4.5 mg is the most common dose that’s documented in the limited research, but some people do better with a higher or lower dose.

Did you start off right off the bat on 4.5 mg? I’ve never heard of that before.

It’s most common to start with a low dose (usually 1 mg, or even .5 mg) and then slowly increase the dose over time. For example, I’m very sensitive to medications and we first started at .5 mg, but I was too wired and had trouble sleeping, so I had to go down to .25 mg to begin.

If you’re having trouble adjusting to 4.5 mg, it could be that it’s too high a dose for you and you may want to consider if not lowering the dose that starting at the bottom and slowly titrating

But if you’re using capsules instead of tablets, the drawback is that you can’t cut those, unless you want to dilute them into a solution, but that gets complicated. I’ve also looked into three different specialty pharmacies and capsules are more expensive than tablets.

I was started at 1 mg. Had problems. Waited a week and started at 0.5. That was the end of Dec. Have had problems every time I up it. Now staying at one dose for a month before going on. Just started 4.0 this week.