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.
JennieNicole,
My son tried the 27mg and had the same hyper effect and the doctor moved him to the 18mg which works much better then the 27mg. Then once it became not enough she added Ritalin, but after a year he developed a little bit of a tic, like wiping his nose a lot or picking a wedgie (happens with some) so we discontinued that and now he takes 18mg Concerta and 1 mg Intuniv, which is a non stimulant to help reverse the tic and its used for ADD/ADHD. It is a calming effect for my son so it made him sleepy at first but then in a day he adjusted. We just made sure to start him on a weekend night like a Friday night so he would be adjusted by Monday for school.So far so good. Intuniv alone without stimulant I saw can cause some side effects I wish not to experience, none real bad just read where some kids wet the bed or were more emotional due to the relaxing effect, but with the 1 mg and the stimulant Concerta we so far have had none of those side effects not even slightly. Dr Handleman what do you know about Intuniv?
My daughter has been on Concerta 18 mg for 3 days now. I’ve noticed evening irritability and crying..i heard this can be a side effect but does this go away? I can’t imagine this would be good for her. I was very against meds to begin with but after every intervention and behavioural therapy we could think of all Dr.’s recommended we try the meds.
Will this continue..i’m very wary of upping her dose and am considering taking her off the meds all together if it contines.
I want to tell you to let it go past the 3 days. My son in the beginning was very emotional and all of that but after I say a good month to month and half they will learn to adjust with the new way their emotions and brains works. Now I will say he still can be emotional but all the crying and that stuff will lessen.
I am a 64 years old and have been on 108 mg of Concerta for the past year. I weigh 215 and my blood pressure most of my adult life has been in the area of 120/90. Currently it is running around 140/ 80 with the Concerta.
I have not been able to find any data on older adult males on higher doses of Concerta regarding any side effects, and am hoping this dose is ok. My doctor has talked about raising my dose to 162 or higher which I have been apposed to. I have been asked to monitor my blood pressure at home 3 times a week and report any sudden changes. Just concerned that the meds are tough on, what so far, has been a strong heart.
He has also suggested jump starting my day with 10mg of Ritalin first thing in the morning so I am awake for work. Sometimes I just make a double shot latte to get things rolling.
Great blog, thanks.
I posted about a month ago with concerns for my daughter, they did knock the dosage down to 18 mgs, and she has done great.. I also noticed the crying and irritability, and its somewhat lessened but overall Im very pleased with the concerta 18 mg
Hi Dr. Handelman.
Our daughter has been taking 18 mg of Concerta for 1 year now. Although it helps, by 4′oclock she’s back to going a mile a minute and seems to be wild until bedtime….mood swings yelling, tantrums, the whole bit. Should we have her take the pill later than 7:30 AM? To boost her time from 4-7? Just wondering what your suggestions may be.
Thanks
Susan,
Three possible options… Talk to your doctor.
1) increase the dose – it may last a little longer
2) take it a little later ( then morning control may not be as good)
3) consider adding a short acting methylphenidate at 4 pm
Last year I was on Daytrana for my ADD. It suppressed my hunger alot, and I was very underweight. Now I swiched to concerta, and I’m allways hungry. Should I let myself gain back the weight, or not give into it because its a side-effect?
I just read you question and don’t know if you’ve found the help you need. My son is on concerta and was not gaining weight. I added a nutritional drink (we use the Publix brand that is high calorie but tastes better than ensure) when he isn’t hungry like at lunch. At night a bowl of ice cream before bed seems to do the trick. Good luck!
Hi Dr. Handelman,
I’m a 30 year old male and was previously taking 20mg Ritalin SR once in the morning. This dosage was working great but I found a little taper in the afternoon (nothing too significant) so my doctor suggested switching to 27mg Concerta once daily. Would this be an accurate conversion?
Thanks,
clr – that seems like a reasonable place to start. You can always raise the dose up if you need to.
