What Does ‘Titration’ Mean?

Q: My doctor prescribed a drug that needs to be titrated. What does that mean and why is it necessary?

A: If you were prescribed an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker or diuretic, your doctor may have explained that the drug needs to be titrated. Titration is a way to limit potential side effects by taking time to see how your body will react to a drug.

In titration, the medication is started at a low dose. Every couple of weeks, the dose is raised (“up-titrated”) until the maximum effective dose (“target dose”) has been achieved or side effects occur.

Not everyone can tolerate a full dose. It’s safer to ease your way up.

The drugs mentioned above lower blood pressure and heart rate by blocking neurohormonal and adrenaline pathways. These are innate mechanisms designed to safeguard humans — and the reason why titration is essential.

You need adrenaline to run away from a bear, but your adrenaline level has to come down after the bear is gone. If you block adrenaline completely, the bear will catch you, so we block some of the adrenaline slowly and gradually. This allows you to react to the bear, while giving your heart time to get better and stronger between bear attacks. The next time we increase the dose, the heart tolerates it better.

Ideally, patients should aim for the target dose of these medications. Unfortunately, titration is sometimes overlooked.

We see patients who have been on a low dose for months. They are on the right drug, but their heart isn’t getting better, because the drug was never up-titrated. Some people don’t need as much of the drug as others, but we don’t know who they are until we discover the highest dose they can tolerate.

— Heart failure specialist David Taylor, MD

This article was adapted from Cleveland Clinic Heart Advisor.