The main reason why doctors should and must be involved is that they can take care of complications if they should arise. The drug does not work for everybody. In clinical trials to date, the drug appears to improve the function of 30 to 40 percent of people with spinal cord injury. People with some preserved function below the injury tend to benefit more. The effective dose of 4-AP varies substantially from person to person, with the recommended dose at 40 milligrams per day in divided doses for safety reasons.
Many factors influence drug effect.
The compounded drug is variable in potency and because it has a short half-life, it tends to have lower potency, especially when it is kept on the shelves for a long time. In addition, different people absorb different amounts of the drug when it is ingested, and its penetration into the nervous system is probably quite variable. Hence, the dose of the drug therefore must be carefully and individually titrated. Some people have gone up to 60 milligrams per day, but this should be done under medical supervision. Some may require higher doses but please don't keep pushing the dose higher if you get any significant side effect of the drug.