Something I Learned Today

I never really considered this before, but this is as fundamental as you get when deciding how to manage your patient's health. When someone has uncontrolled diabetes, seizures, hypertension (or what have you) on the current drug they are on... what do you do?

a. Increase the dose of the current medication?

or

b. Add a second drug?


Today we had a couple pharmaceutical reps talking up ezetimibe, a drug that inhibits cholesterol absorption by the brush border of the small intestines, and how it's an excellent drug to add on to the first-line statins for those with hypercholesterolemia. They were questioning my attending if he ever used it as an add on or if he just increased the statin dose, to which he answered "add on".

There isn't a real correct answer to this question since doctors do both of of these things depending on the individual case, but my attending says he personally prefers to add a second drug if he's able to convince the patient. The problem with increasing doses is you increase the risk for side effects and many patients can't tolerate high doses because of this. So giving two low dose drugs not only synergistically combats whatever pathology you're dealing with, but you're also reducing the potential side effects that would be seen with upping a dose.

That being said, it is a hard sale convincing patients to take two pills when they can just take one, but with the proper communication and education, you can win them over because at the end of the day people want to live as unaltered a lifestyle as they've led up to that point. Nobody likes having to take a pill everyday (sometimes for the rest of their life) and it can be disconcerting to have to take something that causes daily discomfort. The patient is our number one priority and as physicians we want to make him/her as comfortable as possible and maintain a high quality of life. That includes limiting side effects.