Minimal intolerable dose

There are three common protocols for barbiturate detoxification. In all approaches, the goal is to prevent the occurrence of major symptoms and to minimize the development of intolerable minor symptoms. The first procedure is based on protocols described by several authors (Ewing and BakeweU 1967 Isbell 1950 Wilder 1968) (see Table 3 ). The first step is to determine the severity of tolerance. If the patient is intoxicated, no additional barbiturate should be given until the symptoms of intoxication have resolved. If there is substantial evidence or strong suspicion of chronic barbiturate use, it is not necessary or desirable to wait until withdrawal symptoms appear. A 200-mg oral dose of pentobarbital may be given on an empty stomach to a... 

Erythromycin has efficacy similar to tetracycline, but it induces higher rates of bacterial resistance. Resistance may be reduced by combination therapy with benzoyl peroxide. Erythromycin can be used for patients who require systemic antibiotics but cannot tolerate tetracyclines, or those who acquire bacterial resistance to tetracyclines. The usual dose is 1 g/day with meals to minimize GI intolerance. 

Ritonavir induces its own metabolism, and gradual dose escalation over the first 2 weeks may minimize early intolerance. When ritonavir is used as the sole protease inhibitor, it should be initiated at 300 mg every 12 hours and escalated gradually to 600 mg every 12 hours by day 14 of therapy. Ritonavir causes dose-dependent elevations in serum total cholesterol and triglycerides, as well as other signs of lipodystrophy, and could increase the long-term risk of atherosclerosis in some patients. 

Iodinated contrast media used today have been carefully developed with the aim of maximizing their effectiveness for tissue visualization while at the same time minimizing toxic effects. With the relatively safe agents used today, of more concern than dose-related intolerance and toxicity outlined above are adverse reactions covering a range of severities that are mostly independent of dose or concentration. Severity is, in fact, a convenient and useful way of categorizing these reactions since this approach is clinically relevant and provides a guide for subsequent treatment. As with the so-called toxic reactions, the adverse reactions are small in numbo relative to the millions... 

Baclofen can be administered orally or intrathecally. Intrathecal administration is accomplished by means of an intrathecal catheter and a surgically implanted refiUable pump. Intrathecal administration is often preferred in patients with severe spasticity, as very little of the oral dose actually reaches the CSF. These patients may be unresponsive to oral baclofen and/or intolerant of its side effects at high doses. While intrathecal administration may minimize side effects, it poses the risk of potentially severe CNS depression. How supplied ... 

---