Shirah Vollmer MD

The Musings of Dr. Vollmer

Why Would One Size Fit All?

Posted by Dr. Vollmer on February 27, 2013

Ambien sleeping pills

 

http://www.latimes.com/news/opinion/commentary/la-oe-miller-drug-dosages-20130227,0,6503040.story

 

Dr. Miller talks about how, late in the game, dosages for Ambien are being modified for women. This seems so obvious. Anyone around alcohol knows that the average woman tolerates a lot less than the average man, of the same age. No one would go to a store and ask for a “shirt” without specifying the size. The individuality of drug response follows the individuality of our DNA. Personalized medicine is coming. Once we can take a closer look at the genome, then prescribing medication will be more specific, and hence more effective. In today’s world,  prescribing medication is like  shooting in the dark, hoping that for most people we are in the “range,” but we also know that we could be far afield. Like with smart phones, one day, we, physicians will say, can you believe that in the old days, we prescribed without knowing about the patient’s liver metabolism? I look forward to laughing at our current state of psychopharmacology.

7 Responses to “Why Would One Size Fit All?”

  1. Jon said

    One size will not fit all for more than one reason. You state, “The individuality of drug response follows the individuality of our DNA.” Yes, but it also follows how our bodies dealt with our DNA – most importantly, our weight. Is not the volume of medication effected by the volume (and implied weight) of the body? This seems to be true for alcohol. It would be surprising if it were true for a sedative. How well we metabolize a substance most probably depends on both genetic and non-genetic factors.

  2. Ashana M said

    It is interesting that pediatric dosages are calculated by weight, but not those of adults. Anyone know why?

    • Kids dosages are calculated by weight because there is more variation in weight. Once someone is over a hundred pounds, the thinking has been that weight is a more minor factor. Yet, as we become more sophisticated, we realize that most of the factors of drug metabolism have to do with liver enzymes, so the more we understand those, the more we can get a handle on why there is so much variability in drug response. Thanks.

  3. Shelly said

    I don’t see why Ambien needs to come in a women’s dosage, since I believe it comes in several dosage forms. The pharmaceutical industry also goes through clinical trials, and male and females are involved in them. They passed through several phases of safety and efficacy studies and were approved. Why all of a sudden the need to modify the doses for women? Wouldn’t this hold true for all medication, not just Ambien?

    • The thinking is to encourage physicians to be more aware of their audience, such that they are more thoughtful in prescribing. Yes, all medications are going to impact men and women differently, but whether that difference is clinically significant or not, depends on what the drug is trying to do. Altering a mental state is the goal of Ambien, and for this the dosage difference is critical, because if someone is over-medicated the consequences could hurt the person and someone around them. Thanks.

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