THE TENTH COMMANDMENT

 Thou shalt seek to use as few drugs as possible

Before printing off a prescription, consider whether a non-drug intervention might be as, or more, effective. Do not use drugs as a shortcut because alternatives might take more time to explain or be harder to access.
As a general rule when prescribing long- term drugs, it is best to use a single agent and use the lowest dose to start with. This usually provides the best balance between benefit and adverse effects. For example, in heart failure, the lowest doses of an angiotensin-converting enzyme inhibitor have nearly the same mortality benefit as the highest doses, with a much lower risk of hypotension, hypokalaemia, or syncope. If you do decide to uptitrate, discuss the marginal benefit in full with your patient.
It is sometimes useful to use a combination of low-dose agents, for example, to reduce blood pressure. But be aware of potential harms and adverse interactions. Before you increase a dose or add another agent, make sure that you have given your initial treatment an adequate trial and that your patient is really taking it.

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Key Papers

McCormack JP, Allan GM, Virani AS.
The argument for very low starting doses. CMAJ 2011