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Words for the ups and downs

When the good stretch gets shorter

Wearing-off

What rose once no longer holds as long as it used to, and comes down before the next dose is due.

In the graph

An example curve where the dose interval stays the same but the held stretch keeps shortening The horizontal axis runs from 06:00 to 00:00. The vertical axis is how well the body is moving, relative to that person's own range — higher is better movement. Doses are marked at 07:00, 11:00, 15:00, 19:00. The highest point is around 12:00. higher lower 07:00 11:00 15:00 19:00 06 09 12 15 18 21 24 An example curve where the dose interval stays the same but the held stretch keeps shortening The horizontal axis runs from 06:00 to 00:00. The vertical axis is how well the body is moving, relative to that person's own range — higher is better movement. Doses are marked at 07:00, 11:00, 15:00, 19:00. The highest point is around 12:00. higher lower 07:00 11:00 15:00 19:00 06 09 12 15 18 21 24
  • Response through the day
  • Time a dose was taken
An illustration generated for teaching. It does not represent the response to any particular medication or dose, and real curves differ from person to person.

This pattern shows itself not in one curve but in several placed side by side. Above, the spacing between doses is the same all day, yet the held part after each rise gets shorter towards the end of the day, and the low stretches grow correspondingly longer.

It feels like the medication getting weaker, but what actually changes on the curve is usually when it starts coming down, rather than the height of the peak. So recording only the good moments hides it; it appears once you also note the time things started to feel heavy again.

Two values are enough in the record: the dose time and the time it began to drop. Once those two accumulate over several days, whether the interval is shrinking is there as a number.

People often put it like this

  • It used to last until the next dose, now it drops about an hour short
  • My body knows before the clock does that a dose is due
  • The effect seems shorter than it was
  • The later in the day, the less time it holds

Things often discussed alongside it

These are factors that come up in conversation about this pattern. This is not a list of confirmed causes, and more than one of them is often in play at once.

  • The length of time one dose acts for may have become shorter than it used to be.
  • The interval between doses may have grown longer than the stretch that holds.
  • Conditions affecting absorption may differ by time of day.
  • It may feel more pronounced on days with more activity.

Worth writing down alongside this pattern

  • The dose time and the time it began to come down The gap between these two is the core information for this pattern.
  • How long remained until the next dose This is what quantifies how early it dropped.
  • Which dose of the day it was A difference between morning and afternoon is common.
  • Whether it repeats across days A single day rarely tells you. It takes several before it shows.
  • How active the day was This lets you separate days with a lot of walking from days spent resting.

What you could show your care team

A record is material for describing your situation. Decisions about which medication you take, at what dose, and at what time belong with the clinicians who look after you.

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