My 8-year-old (9 in August) son has been on 27mg of Concerta since February. He was having evening meltdowns so the dr. added 18mg of Strattera to take at bedtime. This combination has worked very well. The only issue being his weight. He is currently 59.4lbs and 53 1/2 inches tall. He has been the same weight since starting the meds, and has grown almost 3 inches in height.
Today I took him back to the doctor because i am so concerned about him basically not eating anything between breakfast and dinner. So he suggested trying a lower dosage of Concerta (18mg) during the summer to see if it helps him with his appetite.
My question is just to see if anybody else has done this with their child and did it work, and/or was the dosage then too low and didn’t help with the impulse/attention/focus.
My daughter been on Concerta for two years now. It took almost a full year before her body began to adjust and she began to put on weight and grow.Her appetite was almost nothing in the beginning. She now has gained about 10 pounds and grown 4 inches. Her appetite goes up and down. His body will adjust and he start growing like a weed.
My son is 12 years old and 100 pounds, he has been on daytrana since he was 6 years old, now we are switching to 108mg concerta for the summer instead of the patch. Is this too much medication for him? It seems to work fine but I was worried it was too much. He was on 50mg daytrana and 2 fast acting 20mg ritalin pills in the morning for a jump start with the patches. Thanks
My son is 8 and weighs 70lbs. He is a wonderful, impulsive, hyper and innattentive little boy. He is on 56 mg of Concerta (for over 2 years now) . Although it is working, it does not seem to be strong enough. For us the difference is miraculous but at school he still has a lot of trouble focusing, concentrating and sitting still. His report card screams ADHD even on the medication. I am afriad to go higher (even thought the dr. has suggested it). What are your thoughts? We love Concerta and would rather not switch as we have tried other meds and they did not prove effective.
Dear Doctor,
May I ask what would be a reasonable starting dose of Conerta (generic) for someone taking 400 mg of Alertec (modafinil) per day? A very poor response have resulted in my MD discontinuing the Alertec and immediately starting me on 18 mg of Concerta. (For 2 weeks) I
Unfortunately I have missed work for 3 days and I am so sedated that I can not properly function. I do trust and respect my GP (who is now on vacation!) and he wanted to start out slowly at a low dose, but could 18 mg/day too little?
Thank you in advance for your time in responding to my question
Regards,
Michael
Hello Dr Handelman,
I was diagnosed with ADHD in March, and given 5mg IR MPH. At first, I noticed a dramatic difference – my mind was quieter, I was able to get things done without much effort. However, I was experiencing some rebound between doses and in the evening, after the final dose. So my psychiatrist advised me to try Concerta.
I’ve tried 18mg and 27mg, which didn’t seem to have much effect, and 36mg and 54mg, which made me moody and aggressive. It seems to make me tired and lethargic, rather than alert and motivated like when I was on the IR.
Do you have any idea why Concerta wouldn’t be as effective as the IR, even though they contain the same active ingredient? Do you have any advice on how I could make it more effective? Do you think it would be worth trying 45mg?
Thank you
Jr – a small percentage of people are sensitive to how the medicine is released from the pill and absorbed into the body. You seem to be in that group. Since that is the case, you will have different reactions with different medicines – like Ritalin LA, or Metadate. Talk to your doctor about the different options.
Hi,
According to this concerta pdf http://www.medsafe.govt.nz/profs/datasheet/c/Concertatab.pdf 18 mg = 5 mg tid, 27 mg = 10 mg tid and so on.
I am interested in knowing where you get your information from as I am on 27 mg which feels less than 10mg tid as you say.
sorry I meant 36 mg = 10 mg tid
Tinto – my info comes from the science of the medicine being 22% immediate release, and clinical experience. Of course any one person can have a different response.
Yes, but 22% doesn’t mean it releases this portion three times a day. Am I misunderstanding your response?
Also do you have any evidence (besides clinical experience) to support your claim of 10% of the capsule not being absorbed?
