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    Old 01-18-2007, 12:51 PM   #1
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    titration period?

    Can someone tell me what is titration period? What is it used for? How does it work? What medications does it apply to? Thank you Ed

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    Old 01-19-2007, 06:08 AM   #2
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    Re: titration period?

    Hi Ej, The titration period is just the period in which a new med or or change in meds is being adjusted to reach maximum benefit without causing intolerable side effects. Painmeds, antidepressants, antiseizure meds. even BP meds, coumidin and meds like benzo's for anxiety are all titrated or adjusted during the first few weeks or months to reach a theraputic level.

    There is no set time limit it takes or number of adjustments it should take. Charts that convert one med to another are just guides for docs to folow to insure safety. Every change in pain meds I've done usually took 6-12 weeks and several adjusments just to get back to where I was and then find max benefit without causing more side effects than I could tolerate.

    The longest Titartuion operiod was switching to the pump. That took 6 months and 16 adjustments and I ended up taking 6 times the starting dose. How fast a doc titrates, wheteher they make you wait for scheduled monthly apts to make adjustments or they tell you to call in 10 days or 2 weeks to se how you're doing is pretty much up to the doc. There isn't a guide that says you can only increase once a month or shouldn't increase more frequently than every 2 weeks. Each med has it's own guidlines as to how fast you can titrate. Methadone for example takes more time to adjust a dose, where meds like OxyC and MSC can be adjusted as quickly as 50% every couple days untill you reach a level that's effective. Fentanyl patches takes 3 full rotations to realy know what a dose is doing, meth need tme to build up over it's initial 5 day half-life and then a week to get used to that is fairly common, But every doc has their own time line , policy and availablity.

    It is important to try to find your docs expectations when he first makes a change in meds or a treatment plan. Does he want you to call in every week, every two weeks or simply wait for that monthly apt. A month is a long time to go if your miserable, but there really isn't a formula or chart that can be used that gaurentees relief. For example, if side effects limited a dose of one med you were taking and the next med isn't causing that problem, Titrating may mean not only finding an equal level of relief, but if the med causes less side efects, you may be able to reach levels of relief you were never able too with the previous drug.

    Switching from orals to a pump was really interestigng because the side efects that I drew the line at was feeling impaired. Fortunately that side effect is deminsihed greatly and higher levels of pain relief can be achieved with less side efects from most pump meds. So I was not only able to increase a dose beyond the oral dose due to lack of side effects but I was also able to reach levels of pain relief I hadn't been able to reach due to side effects.

    It is important to get the initial dose or titration correct from the get go. If you give up after 4 adjustments and exept the bare minimum amount of relief because you're concerned about how a dose increase request will be taken can lead to continued under medication. If you except less than what you need after several adjustments, 3 months down the line when you can't stand it, and have to ask for an increase, the doc doesn't know if the med is problematic and causes rapid tolerance or if the dose was just never titrated corectly from the get go. Try to be clear with your doc about his expectations, how long should you wait if your miserable, recieving less relief, or even feeling sick from too little medicaton.

    Experience with meds really doesn't mean the doc will know what dose will work for you or the titatration proces won't take as long. Experience with meds should mean the doc has seen the wide rage of results people have from different levels of meds and should expect to hear from the patient more frequently untill you at least get back to the same level of relief as the previous med. You may hit side efefcts with a new med before you even reach equal levels of relief froma new med, all you can do is report honestly and hpope your doc realizes, everyone is dofferent. X number of mgs may work for one person with a similar DX and do nothing for the next. It may take 3 adjustements in 6 weeks or 16 adjustments over 6 months. But once the right level is achieved you should be able to maintain that level for some time without causing concern about rapid tolerance.

    Good luck, It's never easy switchng meds, but if you trust your doc to continue to work with you to find the best med at the right dose, it makes those intolerable weeks much more tolerable when you know there will be light at the end of the tunnel.

    Take care, Dave

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