(1994; 115 pages) [French] [Spanish]
Slowly raising initial dose
Some drugs cannot be used in full dosage at once. There are three possible reasons for this. The first reason is when a drug has a narrow therapeutic window or a large variation in location of the therapeutic window in individuals. The aim is to get slowly within the window, without an overshoot. This is called dose-finding. A second reason is variation in kinetics among different patients. A third is to induce tolerance of side effects. The rule is ‘go low, go slow’.
As mentioned earlier, it takes about 4 half-lives to reach a steady state. This means that you should not raise the dose before this time has elapsed and you have verified that no unwanted effects have occurred. Table 7 in Chapter 8 lists drugs in which slowly raising the dose is usually recommended.