Drug titration

Drug titration is the process of adjusting the dose of a medication for the maximum benefit without adverse effects.[1]

Therapeutic (green) and side effect dose response curves (red) illustrating a typical starting and progressively increasing titrated doses (arrows).

When a drug has a narrow therapeutic index, titration is especially important, because the range between the dose at which a drug is effective and the dose at which side effects occur is small.[2] Some examples of the types of drugs commonly requiring titration include insulin, anticonvulsants, blood thinners, anti-depressants, and sedatives.[3][4][5]

Titrating off of a medication instead of stopping abruptly is recommended in some situations. Glucocorticoids should be tapered after extended use to avoid adrenal insufficiency.[6]

Drug titration is also used in phase I of clinical trials. The experimental drug is given in increasing dosages until side effects become intolerable.[7] A clinical trial in which a suitable dose is found is called a dose-ranging study.

See also
  • Therapeutic drug monitoring

References
  1. Maxwell S (2013). "Chapter 2: Therapeutics and Good Prescribing: Choosing a Dosing Regime". In Walker BR, Colledge NR, Ralston SH, Penman ID (eds.). Davidson's Principles and Practice of Medicine. Elsevier Health Sciences. p. 34. ISBN 978-0-7020-5103-6.
  2. Schachter M, Pirmohamed M (2012). "General Pharmacology". In Bennett PN, Brown MJ, Sharma P (eds.). Clinical Pharmacology (11 ed.). Elsevier. pp. 74–109. ISBN 978-0-7020-4084-9.
  3. Roden DM (2014). "Chapter 5 : Principles of Clinical Pharmacology". In Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J (eds.). Principles of Clinical Pharmacology (19th ed.). New York, NY: McGraw-Hill. ISBN 978-0-07-180215-4.
  4. Olson KR, Anderson IB, Benowitz NL, Blanc PD, Clark RF, Kearney TE, Kim-Katz SY, Wu AH, eds. (11 December 2017). "Section III: Therapeutic Drugs and Antidotes". Poisoning & Drug Overdose (7th ed.). New York, NY: McGraw-Hill. ISBN 978-0-07-183979-2.
  5. Kruidering-Hall M, Campbell L (30 November 2017). "Chapter 27: Skeletal Muscle Relaxants". In Katzung BG (ed.). Basic & Clinical Pharmacology (14th ed.). New York, NY: McGraw-Hill. ISBN 978-1-259-64115-2.
  6. Furst DE, Saag KG. "Glucocorticoid withdrawal". In Matteson EL, Curtis MR (eds.). Treatment Issues in Rheumatology. UpToDate. Retrieved 13 June 2018.
  7. "Dose-Response Information to Support Drug Registration" (PDF). Guideline for Industry. FDA. November 1994. Retrieved 13 June 2018.


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