Definition
So-called “creeping in” is a gradual increase in the dose of a drug over days or a few weeks. This is used to slowly accustom the patient to the drug and to test individual tolerability. Creeping in helps to avoid undesirable effects. The target dose may be predefined or determined individually. In the second case, it is referred to as dose titration.
Examples
The following is a list of some drug groups for which dose titration may be necessary. It is not necessary for all agents in the group:
- Antidepressants
- Antiepileptic drugs
- Anti-infectives
- Antihypertensives
- Benzodiazepines
- Muscle relaxants
- Neuroleptics
- Opioids
- Psychotropic drugs
Dosage forms
For creeping in, the appropriate dosage forms must be available. So, for example, tablets or capsules with different strengths (eg, 25 mg, 50 mg, 75 mg, 100 mg) or divisible dosage forms such as quarter-divisible tablets. Creep is also possible with liquid preparations such as drops or solutions, and it is also common with infusion treatments.
Dosage interval
In addition to the dose and the dosage form, the dosing interval can also play a role in creeping in, i.e., the time between administration. For example, starting with one capsule twice daily and eventually increasing to one capsule three times daily.
Therapy Success
Treatment success is determined with clinical response and, in some cases, with a determination of blood levels (plasma concentration).
Titration scheme
What is the duration and dosages to be followed? The specific details should be taken from the drug information leaflet.
Tapering
Gradual discontinuation is conversely called weaning out. The organism must be slowly weaned off the drug so that withdrawal symptoms do not occur. A therapy that is started creeping in must often be stopped creeping out.