What is the concerta dose for ritalin SR 20mg BID?
Paul – probably 54-72 mg per day. Start low and increase gradually.
Hey Brian,
I only wish that I had been medicated as a child. As a child I was diagnosed with ADHD. My parents refused the treatment due to their opinions that were similar to yours. I went through life failing at school and relationships because of my focus and memory problems. Needless to say this affected my self esteem a great deal, and left me dealing with anxiety and depression in some very risky ways. Now as a 35 year old man I have just started treatment. I am finally trying to get my life to were it should be. I am constantly feeling like I missed out on a big portion of my life. ADD and ADHD are real disabilities. Holier than though attitudes lilke yours only serve to exacerbate the problem. Think before you Judge.
I have also recently been diagnosed with ADD at the age of 39. Since I have started taking medication my life has changed dramatically for the better. As a teenager if this had been an option my life would have been quite different to what it was. I failed regularly in school and eventually my final year too. I had trouble concentrating throughout school, never made college and in every meeting I have ever attended since then. Today I can sit through any seminar or meeting with total concentration. I can only imagine how different my life would have turned out if I had been on medication much earlier. I encourage anyone to at least give it a try in a controlled loving environment wiht your child or loved one and give it a bit of time before making a decision.
My Husband takes 20 mg of Methylphenidate SA one to two tablets a day depending on how he is doing. He usually only needs one. We have had trouble finding this Rx in the St. Louis area so the pharmacy suggested he switch over to the generic form of Concerta…How much Concerta would he need?? PLEASE help this frazzled wife and mother…he can’t be w/o this med!! My son takes Methylphenidate SA 20 mgs. too but his dose is much much higher…2 tablets each morning and 1 in the afternoon. Life is much easier when they have their meds!! LOL
Thank you!!
I still haven’t received a reply to my questions…am I doing something wrong??
My husband takes 20 mg of methylphenidate SA once a day
My son takes 20 mg methylphenidate SA 2 in the am and 1 before 5:00 pm
How much Concerta should they take?
Hi Dr….PLEASE PLEASE let me know how much Concerta my son and husband should be taking. Their current amounts of methylphenidate SA is listed above in my first post.
Hi,
I’m a late-diagnosed 62 yr. old ADD inattentive type attempting to find a correct dosage level for Concerta. Regular Ritalin worked OK 80mg/day (10-20-20-20-10). Didn’t care for the ups and downs during the day so went to 72mgConcerta (two 36 tabs). Seems weaker to me, so I add small 5mg bumps of regular Ritalin to add strength. It helps but I still have smaller ups and downs during the day, and I’ve read that adding regular ritalin to concerta is not a good idea. Should I just go to 90mg concerta and skip the added ritalin? My insurance won’t pay for anything above 72 per day, but at least I might feel better. Thanks for your help !
John – the reason to not add short acting ritalin to concerta is that it changes the absorption profile of concerta. For some people, that’s a problem. For some it isn’t. If that works for you, just keep doing it! If it doesn’t work, then consider the higher dose of concerta.
good luck.
Dr. Kenny
Hi,
My son will be 16 in October and going into grade 11. He has been on Concerta 36 mg since entering grade 8. It has made a huge difference in all of our lives.
However, lately he has been acting out. Specifically, drinking alcohol, sneaking out of the house to attend parties, getting into fights while there. I know that part of this is the teenage thing but I am starting to wonder if the current dosage is no longer sufficient. He is close to 6 feet tall and weighs about 150 lbs.
Although he feels remorse after the fact, he has little explanation as to why he is doing these things – much like it was back before he started this medication when he would get into trouble at school. We have quite flexible rules (he can go out, he can have a few beers) but there are also times when we expect him to miss “the party” due to commitments he has the next day.
My anxiety has skyrocketed. My patience is wore down. I am angry. I want to be the best support I can to get him through these trying teenage years. I don’t want my ignorance, anger, lack of patience to negatively affect our interactions or to negatively affect his already fragile mental state. What can I do to help? My first thought is to see if increasing his dosage would allow him the self control he currently needs. But I also tend to be one that shies away from “throwing more medication” at a situation.
