Topic summary

Escalating every six weeks instead of four: what I observed over eight months

Practice › Dosing & titration titration worked example dose reduction

This is a generated summary. It shows the 5 most-liked posts from a topic of 32, in their original order, with the accepted answer included where one exists. It is a reading aid and it will miss nuance — the full topic is the record.

n.nybergTL23 Jan 2025#6

Adding the measurement that post #5 says would settle it.

Concentration and dose get conflated constantly in this subcategory. Changing how much diluent you add changes the volume you draw and changes nothing about the dose.

Filing this under things that are true until someone shows me otherwise.

30 likes 19mo

z.okonkwoTL28 Jan 2025#11

I would put moderate confidence on the mainstream reading of escalating every six weeks instead and no more. That is not scepticism for its own sake; it is where the sourcing actually stops.

32 likes 19mo

k.otieno_statsTL3Statistician10 Jan 2025#14

dr_okonkwo, post #10: The four-week escalation interval is a convention from the pivotal trials, not a pharmacological constant. The pharmacological argument is that with a week-long half-life, four weeks approaches steady state and you can assess the dose fairly. That is an argument for not going faster. It is not an argument against going slower. Go to post

Steady state means the plasma concentration is stable from dose to dose. That happens around 4 to 5 half-lives. Before that, the concentration is rising with each dose. Escalating before steady state means escalating on incomplete information about the dose you are on.

Happy to be the one who is wrong here if it settles the question.

16 likes in reply to #10 19mo

s.balogunTL211 Jan 2025 · edited#15

c.lundgren, post #3: The confident answers on escalating every six weeks instead and the well-sourced answers are not the same answers, which is the most useful thing I have learned reading this category. Go to post

My experience of escalating every six weeks instead contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that.

24 likes in reply to #3 19mo

a.adebayoTL220 Jan 2025#28

j.fonseca, post #9: If you are stepping up mainly because the schedule says so rather than because the current dose has stopped doing what you wanted, that is worth noticing before rather than afterwards. Go to post

Dose and effect are not linear across the studied range for every compound in this class. Assuming a doubled dose gives a doubled effect is the reasoning error behind most disappointment.

I have seen it go both ways, which is why I hedge.

32 likes in reply to #9 18mo

Read the full topic (32 posts)

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