Concerta Dose: Getting It Right
ByConcerta is a newer, long acting preparation of Methylphenidate – which is the medication name for Ritalin.
It has been out for several years in the USA and Canada, and many other countries in the world.
Despite the fact that it has been around for quite some time, I still see dosing mistakes in patients who are sent to my office.
Allow me to explain to you how Concerta should be dosed.
To start off, we need to go back to the original Ritalin.
Here are the dosing guidelines for Ritalin:
Recommended daily max = 60 mg
Timing: as each dose only lasts 3-4 hours, it is generally dosed 3 times daily – i.e. morning, noon and 4 pm
It is not dosed too late in the day, as it may lead to insomnia
Children would be started at 5 mg twice to three times daily, and the dose would be increased upwards as needed.
When Concerta was developed, they used a fascinating technology called OROS. OROS refers to: osmotic-controlled release oral delivery system. What OROS does, is use the water in the gut to cause the medicine to be absorbed gradually, through osmosis. Suffice it to say that this new pill takes a medicine that has to be taken 3 times daily, and makes it once per day. You can see a short video of how this works here.
Concerta comes in 4 doses:
18 mg
27 mg
36 mg
54 mg
The way to convert Concerta doses into the equivalent of Ritalin doses is this:
Take 22% of the Concerta dose, and that becomes the effective Ritalin dose, three times daily. In other words, the initial 22% is quickly released, and the whole rest of the pill supports that dose.
You need to remember that not all of the medicine is released from the Concerta pill – about 10% is not absorbed.
Why?
Just picture a ketchup bottle – can you ever get the last bit out?
So, here is a conversion:
18 mg Concerta = 4 mg Ritalin 3 times per day
27 mg Concerta = 6 mg Ritalin 3 times per day
36 mg Concerta = 8 mg Ritalin 3 times per day
54 mg Concerta = 12 mg Ritalin 3 times per day
Here is an example of how some people get into trouble:
Let’s say that a teen required 60 mg of Ritalin per day – i.e. 20 mg three times daily.
If the doctor converts the dose of 60 mg Ritalin to 54 mg of Concerta – because they seem close, this can have dire consequences.
54 mg of Concerta is like 12 mg of Ritalin 3 times per day, so there would be a significant dose drop from 20 mg 3 times per day to 12 mg 3 times per day (i.e. a 40 % dose reduction!). It would be no surprise if the people noticed a change and felt that Concerta wasn’t working.
In the recent past, there has been approval in the US for 72 mg of Concerta for teenagers if needed.
Recent ADHD practice guidelines published by CADDRA – the Canadian ADHD Resource Alliance, suggest that teens and adults with ADHD may require up to 108 mg of Concerta daily.
To put these doses into perspective:
72 mg Concerta = 16 mg 3 times per day
90 mg Concerta = 20 mg 3 times per day
108 mg Concerta = 24 mg 3 times per day
To achieve these doses, you can use:
72 mg Concerta = two 36 mg tablets, or 54 mg + 18 mg
90 mg Concerta = 54 mg tablet + 36 mg tablet
108 mg Concerta = two 54 mg tablets
What’s the bottom line ?
If you or your loved one was switched from another form of methylphenidate to Concerta, and it seemed that Concerta didn’t work, please consider the information above.
You may even want to print this article, so that you can take it with you to your next doctor’s appointment.
Concerta is a great preparation of methylphenidate, and can work very well.
Don’t give up on it unless you are sure you have had the right dose.
My grandson has been on concert a 54mg for 4 years. He is starting to struggle in school and having more trouble concentrating. What dose is safe for him. He weighs 98 lbs.
MY SON IS DOING THE SAME THING AFTER 3 YRS, I THINK THERE METABILZING IT FASTER THE NORMAL
I have been on concerta for four year. In that time I have increased my dosage may times. I went from 18mg at the beginning to 74mg right now. As you get older either your system gets used to it or you need more to support you. This is totally normal.
My son is 10, has ADD, he has tried Vyvanse (30mg) could not believe the change in my son, he was talking at a regular speed( normally when he talked you could finish his sentences for him because it was hard for him to process what he wanted to say) and telling me everything about his day. It felt like Nicholas was set free from him his shell….. he was happy! after a week being on it, i noticed changes for the worse,lost 5lbs, crying all the time, he didn`t know why, Nick lost his smile, and to know Nick he is known as a smiley boy. Doctor changed his doses to 40mg, which still didn`t help.
