How does a hyper-sensitive person titrate?

How does a hyper-sensitive person titrate?

With MCAS, are you using a slow tapering dose of LDN to help these hypersensitive patients find their happy dosage? Are you using tablets, capsules, or liquids for your patients? 

I've used liquids, but I would say that I primarily use capsules. It's really important to figure out what excipient issues that you have. So, as Dr. Weinstock talked about, the methylcellulose can be an issue for some people and there could be methylcellulose in the capsule, could be a bit in the filler. 

Sometimes we have to use gelatin as a capsule. Sometimes we have to use various different types of fillers to figure out the right combo, okay? That's number one. Because that sometimes can help this issue with hypersensitivity. Like some patients just are taking things that they're reacting to at the same time as taking the drug that could potentially help them. 

In general, again, depending on the patient, I might start really, really low, like somebody else had asked about starting with 0.1 mg. I certainly have done that. I've actually started lower than 0.1. I think the lowest I started was  .001 and an exquisitely sensitive patient. Then you titrate up really, really slowly. I have patients where their happy dosage; I have one patient who made it up to 0.3, and I have patients who are on 9 milligrams at the opposite end of the spectrum. 

So it really does vary, and that's why you have to, kind of, figure that out early and try to figure out how to titrate. Sometimes we're titrating by 0.1. Sometimes we're titrating by 0.5. Sometimes we realize that, let's say at 0.3, there is some benefit, and with this particular patient, we were able to, she actually wanted to stop it. We knew that stopping it was a problem, but going higher than 0.3 was also a problem, but at 0.3, that was like the sweet spot for that patient.

And so again, it's just working with your healthcare practitioners to figure out if this is the right drug for you, you have to try it. It may not be. 

There is a subset of patients who, regardless of how low, could be  0.001, they will react to the drug. There's always a chance of that. But I would say a good 60 to 70% of patients that I try LDN in can be very successful with it. And again, it just takes some time to figure out the dosage.