This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
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.
Adding a source would improve this post and I do not have one to hand.
Building on post #60 rather than restating 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.
Not disagreeing with anyone above, just adding the bit I keep having to look up.
Escalating before steady state means you are judging a dose you have not yet fully experienced. That is the whole argument against compressing the schedule and it is a good one.
Seconded. It reads as careful rather than confident, which is the right register.
Post #65 is the version of this I will quote in future. One addition.
There is no published evidence about slower escalation because nobody studied it. That means the trials support not going faster and are silent on going slower, which is a different claim from "slower is fine".
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.
It is worth stating the boring hypothesis before the interesting one.
Titrating on symptoms rather than on the calendar is what most people here actually do. It is defensible, it is not what was studied, and describing it as the protocol would be wrong.
Somebody will have a better source than mine, and I hope they post 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.
It reads as pedantry until the day it does not.
Adding the measurement that post #70 says would settle it.
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.
Post #68 describes the usual case. This is about the unusual one.
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.
This is the sort of thing that ought to be settled and apparently is not.
When a dose reduction is the correct response to a side effect: if a side effect is dose-dependent (nausea, constipation, injection discomfort), reducing the dose is a reasonable response. If the side effect is not dose-dependent (e.g., hypoglycemia with insulin), dose reduction does not address the issue.
I would hold that lightly until someone with a larger sample weighs in.
The arithmetic in post #73 is right; the assumption feeding it is the part to check.
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.
I would want to see it done twice before believing it once.
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.
A partial answer, offered because a partial answer beats none.
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.
Post #76 put the caveat in the right place and I want to underline it.
The most common practical error is not the schedule at all — it is losing track of which step you are on after a break, and then resuming at the top rather than re-approaching it.
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.
Adding it in case it saves somebody the afternoon it cost me.
I came in to disagree and I am leaving without a disagreement.
I read post #81 twice before replying, because I had assumed the opposite.
Writing down the date, the dose and the site each week takes fifteen seconds and is the single most useful record anyone here keeps. Memory reconstructs a titration history that never happened.
The interesting part of this is the exception, and I do not understand the exception.
Post #81 answers the question as asked. The question underneath it is different.
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.
The most common practical error is not the schedule at all — it is losing track of which step you are on after a break, and then resuming at the top rather than re-approaching it.
Small point, but it is the one that usually catches people.
This follows post #85 rather than contradicting 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.
It is one reading of the data and not the only reasonable one.
Coming back to post #85, because the follow-up matters more than the original answer.
Stepping down deliberately: the withdrawal trials show that stopping is followed by regain. The step-down literature is thinner. The conservative assumption is that stepping down is followed by some regain, with the magnitude unknown.
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.
Picking up post #88: that is the part I would want checked first.
Stepping down deliberately: the withdrawal trials show that stopping is followed by regain. The step-down literature is thinner. The conservative assumption is that stepping down is followed by some regain, with the magnitude unknown.