It is not cumulative and it has a short half life. There was a phase 2 clinical trial for chronic pain but it was very poorly designed. That lasted 3 months. The dose was still 50mg but my pain doctor understood the mechanism of this drug in depth and was aware of the 50 years of research that went into the development. He was very adamant that the dose was too low but who knows? This is a novel drug...there could be unexpected side effects at a higher dose, regardless the price is astronomical.