Please help.
Lisa
Lisa – talk to your son’s treating doctor about the dosage and the possible need for increasing it. 36 mg is a low dose for a teen. Increasing the medication isn’t a failure, and you’ll need to work on an overall treatment plan to improve things.
I hope that helps.
Dr. Kenny
To learn more about my approach – visit: http://www.attentiondifferencedisorder.com/book
Lisa,
I agree with Dr. H. , see your doctor.
I guess I am left to wonder why your doctor is still prescribing 36 mg of Concerta? If your son is not really being reassessed after 3 years on the same dose, how do you know it is really helping? Not only does growth play into dosage changes, many other things (more independent/advanced academic work) can as well. I learned a great deal from my son’s doctor, who specializes in ADHD. My son is re-evaluated every 3 months and sometimes the med changes but more often than not,counseling and a better daily routine make the difference.
hello, i am a 18 year old ADHD girl and
i was put on the highest does of concerta (75 mg) in the 9th grade. it made me sick. i was depressed, i was angry, i was crying uncontrollably, my heart raced, i would sweat constantly, my pupils were dilated, and i would lash out at anyone for no reason. my entire freshman year i never ate lunch or dinner. i lost more weight than anyone should. the drug did help me in school but the side effects were too terrible to stay on the drug.
I hated the drug Concerta but i have friends who have been on it for years and it helped them immensely. The drug isn’t for everyone so if you child is on this drug and has some kind of side effect change the drug. i am on vivance now and i don’t have any side effects at all. i hope this helps you make your decision
My 12yo daughter is on Dexmethylph 10mg twice a day for ADD.
She was off during the summer and has since started again for school. She comes home from school withdrawn and she is now complaining of being very sad. Is this to be expected or does she need a change in meds or dosage?
Hi,
My son is 8 years old. When he was 7 he was diagnosed with ADHD, the doctor started with Ritalin, we went through the whole ‘testing period’ to find the right dosage, which ended up being 20mg of Ritalin 3x per day. I then asked for long acting medication and he subscribed concerta 36mg. His monthly observation chart from the school showed a negative result, so the dosage was increased to 54mg. His teacher spoke to me again about a week ago, and asked that we should look at the dosage again as he struggles to concentrate in class.
Is it possible that concerta just doesn’t work for him, should I go back to Ritalin? Is 54mg a high dosage for his age, he is small build. What is the best medication, Ritalin or concerta?
Please help
My 12 yr old son was diagnosed with ADHD and anxiety issues in June. Had him start on Vyyance in August….on it for 3 weeks. Horrible meltdowns and anger..emotions were all over the map. Doc. switched him to Concerta 27 mg. about 2 weeks ago. So far, so good. Has been in school since Sept. 1. He seems so much happier and actually said he likes school and his teachers. Am not getting too excited yet! lol…
Thanks.
He is (just) 12 and weighs 72 lbs. He goes in for check up in early Oct. Just wondering if the dosage should be higher?? As he was on 50 mg of Vyvance….
Main reason we put him on meds was for academic reasons. I have dealt with his hyperness for 12 years…but it was really becoming a prob. with school and social life…..as far as friends. Praying this med helps!!!! He still has emotion issues and gets mad fast….but alot of that is genetic.
