10 Things To Consider When Cross Titrating Drugs

John J. Miller, MD

Over the years, Psychiatric Times’ editor in chief has developed “Miller’s Formula,” his 10-step system to ensure a successful cross-titration for his patients. The strategies are straight-forward and can be used for any drug and in any specialty.

In this Mental Health Minute video, John J. Miller, MD, explains how you can integrate this system into your practice and why it works. 

The steps include asking yourself the following questions:

1. What are the pharmacodynamics of drug A (the drug the patient is currently taking) and drug B (the drug you wish the patient to take)?

2. What is the half life of drug A and drug B?

3. What are the metabolic pathways drugs A and B?

4. What is the patient’s current dose in comparison to the usual effective dose?

5. How long has the patient been on drug A?

6. What is the current acuity of the target symptoms?

7. What are the withdrawal adverse effects of drug A that is not compensated for by drug B?

8. What is the patient’s motivation for changing medications?

9. What education can be shared with the patient and their guardians and caregivers?

10. What are the delivery systems for each of the drugs?

Dr Miller is Medical Director, Brain Health, Exeter, NH; Editor in Chief, Psychiatric Times; Staff Psychiatrist, Seacoast Mental Health Center, Exeter, NH; Consulting Psychiatrist, Exeter Hospital, Exeter, NH; Consulting Psychiatrist, Insight Meditation Society, Barre, MA.