What does titration of a medicine mean?

Titration of a medicine means slowly increasing the dose of a medicine by very small amounts over days, weeks, or even months, to find the right dose that is effective for you. This allows your doctor to see how your body reacts to the medicine without giving you excessive side effects. It is safer to start many medications slowly because not everyone can tolerate a full dose.

Medicines that are titrated are usually ones that affect nerve or hormonal pathways, such as medicines used to treat high blood pressure, heart disease, seizures, or mood disorders. These need titrating because it takes time for the pathways to get used to the blocking effects of these drugs, but still be able to respond. For example, some heart medications called beta-blockers reduce blood pressure and slow your heart rate by blocking the action of hormones, like adrenaline, on beta receptors. But we still need to be able to respond to the release of adrenaline in emergencies if we need to. By increasing the dose of the beta blocker slowly, we block some of the adrenaline but not all of it. This allows us to react quickly when required, while still lowering our blood pressure.

Titration is also used with medicines that have a narrow window between an effective dose and a toxic one. With drugs that cause side effects such as drowsiness, sleepiness, headache, or nausea, slowly increasing the medication allows your body to get used to these side effects without them affecting your daily life.

Examples of medicines needing titration include:

• ADHD medications
• Angiotensin-converting enzyme inhibitors
• Angiotensin receptor blockers
• Anticoagulants, such as warfarin
• Anticonvulsants, such as phenytoin
• Antidepressants, such as citalopram
• Antipsychotics, such as quetiapine
• Diabetes medications, such as insulin and metformin
• Diuretics
• Opioids, such as morphine
• Some antibiotics, such as gentamicin and vancomycin
• Stimulants, such as amphetamine/dextroamphetamine.

When a medicine is titrated, it is started at a very low dose. Depending on the medicine, every couple of days or weeks the dose is increased, until the maximum effective dose is reached (this is called the target dose). This process is referred to as “up-titration”.

Sometimes, communication that a drug is being up-titrated gets lost, especially if people are seeing multiple doctors. This can result in a person remaining on too low a dose of medication, which is usually ineffective. Always ask your doctor what your target dose should be when they start you on a new drug with a titration schedule. Then you can ensure subsequent doctors know what dose to aim for.