Dear Dr. Kenny,
My daughter was diagnosed with ADHD the summer after her freshman year of high school. I think my doctor is understanding your dosage examples due to the fact that my child showed improvement with concerta but needed to have the dosage increased over the years. She is now a senior and has been on 72mg of Concerta…2 – 36mg pills each morning for the past year. My daughter had the best academic year of her life this past year! Although that is wonderful news…she is now developed some problems with anxiety! My daughter has always had some anxiety from the time of being a young child…fear of dogs and storms. Now at 17, for about the last 4 to 6 months, she is crying at school over dark storm clouds and asking to sleep with me during small rain showers over fear of tornadoes! We live in Maryland not tornado alley!! I took her to the doctor…I was sure it was due to the Concerta…he disagrees saying that she has always had some anxiety and thinks we should just add Paxil, as an anxiety treatment. It took me a long time to convince my husband to let our daughter take ADHD medication but he has seen the benefits. We are both concerned about just adding another medication before first try lowering her Concerta to make sure it isn’t causing the increased anxiety. I am also concerned about how that will show on her academic progress? She said she thought she heard gunshots outside the other day and seems to be very in tune to every little noise she hears outside! It seems to be evolving into more than just anxiety over storms and dogs!! If concerta was going to have this effect on her…would it have shown up immediately since she has been on it for about 3 years and at the 72 mg this past year…or could it build up in her and now be causing her increased problems over the last several months? Please give me your professional opinion, I am unsure what to do?
Thank you, S
I have a 17 year old son he has been on concerta going on two years. The Dr. started him on 54 mg. moved him to 72 mg. for a while and then he went to 108 mg, but then over the summer he took a break and didn’t take any all summer. A week before school started he went back on Concerta 108 mg. I asked the Dr. about him going right back to he high dose after being off of it all summer and she said it would be fine. But since school has started he has been hard to control his anger, been into trouble at school and he has failing grades. He finally told me that he fills like he is overdosed on his concerta. I called the Dr. today and they are suppose to get back to me tomorrow about changing the dosage. Do you think the high dosage could be the problem and could he possibly feel over dosed since he was off of it all summer? What dosage do you recommend?
Years ago when i got dianoised for ADD they tryed me on ridelin,cylert-now off the market, and dexadrine which i found worked the best…..when i moved out of my adoptive parents house and in with my bio mother her Dr put me back on ridelin….i stoped a few years ago went back for more testing about 3 months ago and my Dr has put me on concerta at 36mg i told her how i felt and the worse part was after 4-6hrs i was exstremly drained, so she uped it to 54mg ive been taking that for about 1 weeks and i feel the same but the tiredness hits after 2 hours and i;m drained again, its fustrateing when your at wrok and all you want to do is sleep….i really dont understand why she wont put me back on my dexatrine.? you would think the higher dose would make me better not worse right?
My son is in 3rd grade and has been taking 36 mg a day of Concerta since the end of 1st grade. It has worked wonderfully and he has no appetite loss. In the past month, we have started to see extreme irritability in the evening. After school his temper is short, he is annoyed by just the sound of his siblings talking. He can’t concentrate on homework and has angry outbursts at the slighest disturbance. The tiniest thing can send him into hysterics. Does this sound like we are due for a medication increase??
My 9-year-old son has been on 27mg Concerta and 18mg of Strattera since February of this year, and he was doing awesome. We recently went back to his doctor because it didn’t seem to be working as it used to (struggling in school again and meds seem to wear off early afternoon or not appear to work at all). The doctor bumped the Concerta up to 36mg and left the Strattera at 18mg for now.
Unfortunately, neither myself or his teachers are noticing any real difference between the 27 and the 36 (it’s only been about 10 days) but still I am surprised that it doesn’t seem to make any difference at all. Is this common? Could increasing the strattera dosage make a difference? (he takes that at night before bed).
I hate the thought of increasing the dose even higher, but I don’t know what else to do.
I am a 40 yr old woman who has just been finally diagnosed, I have suspected for the past 5 years that I am possibly ADD, (inattentive type) I finally got around to seeking help….I am feeling frustrated because the Dr wanted to treat me for “depression” first, which I don’t feel I have, if anything I have sever pms symptoms once a month. She has finally put me on ADD meds, she chose a low does of Concerta at first and I honestly have not felt ANY difference at all, she increased it to 36 mg dose now and still I feel nothing. Finding the right meds has become very frustrating to say the least. I am close to giving up! I am 40 yrs old and I weigh 195lbs, does your weight have anything to do with finding the right dosage? Also would like to know, if the medicine does not have any effect on me does that mean I don’t really have ADD and my problem could be something totally different?
