What Does It Mean to "Titrate" the Dosage of a Medication?

How Your Doctor Decides the Right Dose for You

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How does a doctor know how much medication you or your child needs? In the initial equation, they will factor in your height, weight, and symptoms. Yet, because biology is an inexact science, and every individual is unique, your doctor's first estimate may not be an ideal match. They will need to "titrate" the dose.  

What Is Titration?

Titration is the process of determining the medication dose that reduces symptoms to the greatest possible degree while avoiding possible side effects.

When your doctor "titrates" a dose, they are making adjustments to how much medicine you're taking. This process may be rather quick, or it could take some time.

The purpose of titration is to find that perfect balance of a particular medicine for your body. The goal is for the medication to do its job and produce the desired effects. At the same time, your doctor wants to reduce or eliminate negative side effects.

Titrating can be done for any medication, including stimulants for attention deficit hyperactivity disorder (ADHD). If the adjustments do not find that balance, then your doctor may choose to try another medication.

While it can be frustrating and seem like nothing is working, it' important to remember that this is a very individualized endeavor. With patience, time, and by working closely with your doctor, it is likely that a suitable medication and dose will be found.

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.

This will also ascertain 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 or the effects are too minimal.
  • 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 become passive, depressed, or unlike yourself.

To avoid such problems, if you are beginning a trial of stimulant medication, the doctor will likely start with an initial low dose of stimulant. At this point, it will largely be 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 effects increase or decrease over time.

Watch for Any Side Effects

With stimulant medications prescribed for ADHD, there are a few things you can watch for. Your doctor may add to this list, so write them down if needed. It's also a good idea to read through the information you receive from the pharmacy and ask any questions you may have.

  • 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.

Any problems you experience may be due to the wrong level of medication or to an unusual reaction indicating that the medication is not the right one for you.

In no case should you simply take your child off the medication without medical advice. 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, they 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.

Source:

Candian Agency for Drugs and Technologies in Health. High-dose Stimulants for Attention-Deficit/Hyperactivity Disorder: A Review of the Clinical Effectiveness, Safety and Guidelines. CADTH Rapid Response Reports. 2016.

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