Same dose – different effect
Many of the medications we use today were originally tested primarily on men.
That is why standard dosages are often prescribed for everyone—even though women and men differ biologically.
And this can mean that womenreact differently to the same dose.
Many of the medications we use today were originally tested primarily on men.
That is why standard dosages are often prescribed for everyone—even though women and men differ biologically.
And this can mean that womenreact differently to the same dose.
Understanding Dosage
Heart medications are among the most important treatments in cardiology. They stabilize circulation, reduce the strain on the heart, and can prolong life. For many of these medications, there are clearly defined target doses that guide treatment—generally regardless of gender.
Yet it is precisely here that it is becoming increasingly clear: this standardization has its limits.
“For a long time, many medications were tested primarily on men. That’s why standard dosages are often applied to everyone—even though there are differences.”
Dr. Julia Lueg, cardiologist at the DHZC
“For a long time, many medications were tested primarily on men. That’s why standard dosages are often applied to everyone—even though there are differences.”
Dr. Julia Lueg, cardiologist at the DHZC
Biology Matters
Women and men differ in several factors that are crucial to how medications work. These include, among other things, body composition, hormonal influences, and the activity of enzymes that break down active ingredients.
These differences can lead to higher levels of the active ingredient in the blood even at the same dose. The result: The effect may be stronger—but at the same time, the risk of side effects also increases.
A recent review in the European Heart Journal – Cardiovascular Pharmacotherapy (2024) summarizes these relationships. The authors show that women report side effects more frequently with various heart medications and that lower doses may be sufficient for certain active ingredients. At the same time, the review emphasizes that the data is still incomplete because many studies were not specifically designed to examine gender-specific differences.
In addition, recent reviews, such as those in JAMA Network Open (2023), show that women remain underrepresented in cardiovascular studies—a key reason why questions regarding dosing often cannot be answered with sufficient nuance.
Research evidence is growing
The evidence is currently most robust for the treatment of heart failure with reduced ejection fraction.
Analyses of large patient cohorts, including data from the BIOSTAT-CHF registry (published in The Lancet), show a clear difference: Women achieved the lowest risk of death or hospitalization at approximately half the guideline-recommended dose of ACE inhibitors, angiotensin receptor blockers, and beta-blockers. Higher doses did not provide any additional benefit for them. In men, however, the optimal dosage level was significantly closer to the full target dose.
Recent analyses and reviews confirm this observation and place it in the context of gender-specific pharmacology, although no concrete gender-specific guideline recommendations have been derived from this to date.
Understanding pharmacology
The clinical observations are consistent with pharmacological data. Studies show that, at the same dose, the maximum drug levels of ACE inhibitors, ARBs, and beta-blockers can sometimes be higher in women than in men.
There are even more detailed studies on individual active ingredients. For the beta-blocker metoprolol, recent pharmacokinetic analyses and modeling show that women can achieve comparable drug exposure to men even at lower doses. The current review in European Heart Journal – Cardiovascular Pharmacotherapy(2024) describes in this context that for some substances, dose adjustment may be advisable to achieve comparable effects.
Note side effects
These differences are also evident in everyday clinical practice. In studies, women report side effects of cardiovascular medications more frequently, such as dizziness, drops in blood pressure, or changes in electrolyte balance.
Recent analyses also indicate that side effects are still too rarely evaluated systematically by gender. However, where relevant data is available, consistent differences are evident—suggesting that individual dose adjustment should play a greater role.
Tailored treatment
Despite these findings, the fact remains: There is no one-size-fits-all “dose for women”. The optimal treatment always depends on the individual situation—specifically, the condition, comorbidities, age, and tolerability.
Despite these findings, the fact remains: There is no one-size-fits-all “dose for women”. The optimal treatment always depends on the individual situation—specifically, the condition, comorbidities, age, and tolerability.
“That doesn’t mean women automatically receive too much—but it does mean we need to take a closer look,” says Julia Lueg. “The key is to tailor the treatment so that it works optimally for each individual patient.”
In Plain Language
For patients, one thing is particularly important: changes and side effects should be taken seriously and addressed openly. In many cases, the treatment can be adjusted—whether by changing the dose or switching to a different medication.
Cardiology is increasingly moving toward personalized treatment. This also involves better understanding gender-specific differences and consistently incorporating them into treatment.
