Microdosing is the use of drugs at much lower doses than their standard manufactured strengths. Many pharmacologists have explored microdosing since the 1950s as a method to minimize drug side effects while still achieving drug effectiveness.
Microdosing Applications
More recently, the practice of microdosing has gotten a lot of attention in relation to use of psychedelics like psilocybin mushrooms and LSD in microdoses for creativity, energy, and mood benefits without having to go through intense psychedelic “trips” to get these benefits (Lea et al 2020). However, the potential applications for microdosing as a pharmacological technique are far greater than just for psychedelics. And that’s not to say that microdosing psychedelics is anything to overlook- early research has shown some significant benefits with minimal safety issues (Polito and Liknaitzky 2022). Yet, microdosing can be applied to so much more!
Beyond these trendy psychedelic applications, microdosing has huge potential in all drug development for personalized medicine, as well as in the realm of compounding pharmacy.
Let’s say Patient A responds well to the standard 100mg commercial dose of Drug X, but Patient B responds poorly to this 100mg dose of Drug X. Upon re-trial, Patient B then responds well to a mere 25mg of Drug X. Conventional medicine and pharmacy would say that Patient B is mistaken and the “evidence-based” dose that he or she should receive is still 100mg, not 25mg. In theory, 25mg does nothing and we are simply observing the placebo effect. And yet, here we are as clinicians, witnessing the drug work well at 25mg, with no side effects, and denying our own observations! As healthcare providers, we will ignore our own eyeballs and what we witness clinically, and put all patients on the same standard doses, even when they are getting lots of side effects with no benefits at that dose!
Personalized Medicine
Manufactured drugs have set dosage units and “once-size-fits-all” doses designed around “average” test subjects in big clinical trials, but human beings are not “average” test subjects. Furthermore, clinical trials have historically collected much more data in healthy male volunteers due to ethical considerations (the ethics of studying experimental drugs in women and children is considered more controversial and more complex ethically). As a result, many standard established drug doses are based on average adult male body weight, not other patient demographics that may be affected. There can be huge variations in how different human individuals metabolize and respond to pharmaceuticals, nutrients, and hormones.
Each individual human is a unique biochemical factory that has differing needs from other individual humans based on genetics, medical conditions, allergies, sensitivities, as well as other drugs and supplements they are taking.
This is the consideration and philosophy behind the future of healthcare, known as personalized medicine.
As a pharmacist, I see massive ranges of effective dosing every day. There are several classes of medications commonly dispensed in community pharmacies that can have very large dose ranges and can be effective at microdoses instead of standard manufactured doses. Some classic examples of drug classes whose minimum effective dose can vary up to 10x from smallest to largest dose include antidepressants, antihypertensives, thyroid medications, opioids, benzodiazepines, statins, and bio-identical hormones (estrogens, progesterone, testosterone, and DHEA), amongst others.
One patient with hypothyroidism may get good effects using levothyroxine 12.5mcg for their thyroid, and another may need 150mcg therapeutically. Pharmacists see this all the time and yet we don’t question the possibility that dose ranges may need to be rethought. What if we are consistently overdosing patients on pharmaceuticals because only a very few “standard” doses have been studied? Can we find the smallest possible dose that provides the desired effect without side effects? Why is this not our logical goal as pharmacists?
The Role of Compounding Pharmacists
This is why I have spent much of my life becoming a compounding pharmacist – compounding medications allow us to customize drug dosing to each individual patient’s needs. This results in far better therapeutic results for our patients overall. Compounding medications and finding a patient’s “minimum effective dose” where we get the drug’s benefit with minimal or no side effects, is the main objective for a good compounding pharmacist. We want the good without the bad for all our patients!
If you or a loved one is experiencing significant side effects from your medications, or you are wondering if your medications could be dosed better, come into NutriChem today to speak with one of our compounding pharmacists. We love to help patients optimize their medications, find safe alternatives to common drugs, and achieve their best health outcomes!
References
Lea T, Amada N, Jungaberle H, Schecke H, Klein M. Microdosing psychedelics: Motivations, subjective effects, and harm reduction. Int J Drug Policy. 2020 Jan;75:102600. doi: 10.1016/j.drugpo.2019.11.008. Epub 2019 Nov 25. PMID: 31778967.
Polito V, Liknaitzky P. The emerging science of microdosing: A systematic review of research on low dose psychedelics (1955-2021) and recommendations for the field. Neurosci Biobehav Rev. 2022 Aug;139:104706. doi: 10.1016/j.neubiorev.2022.104706. Epub 2022 May 21. PMID: 35609684.
