Doctors urged to prescribe lower medication dosages to reduce patient side effects and protect the environment

A new paper in the journal Science of the Total Environment argues that carefully lowering dosages of many medications has the potential to not only lead to more effective treatment, but also reduce environmental impacts of pharmaceuticals.

Christian G. Daughton and Ilene Sue Ruhoy, in "Lower-dose prescribing: minimizing "side effects" of pharmaceuticals on society and the environment" put forth the idea that the most important variable in achieving a successful outcome of prescription use is through dose. The rise of large, controlled clinical trials and one-size-fits all recommended dosages has led to over-treatment for some patients and more side effects, which, in turn, can result in patients discontinuing their medicine use and accumulating those unused medications in their homes. These unwanted medicines might be flushed down the drain, tossed in the trash, or stored insecurely in the home (where they can lead to accidental poisonings or be misused by other family members).

Improved information sharing might be one tool to help doctors feel more secure about prescribing lower dosages, which in turn may decrease some adverse side effects patients experience from over-treatment and also allow patients to feel that they are more actively participating in their healthcare choices. The authors also note that lower doses for the same medicines are generally prescribed in the European Union and Japan, and that when dosing suggestions are revisited after the release and use of a new drug, they are almost always revised downward.

In addition to fewer side effects, lower dosages may also result in less environmental contamination from pharmaceuticals. One of the primary ways pharmaceuticals enter the environment is through human wastewater containing ingested or topical medicines. Daughton and Ruhoy suggest that if less medicine is used, fewer pharmaceutical compounds will be excreted or washed off, consequently leading to lower levels of drugs in the environment. The authors summarize this approach as sustainable prescribing, an idea that views the patient as not only the person taking the medicine, but also includes the environment and bystanders, such as people who could be hurt by accidental poisoning or prescription drug diversion and abuse.

The full article is available at:

Daughton, C.G., I. S. Ruhoy. Lower-dose prescribing: Minimizing "side effects" of pharmaceuticals on society and the environment. Science of the Total Environment 2013;443:324-337.

Written by: Corrie Layfield

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Posted by Laura Kammin at 2:28PM on 1/16/2013
Categories: Latest Research Resources