Thanks for your response
Joanna,
Weight/metabolism can have some impact on the dosing – though sometimes thin people need high doses, and heavier people need low doses – it has to be totally individualized.
If the low dose doesn’t work, raise the dose. If Concerta doesn’t work, try a med in a different category, like the amphetamines (i.e. Adderall or Vyvanse).
You may benefit from the support in our Insiders program: http://www.attentiondifferencedisorder.com/members/join-insiders
Hi,
I am 19 years old and I am in second year of university. I’ve recently been prescribed Concerta 36mg by my family doc, after a friend gave me one to try and it made a big (positive) difference in me, and I felt like I needed it for school, to improve my concentration problems. The pharmacist said that the dosage is really high for a starter but because of my desperation for it (to prepare for upcoming exams) I just convinced my Mom to get it for me and if anything I can get a smaller dosage later. I have 2 questions. If I start off with 36mg would it be possible for me to go a lower dosage (ex. 24mg) after I finish these 30 pills? And the second question is, can I take it only on certain days when I need it or do I need to take it every day in order for it to work? (only weekdays for example) That’s what the pharmacist said but even though it helps my concentration and overall makes me feel organized, I could get very anxious, dizzy at times, it kills my appetite for the whole day and I may stay up all night because I simply cannot fall asleep. Is there anything you can suggest for me to do?
Thank you.
Alina
Alina, it sounds like you need to get some specific and expert medical advice. Talk to your family doctor, or go see a specialist if needed.
Some quick thoughts – yes, you could lower the dose later (i.e. to 27 mg or 18 mg) if needed. And yes, there are people who stop it on weekends. Talk to your doctor about your options.
Dr. Handleman: Thanks for this page I was quite excited to have found it and I ordered your book. Should we be worried about a fourteen year old girl who is above that “safe dosage” amound you quote. She is on 108 mg daily along with a 20 mg dose of Ritalin. She has been well followed by a child psychiatrist. How long does it take for the Concerta to kick in?
My nephew is going to start takeing 54mg of concerta in the morning and 18mg at noon. He is 8 years old and weighs around 50 pounds. Is this too much? He has been on concera for a year in a half and over the cource of this time his medicine has been increaded to this.
i have loose bowel movements when i take concerta,i also get very tired early,no matter how early i take it,by 8-9 pm,i get very tired. i am 19yrs,currently on 54mg,what should do? am i taking it wrong?
My son turned 10 in June, has ADHD- inattentive, some impulsivity. We’ve used concerta for a few years, added Straterra last year to help him manage better in the a.m. And evenings whe he was on athletic teams or completing homework. Last January things began deteriorating quickly -he lost something at school almost daily, was incredibly impulsive around our home etc.
We did what seemed natural, increased Concerta dose to 36 mg; he developed an eye tic, stopped eating and had terrible sleep quality. After trying a few options, another drug, we went back two 36 mg BUT I wanted to use up what I already had at home so gave him 2 x 18 mg – no eye tic, sleeping and eating were fine. I filled the prescription for 36mg last week and almost instantly the eye tic is back, he has dysfluency – like he’s drunk at times……. The doctor is going to think I’m crazy if I go back and say that 2x 18 mg is great but 1 x 36 is disastrous.
Does anyone have an explanation for this, hopefully scientific, that I could discuss with the doctor?
Just to clarify my previous note (some typing errors):
2 x 18 mg Concerta gave good results
1x 36 mg poor sleep quality, decreased appetite, eye tic, dysfluency (unclear speech)
Any scientific explanation?
Hi,
I am 32 years old recently diagnosed with ADHD. I have been started on Concerta 36mg, Ist day was amazing, full of energy, focused, maximum concentration, could sleep only 6 hours with 3 times woke up during night.
