Reaching a dose and staying there for a year: a longitudinal note — does this still hold?
Post #6 is right about the mechanism and I think understates the practical bit.
A missed dose in a weekly schedule is not a trough to chase. With a week-long half-life you are perturbing a slowly moving average, and the labelling for licensed products in this class says take it if the next dose is far enough away and skip it otherwise.
Titrating on tolerability rather than on the calendar: some people escalate when they tolerate a dose well, others escalate on the prescribed schedule regardless. The published trials used a calendar-based schedule. Tolerability-based escalation has no formal evidence base but is not uncommon in practice.
On balance I think that is right, and I would not bet much on it.
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.
A guess, clearly labelled as one.
Taking post #24 at face value and following it one step further.
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.
Stating my assumptions rather than smuggling them in.
I had written a reply contradicting post #29 and deleted it. Here is what survived.
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.
The strength of my opinion here exceeds the strength of my evidence.
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This topic was referenced in
- Escalating every six weeks instead of four: what I observed over eight months — one year onPractice › Dosing & titration · 59 replies
- How the published trials escalated, tabulated side by side — does this still hold?Practice › Dosing & titration · 2 replies
- Restarting after a long gap: what the labelling implies — the long versionPractice › Dosing & titration · 17 replies
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