We started Adderall XR (15mg) his smile was back, and the crying stopped, but not much change when it came to focusing in class, 20mg still nothing, and wasn`t able to gain weight.
Now on day 7 with Concerta 18mg, after 14 days on the 18mgs i am to switch him to the 27mg. He is still eatting good smiling. but the teacher notices no differents with him on it or not. he is not a hyper child, he is one that well sit at his desk just not get much work done on his own. processing info. is hard for him.
where to turn to next….. these medications scare me, the doctor mentioned a medication that would be in his system 24-7, I`m not liking that idea. It`s so hard what to do next….
My 16 year old is was put on (18) concerta just over a year ago now to disappointment we have now agreed to put him on 27, but i am still concerned about the side affects. We were asked a lot of questions about his health, he had his weight, height and blood pressure taken, but is this enough i have heard children died from this medication or get addicted.
THAT IS ROUTINE, AND A VERY LOW DOSE FOR A 16 YEAR OLD, WITH MY SON THE SIDE EFFECTS HAVE ALWAYS BEEN VERY MILD
I am 17 and started taking 18 mg when i was 13. As i got older i needed to increase my dose. I am not taking 74mg a day. The tests are all standard procedure. The only thing about concerta is that there is a bit of an appetite loss. I have been very skinny my whole life even though i eat lots, so this was a concern for me. I noticed the appetite change. some days it affects me more than others, but it isn’t that big of a drawback. I went from getting really low grades to now being at the top of my class. Kids usually only get addicted if they are diagnosed and prescribed incorrectly. Those who are prescribed concerta when they should not be get high (hence the addiction), but for us, concerta doesnt get us high it only fixes broken links in the chain. I cant express how greatful i am for concerta. it has literally changed my life. there was no way i would have been able to accomplish the things i have without it.
HI MY SON IS ON 54MG A DAY, HE WILL BE 9 IN APRIL AND WEIGHTS 86 POUNDS, HIS WEIGHT WITH THIS MED HAS NEVER BEEN A ISSUE, HOWEVER A COUPLE MONTHS AGO HIS TEACHER SAID HIS CONCENTRATION AND ABILITY TO STAY ON TASK HAS DECLINED, SO THE DOC UPPED HIM TO 54 FROM 36 WE STILL SEE NO IMPROVEMENT, HE WASNT LIKE THIS LAST YEAR, THIS YEAR HE FORGETS THINGS EVERYDAY, THINGS THEY HAVE BEEN DOING ALL YEAR THAT IS ROUTINE, FORGETS PAPERS, BOOKS, COATS, EVERYDAY HE LEAVES SOMETHING, IS IT POSSIBLE THAT THIS MED COULD JUST STOP WORKING FOR HIM?
Have u tried different diets? That’s one thing that worked for me when I was around that age. Sometimes my mom would drop off a little sugar free treat it’s also helped me stay healthy at this age. A great age to develop a healthy life style.
J
Hi I’m 35 yrs old and I got diagnosed about 4 months ago. I have been on concerta for a couple of months and It’s not really doing anything. My Doc has been upping my dose steadily and I’m just about to go on the 54mg dose. It has had No effect on me be it negative or positive. No more focus then before, no added energy or jitters either.
Anyone know if I should be asking about Adderall or something else? Is this unresponsiveness normal? I don’t really like the idea of going up a lot higher. I always thought 54mg was the max you can really go before the side effects outweigh the benefits.
since you are older you will need higher a higher dosage for you to notice improvements. They start low so they can see how much you need. I would keep trying. i started at 18mg and over the years increased to 74mg.
BTW I’ve got the inattentive part of ADHD.
Hello,
I hope you can help. My son just started on Concerta 18mg on Saturday – he is 12 (almost 13) and weighs about 140ish pounds. We started him on such a low dose because as a parent, I have been VERY leary of putting my child on meds. Not a big fan at all…however, I know it is for the best and decided to give it a try – Also, my doc said ” low and slow” as I’ve heard so many times. Which is a good thing. So since I gave it to him starting Saturday, I have seen no side effects at all.. no loss of appetite, no sleep issues, no stomach aches, etc, etc…. which sort of concerns me because I’ve read that this med is supposed to work immediately. I’m not complaining, because I dont want him to have those side effects, but should I give it a little more time and see what happens before I call the Doc ? he has a follow up in 2-3 weeks. Thank you so much !!