Today is 2nd day, I am feeling so lethargic, so tired, like ‘hit by a bus’, in the morning I felt some anxiety also.
(my doctor is not cooperative at all, didn’t give me much information, too busy……)
My question is, if this happened to anybody, how long or for how many days this lasted, would this settle down? should I ask to decrease to 18 mg dose? did any body tried concerta 36 mg at night once a day? better with less side effects?
Many thanks
Hi,
My son, who is a fast metabolizer, was taking Concerta 36mg first thing in the morning, then 10 mg Ritalin at 11:30AM, and 10 mg Ritalin at 3PM, but the treatment had become ineffective. In July, we changed from the Concerta/Ritalin plan and started using Vyvanse (I know it’s from the Adderall family) @ 40mg but still didn’t have the longevity needed, so we moved up to 50mg and got some undesirable results. Ultimately, we landed back at Vyvanse 40mg, which does last longer than Concerta, but when taken first thing in the morning (about 6:30am) it wears off by 2PM, and we can’t supplement it with a quick acting dose in the afternoon like we could with Concerta.
My question is, can Concerta be prescribed for administration twice per day? For example if we went back to the 36 mg could it be given first thing in the morning, and then again at around 11AM when the effects of the initial dose begin to wane?
I’m capable of dealing with the insane hyperactive behavior at home in the afternoon and evening, but he’s not making it through the school day, and it is consistently reflected in his behavior in the afternoon.
My son was metabolizing now at a faster rate too (say a growth spurt) and I noticed his 8 hr Concerta was lasting 4 tops and talked to the doc who wanted to change meds ,but I liked the Concerta since it had no side effects at 18mg (higher doses did) and asked to do the 2 doses and she said sure lets see how it works. It worked awesome, but my son hates going to the nurse to take the second dose, however in the mean time we had a med check with a different doc other then his pediatrician (tyhe female I talked to about taking the second dose) she was out and this doc he said lets try Vyvanse 30mg and see if it lasts him all day. SO I hated to change since I was SO comfortable with Concerta but we tried it since he would not have to go to the nurse. It is working but we still have trouble with homework, but when I went back and saw this same doc who said to try Vyvanse the doc said that this behavior was normal at that time of day for a boy and basically I needed to except it was what it was since he was getting results in school, but when he plays sports in the evening I want him not to get frustrated with himself (like he used to) Wish there was a 1 time Concerta 18 that lasted 12hrs. We have previously tried 2-4mg of Ritalin for a boost in afternoon but he developed tics which was not worth it and we stopped Ritalin and they went away. So to answer your question yes you can take 1 dose of concerta a.m. and 1 dose afternoon, but the doc said why if you can take another and it last the full 8hrs. (which I get)
My issue is I do not know much about Vyvanse (we have been on it now for 19 days) but it does last for the 8 hrs, but come afterschool care itll I get off work he is a little wired and emotional. I am guessing the rebound effect. Which he didn’t have with Concerta, (unless it was a higher dose) It is only day 20 today. Will this go away? The only side effect we had with Vyvanse was on day 1 he was sleepy and lathargic but it was gone by day 2 or 3. Any recommendations?
