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Editor's Correspondence
November 26, 2001

Start Low, Go Slow, Is Not Always Best—Reply

Arch Intern Med. 2001;161(21):2623. doi:

In reply

As Dr Reinharth suggests, no one approach works for all patients. However, in my practice, I found that compliance actually increased by using a "start low, go slow" approach if patients were informed. When the standard and low-dose approaches were explained to patients, the majority chose the latter. Many patients worry about medication side effects, and a low-dose, individually titrated approach seemed to allay many of their fears. Extra visits were minimized by written instructions and brief telephone consultations for making simple dosage adjustments. Overall, adherence was improved, and fewer visits were required for dealing with adverse effects. Some patients responded to the low initial doses and never required higher doses. In other cases, the standard approach was chosen and generally worked well. The key is patient selection.

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