The Milligram Myth
Q. When is a 10mg tablet considered to be a high dosage and 40mg a low dosage?
Conversely, when can a 500mg tablet be perceived as “weak” whereas a 20mg tablet is “strong”?
A. It never ceases to amaze me how most patients’ perception of tablet strength is based purely on numbers or milligrams. This is simply pharmaceutical code for the number of molecules packed into a medication in order to make it clinically effective.
Patient comprehension of these numbers is very often inversely correct. For instance, when one compares a 1mg blood pressure tablet with a different 10mg blood pressure tablet, the patient’s understanding is that the higher dose 10mg tablet ‘must’ be stronger, therefore, carrying a greater possibility of side effects.
The opposite, may in fact be closer to the truth. The 1mg tablet is a stronger molecule in reducing blood pressure whereas the 10mg tablet, due to its weaker status, requires more to be packed into the tablet in order for it to do its job. As a result, the “lower” 1mg tablet may be the one to watch out for in regards to side effects.
Doctors will always do their best to prescribe the appropriate medication for their patient at the appropriate dose, weighing up the benefits versus the adverse side effects. Certainly, patients who have been on a particular medication for a length of time may be able to comment on the various effects of different dosages. What always fascinates me is the comment that is so often made when prescribing a new medication - “But isn’t that a high dose?”
The dose is usually the lowest dose of that particular medication but the milligrams may not be perceived as low based on a comparison with a different medication.
This may all sound rather amusing; however, there may be clinical implications to this myth. When patients perceive their medication dosage to be of a “high” strength, the power of suggestion may actually lead to side effects, which may not had occurred, had their perception of dosage been accurate.
It is imperative for doctors to ensure their patients are clearly made aware that they are not in a position to compare one medication to another or to determine their “own” strengths based on what they believe.
When dealing with our health and bodies and what we put into it, there is absolutely no excuse for risk taking. Always follow your doctor’s instructions and if in doubt, just ask. That’s what we’re here for.