Hey
I have the same problem
Now my dr advised me to take 18 mg 3 times daily
(I can’t tolerate 36 get a lot of side effects)
So I take it at 7am ,The second one between 12-2:30 pm, and the last one 4-4:30 pm
It’s working just fine with me , I can sleep, study, drive, and I have a huge appetite
I think I might even be over weight ( got to talk to dr about that because I’m not over eating but I’m gaining weight like crazy)
All my life I knew I had a problem with staying focused. I started going to a couselor and she had me take the screening for ADD and I definitely am that. I went to a Dr and he started me on Concerta 18mg. One fo my daughters took that when she was younger and i remembered it did work for her but her dad took her off of it cause he felt guilty for putting her on it. I know it would have helped her if he would have allowed her to stay on it. But anyways I am 49 and my question is can I double the dose since I just bought them a week ago and do not want to spend the money to go get a higher dose until all of these are gone. I didnt know if you could do that. Or just get a higher prescription now or give it a little more time to see if it works. It seemed to be working at first or maybe I was just believing it was. I still cant stay focused or complete even reading a book. I am easily distracted still. Thank you
Hi,
My son who is 12 yrs old has been on 18mg of Concerta for 1 yr. It seems as though its wearing off faster in the evening and during school he is starting to have trouble focusing again. Is it ok that i switched him to taking 2 18mg pills equaling 36 mg a day? I thought upping the dose would be better but now he has major headaches and last night he was almost throwing up. When do the headaches go away? What can he do to help them during school?
My sons had same reaction and the pediatrician let him try the 2 doses of 18mg and it helped. Unlike the 36mg Concerta which caused unwated rebound effect. Then when seeing another doc he said why take 2 doses try Vyvanse 1 dose of 30mg (my son weighs 62lbs and is 10, but eveyroen is different) and it dose last the 8hrs. Not sure what I am going to do when it comes to afterschool care or sports in the evening. I just try to pick him up as soon as I can get off work so the afterschool teacher doesn’t get frustraed. Not sure yet about evening sports, still waiting on an answer for that.
My son is 7 years old and has been taking Concerta 18mg for a week now and everything was going well. Focus in school, getting his homework done, helping around the house. No side affects until the 8th day he woke up around 2am with a horrible stomach ache. I thought it was something he ate, but then the next day, same thing stomach ache! I took him to his pediatrician and hisDoctor said it was just constapation. Gave him some meds for his constipation but still pain in his stomach. It’s been 4 days with this pains always at about 2am. During the day he is fine, no pain, he is focused. I stoped giving him the meds this past weekend and no pain at night. Does Concerta cause this pain?Is this normal? does the pain go away as his body gets used to the meds?
Hello,
My daughter whos 12 years old has been on 36mg of Concerta for two years now. We are beginning to see it wear off earlier and earlier. By 3 oclock she can’t focus and becomes hostile and miserable. Is it possible with her growing older hormones are changing her way of absorbing the medication? I do not want to up her medication if not necessary but her teacher has now said she isn’t as focused as she once was. Her organization has also become an issue.
Please any suggestions would be great! Thanks
My 8 year old son has been on the 18mg concerta since August. We then moved him up to the 27mg at the beginning of November. I’m now getting calls from the teacher asking me if I took him off the medication because he can’t focus or sit still in class, I have even noticed at home that it is not helping. Has anyone else had this problem?
I am 29 years old and have been diagnosed with ADHD. I just started taking Concerta today 36 mg once a day. All day I have felt out of control and extremely sick. Is this going to improve with time? Also I am a former meth addict (clean for 10 years) I informed my doctor of this yet he still prescribed me the Concerta instead of Strattera.
Dr. Handelman,
I am frustrated in tears. I was on paxil for severe depression for 2 yrs and then it stopped working. while trying to wean myself off it and started lexapro 10mg, I was admitted to ER in attempt to commit suicide. my lexapro was upped to 20mg and this is my 3rd week of 20mg. I see some improvement. I have been told to wait and see for 2 more weeks. Should I wait? Then, I started concerta yesterday 18mg, it didn’t do nothing for me. Made it more harder for me to focus. So today, I took 54mg, same thing. Couldn’t focus. I am in tears now thinking what to do. Should i wait and see for 2 days on it or go on other drug. Please help.
I have an 8 year old daughter that just started taking 54mg of Concerta and it’s making her lethargic and zombie-like. We started with the 18mg and then 27mg but didn’t notice a change. We still haven’t noticed her attention getting any better either. Should we be looking at a different medication or is there an adjustment period and we just need to wait it out.
Any help would be most appreciated.
El