Why maximum tolerated dose?

Hans G. Stampfer, Genevieve M. Gabb, Simon B. Dimmitt

Research output: Contribution to journalReview articlepeer-review

13 Citations (Scopus)


A long-established approach to the pharmacological treatment of disease has been to start low and go slow. However, clinicians often prescribe up to maximum tolerated dose (MTD), especially when treating acute and more severe disease, without evidence to show that MTD is more likely to improve outcomes. Cardiovascular guidelines for some indications advocate MTD even in prevention, for example hypercholesterolaemia, without compelling evidence of better outcomes. This review explores the origins and potential problems of prescribing medications at MTD. Oral effective dose 50 (ED50) may be a useful guide for balancing efficacy and safety.

Original languageEnglish
Pages (from-to)2213-2217
Number of pages5
JournalBritish Journal of Clinical Pharmacology
Issue number10
Early online dateJul 2019
Publication statusPublished - 1 Oct 2019


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