Indeed, there was no increase in hepatic toxicity in alcoholic patients who were given the maximum therapeutic dose of paracetamol (4 g/day) [29].
Of those on PPI therapy for a one-year continuous period, the majority 34,589 (95%) continued on maximum therapeutic dose.
As a result, the maximum therapeutic dose which can be given and, therefore, the maximum anti-cancer effect these agents can exert is restricted.
The analysis of the HSE-PCRS pharmacy claims database indicated that the majority of patients on long term PPI therapy were continuously prescribed maximum therapeutic dose; costs were potentially reduced by one quarter with use of step down therapy.
In a murine L1210 tumour model, for example, no long-term survivors were seen in animal groups treated with free drug, whereas at the maximum therapeutic dose of liposomal mitoxantrone survival rates of 40% were observed.
The most common PIP issues were use of PPIs at maximum therapeutic dose for > 8 weeks (3.7%, 38,153 patients), NSAIDs for > 3 months (3.2% 32,373 patients), and use of long-term neuroleptics (2.1%, 21,012 patients.
