Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a tolerability convention.
The arithmetic in one line: half-life about a week, so steady state at four to five weeks, so a four-week interval is one steady state per step. Two-week intervals mean every step is dosed onto a rising curve.
What I am after is why the interval is four weeks rather than two, and whether a slower ladder gets to the same place.
Practical detail welcome, however dull — the duller the better.
Answering the narrow version, because the broad one does not have a single answer. The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks later. The end point of the ladder is set by tolerability, not by a schedule, and there is no evidence that reaching the top faster produces a better outcome.
TrialTracker_MD said:The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks…
Agreed on the arithmetic, with one condition: holding indefinitely at a dose that is not doing anything is not patience, it is a stall with a nice name. The distinction is whether appetite has changed at all at the current step.
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Shop Reference StandardsWendyG_ATL said:Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a…
Same position here, arrived at the long way round. Four weeks is the pharmacokinetics, not caution. With a one-week half-life you need four to five half-lives to reach steady state, so at two weeks you are dosing on top of a concentration that has not finished rising. Escalating then stacks exposure and you get the side-effect burden of the higher dose before you have seen the benefit of the current one.
Adding the clinical framing, because it changes how the question reads.
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