We talked about this in the following link (read the page that comes up, and the next, I think....):

http://neurotalk.psychcentral.com/thread50240-47.html

I upp'd the dosage because I was hoping to get additional improvements. If I did get them, they were much more insidious than the one's I got in the beginning, but by 3 months on 4.5mg (9 on LDN, all told), I was down one EDSS point.

I do have to drop it down to 3.75 every late fall, till I adjust to the "change" in weather, but I always make my way back up to 4.5 mg (for no particular reason except that I don't have problems with it and it is said to be "optimal" . . .).

I had an infection I ignored for over a year (under a cap), which cause all sorts of other infections, so I spent most of 2007 on antibiotics. Coincidentally, I was measuring my liquid LDN wrong and only getting about 2.75 mg daily throughout that period. I wasn't doing so well, and I did have a very LONG (but not as severe as usual) attack . . . but as soon as I had the tooth removed and got back up to 4.5mg, everything stabilized again.

I guess I'll never know if it was the inadvertant reduction in dosage, the infection, or a combination of both that caused the flare . . . but I won't be making either mistake again. The good news is that my EDSS remained the same after that experience, and only minor "permanent" damage was caused from that ordeal.

I think we know if we have "maxed out" based on how we are feeling. If it makes NO difference (good or bad) to go to 4.5mg, then I would. If it has a positive effect, again I would stay at 4.5 mg. If it has a negative effect, I would give it a few months (unless it is TOO difficult), and drop back if I have to.

You can increase the dosage less then 1.5mg at a time by mixing the pill content with distilled water too . . .

Probably no point in going into all the options, but when you decide to go up, we'll walk you through any difficulties you might have.

Cherie