The drug titration paradox: something obvious finally understood

Abstract

The drug titration paradox is an emerging concept in clinical pharmacology. The paradox refers to the observation that when drug is titrated to a specified level of effect in a population of patients, the expected positive correlation between dose and effect is reversed. That is, when titration rather than fixed dosing is used, greater drug exposure is associated with lesser effect, and vice versa. The drug titration paradox may have important implications for study design and data interpretation in anaesthesiology investigations, particularly in big data studies.

Keywords: clinical pharmacology; drug titration paradox; pharmacodynamics; pharmacokinetics pharmacology; target-controlled infusion; titration.