Titrating Medication to Determine the Perfect Dosage

How Your Doctor Decides How Much ADHD Medication You Need

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How does a doctor know how much medication you or your child needs? Height, weight, and symptoms are all part of the initial equation. But because biology is an inexact science, and every individual is unique, your doctor's first guess may not be right for your child.  Titration is the process of determining the dose that reduces symptoms to the greatest possible degree while avoiding possible  side effects.

Is Your First Dosage a Good Match?

Once your doctor provides you with an initial prescription , you will go through a process of determining whether the dosage should be increased or decreased -- and whether the particular medication is the best choice for you or your child.

You and your doctor will be working together to determine whether you are experiencing:

  • Too little response (the medication isn't working)
  • Intolerable side effects (the medication may be working, but the side effects are very severe)
  • Too much response (instead of gaining greater control over issues such as impulsivity, you or your child has become passive, depressed, or unlike him or herself)

To avoid such problems, if you or your child are beginning a trial of stimulant medication, the doctor will likely start with an initial low dose of stimulant. At this point, it will be largely up to you to watch carefully to determine whether:

  • The medication is helping to alleviate symptoms
  • Whether and to what degree there are side effects
  • Whether and to what degree improvement of side effect increase or decrease over time.

With stimulant medications, a few things to watch for include:

  • New nervous tics (twitches, unusual blinking, odd facial movement)
  • Irritability or agitation
  • Depression or increased anxiety
  • Unusual physical sensations or hallucinations

Mild side effects may be reported to your doctor at your next visit, but significant issues should be reported immediately. The problem may be due to the wrong level of medication or to an unusual reaction indicating that the medication is wrong for you or your child. In no case should you simply take your child off the medication without medical advice, as doing so can be dangerous.

Titrating to an Ideal Level

Assuming that the medication you are trying is reducing symptoms with few or no side effects, your doctor will carefully adjust (titrate) the dose upwards to adequate levels. Titration helps the body adapt to the medication; it also helps you and your doctor find the optimal dose to improve daily functioning.

Your doctor will increase the dose slowly to the highest tolerable dose. If you begin to see no more improvement in symptoms as the dosage increases, the doctor will lower the dose to the previous one. Also, if you find that a higher dose produces too many side effects, the dosage will be lowered.

Medication management is really based on an individual’s own personal needs and responses.

The optimal dose of medication is one in which daily function is significantly improved and side effects are minimized. This is why close communication with your doctor is vital. Think of your relationship as a partnership. Be open and communicative and together you will arrive at the most beneficial outcome.

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