That’s totally normal. When I started (around the same age I might add) I started on the 18mg. It seemed to have no affect on me. We slowly increased the dosage. Eventually I found a good dosage that worked for me. Not everyone experiences the same side effects (for example I never have stomach aches). The main thing you want to look out for is his concentration levels and performance, not appetite or sleep issues. It sounds like you’re nervous about this, which is totally understandable. But the difference it can make in his life is immeasurable. I am very grateful for concerta. It literally changed my life.
My son has been taking generic Concerta 54 mg daily and can use 10 to 20 short acting Methylin as needed, since the long acting is less effective after 6 to 8 hr. His psychiatrist tried to increase him to 54 mg twice daily, but the insurance denied it. Now, I have lost my job, so we will be using generic, but since he is not dependent on insurance auth, and he is 5′ 11″ tall, 18 years old, and weighs 310 lb, what other options might he have for dosing. Obviously without insurance cost is a factor but approval is not.
I got perscribed the 27 mg and the 36 mg concerta’s and was initially told to try the 27 once a day and see how that works and if needed see if the 36 mg is any more effective. Well it’s been about 2 weeks and within the time I took it upon myself to start taking 90mg (two 27′s and a 36). My question is is this okay? and how should I know which dose is the best for me? I’m 16 and weigh around 150 if that information is relevant to giving me an accurate answer. Also, I took the 27′s for about a week, then I tried the 36 for a day or two, one day I tried 3 of the 36′s, and tomorrow I plan to begin trying the 90mg dose. My question with that regard is are my observations on how its working plausible if I’m sort of switching my doses that frequently? Basically, can I judge how the dose is working from just the one or two times I may try that dose to decide weather to change it or not?
Any info would really help and I’d really appreciate it, thanks~
Please stop what you are doing and go back and speak with your doctor. You’re playing with fire. Your body needs time to adapt to the medication. Your doctor gave you two separate dosages, not to be combined to make it a higher dosage. You cannot judge in the span of a couple of days if it is right. And under no circumstances should you be taking 90mg, let alone 108. Your parents should be in control of your medication and dosing it to you as prescribed.
I don’t recommend switching up your dose that frequently, and to the increased extent that you have without talking with your doctor. Concerta also has addicting properties which could be dangerous for your health, so I’d be careful. It’s difficult to see the improvements if you are switching that often.
Cheers
Hi Dr Kenny,
Thanks for all the great info on your blog, I wanted to ask you a question on the info you have on the Concerta dosages above.
I am recently diagnosed ADHD Feb ths year 48 year old male with 8 year old son diagnosed ADHD prior to my diagnosis. After reading the info on dosages of Concerta you have on your BLOG the penny dropped for me regarding my recent conversion from Ritalin 5-6 10MG day to 54mg Concerta with 2-3 10mg ritalin later in the day 10mg at a time. my 8 year old son who is on 27mg is having similar problems.
My Pdoc says he will put me on another 18 or 27mg Concerta after next visit to replace the Ritalin tabs.
I have printed out the dosage rates like you suggest and I will take them to my next appointment with my doctor, Is there any technical / pharmicutical / anecdotal evidence I can take to my doc as well cause I am thinking he may not take a web page print out that I hand to him to seriously. Not suggesting that the info is incorrect or anything like that because it certainly coincides with my prior uncollected thoughts on what was going on in my head. Also my son has been topsy turvy throughout most days since starting on Concerta.
Thanks again.
Greg, I don’t know of any specific studies that you can quote – but all of the Concerta literature discusses the 22% immediate release. By using this logic, hopefully your Pdoc will understand. He/she could call a colleague, or even as the pharmaceutical rep for Cocnerta to give some insight/suggestions around the dosing. I hope that helps. good luck!
My was diagnosed in feb of this year with add. He was put on 18mg to start, now he is at 27mg. The school part has improved immensly. But before and after school is utter hell. He is so angry,more then before. He freaks out over everything, and I can only handle so much. Anyone else have this problem?