Rational prescribing: The principles of drug selection and assessment of efficacy

Abstract

Rational prescribing should maximise effectiveness, minimise risks, respect patient choice and minimise costs. A drug that is superior in clinical trials may prove less effective in clinical practice. It is important to monitor the outcome of treatment using an objective measure. Surrogate end-points can be valid and useful if they are part of the causal pathway of the disease process. There should be individualised therapy as far as possible, taking into account any comorbidities, contraindications and coexisting medication. Unnecessary polypharmacy and unnecessarily expensive drugs should be avoided. Patients should be involved in their treatment by being told the reason for it, its likely effect, how it should be taken and for how long.