What is the best way to determine the proper dosage?
There are a variety of ways that medical professionals determine the proper dosage for a given individual. They range from elaborate and costly controlled trials, on the one hand, to more random and subjective dosage selection and modification, on the other hand. I have found the following procedure to be an ideal middle ground:
- Documentation of ADD.
- Systematic trial testing. When using stimulant medications, I select the lowest dose that is likely to have a positive benefit. A patient takes this dose and comes into the office on the same day at a time when it should be at its peak effectiveness. My team and I document its effectiveness by comparing on-medication attention to an off-medication baseline using objective measures and structured observation. This trial testing may be repeated several times before I find the dosage that is most likely to be optimally effective in the real world. By having these initial experiences with the medication in my office, my staff and I are also able to observe and interpret any untoward effects for the patient and parents. I modify this process when using Strattera because its effects build up more gradually rather than occurring with each dose. In my experience, it takes at least a week on the target dose of Strattera for patients to experience about 80% of the benefit they will get from a given dose. Therefore, when starting Strattera, I have patients come into the office for systematic trial testing about 10 to 14 days after they have started the target dose. If the trial testing shows the dose to be inadequate, I increase it and repeat the trial testing in another two weeks and so on until I find what seems to be the optimal dose.
- Clinical trial testing. Next, I have the individual begin regular use of the medication in the real world. After about two weeks, I obtain feedback concerning the impact of the medication on all aspects of life functioning during a follow-up visit with the individual, his parents and/or spouse. When appropriate, I gather additional feedback from teachers, employers and other professionals through phone calls or simple attentional status survey questionnaires. Based upon the feedback, I adjust the medication accordingly.
- Fine-tuning of the dosage. When necessary, the systematic and clinical trial testing procedures are repeated in order to maintain optimum attention as the ADD individual grows and faces new challenges in life.
With these procedures, it is possible to determine safely and systematically the most effective medication dosage for each individual who is diagnosed with ADD. Regardless of the specific procedures used in establishing a dosage, it is imperative that medical professionals act reasonably and responsibly. After all, the quality of peoples’ lives is in the balance.
For a more detailed, clinical discussion of the use of medication to treat ADD, visit ADDBasics.org to download Dr. Liden’s ebook, ADD/ADHD Basics 301: Rationale for Clinically Necessary Off-Label Use of Stimulant Medications in the Treatment of Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder (ADD/ADHD)
Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.