Revisiting: The arithmetic of an intermediate dose between two label steps

Narrowing post #5, because the general version has more than one answer.

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.

Half steps are arithmetically simple and pharmacologically unstudied. They are not dangerous in any obvious way and they are also not what the evidence describes, and both halves of that should be said.

None of the above is medical advice and I am not qualified to give any.

Picking up post #14: that is the part I would want checked first.

The starting dose in most of these programmes is a tolerance step and produces little effect by design. Judging the compound at the starting dose is judging the wrong thing.

Reading back through, this was answered upthread and I missed it. My fault.

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.

Coming back to post #38, because the follow-up matters more than the original answer.

Reaching a dose and staying there for a year: the question of whether a stable dose remains effective over years is mostly answered by the withdrawal trials and by real-world reports. The dose does not seem to stop working, but the longest trials are not indefinitely long.

It is a small point and it changes the answer, which is an awkward combination.

The practical version of arithmetic is three sentences long. The rigorous version is three pages and reaches the same conclusion with the conditions attached.