#TellingDoseVsOptimizingDose
Morning dose - Till 12 noon
Afternoon - 12 noon to 6pm
Night dose - Before 12 AM
1. That is the unfortunate reality. In India, “dose” is often reduced to instructions like one tablet twice daily, before food or after food. It is treated as a schedule, not as a scientifically individualized quantity.
2. The deeper meaning of dose—how much exactly this patient needs, based on their physiology, disease state, organ function, and concurrent therapy—is rarely examined.
3. True dose optimization goes far beyond timing. It asks critical questions:
👉 Is the patient’s kidney clearing the drug normally?
👉 Is the liver metabolizing it efficiently?
👉 Is the body weight appropriate for the standard dose?
👉 Is the drug reaching therapeutic concentration?
👉 Is the patient elderly, pediatric, critically ill, or on interacting medicines?
4 Without answering these, giving “one tablet twice daily” becomes a ritual, not rational therapy.
5. Optimization is the science of precision.
6. Optimization prevents toxicity when the dose is too high and prevents treatment failure when the dose is too low.
7. Optimization converts prescribing from habit to accountability.
8. In India, timing is emphasized because it is easy to instruct and easy to follow.
9. Optimization is neglected because it requires measurement, documentation, expertise, and ownership.
10 Until healthcare formally assigns responsibility for dose optimization—supported by clinical pharmacology services and PharmD professionals—dose will continue to mean frequency, not precision.
11 And that is the difference between giving a medicine and managing drug therapy scientifically.
POV: Bhagwan PS
