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.
I am a 36 yr old female and was diagnosed with ADHD about 1 year ago. I didn’t really do anything about it at that time, but have since tried various meds. I already was on 60 mg of Cymbalta for anxiety and some depression, but mostly anxiety.
I am a stay at home mom but also do bookwork for our family business and am very involved in my church and other things. (I always have to be busy) I find it extremely hard to relax and just not do anything and also my biggest problem is feeling “keyed up” all the time, especially around my 3 young sons (2 of which have recently been diagnosed with ADHD).
My current med regime is 10 mg of Ritalin (generic) 4 times per day, 18 mg of Strattera per day (to help with anxiety) and 60 mg of Cymbalta. Before I started taking anything for my ADHD, I was taking 1.5 mg or 2 mg per day of Lorazepam to help me cope and just calm my nerves. I realize this is a very addictive but it was the only thing that helped me until I started taking Ritalin. As soon as I started taking Ritalin I noticed I was taking less Lorazepam. But because of the big let down in the evening, I decided to try Adderall as I had heard that it was smoother. I took it 10 mg 3-4 times per day and became extremely anxious. I had a huge anxiety attack and my dr. told me to stop taking it.
She now has me back on the Ritalin IR (10 mg) 4 times per day. My question is it seems to only last 2-3 hrs for me and I find myself feeling slightly anxious still especially right before the next dose. Do you think I am having withdrawals from the Lorazepam or is my dose not big enough of Ritalin. I’ve only been taking Strattera for about 4 days so I don’t think it has helped my anxiety yet. I know this is probably confusing, but any light you can shed on this will ease my wandering mind. Thank you.
Dr. Handelman,
I was involved in a MVA wand my seatbelt retractor was broken so I sustained some head trauma. I was having some personality changes and anxiety so my neurosurgeon referred me for neuropsych testing. My PCP had put me on Pristiq for the mood swings so the psychologist that performed the testing recommended Concerta 18mg, Xanax .25mg for acute anxiety episodes and switching from Pristiq to Cymbalta. My PCP wasn’t comfortable with prescribing these meds so he referred me to a psychiatrist for medication management. The problem is that I can’t get into see him for 1 month. The Neurosurgeon did call me in a 1 month supply. First, I think the Concerta is helping me for about 2 hours then I can’t tell much of a difference. Also the anxiety seems to be better. Does this mean I need a higher dose? Also, since I have to wait a month for medication changes, should I take 2 on the days I work and not take it on days I don’t work? This is a frustrating situation. 2nd, I’ve always had insomnia and work night shift and continue to have difficulty sleeping. I’ve tried Ambien and Benadryl and they do not help. Do you have any suggestions? 3rd, I’m not sure how to transition from Pristiq to Cymbalta and my Dr. didn’t know. I feel horrible when I miss a day of the Pristiq but the psychologist thought it might be contributing to my anxiety. Also since I feel bad when I miss a day, should I switch?
Hello,
I have been on 20mg methylphenidate 3 times a day for about 6months. It worked great for a while. But I have noticed it basically stop working. NOt totally but I was not getting the great benefits as before. I have never had side effect, it simply made me concentrate, follow through, and work. As soon as it started “not working” i told my doc and he suggested we try Concerta 36mg along with my normal dosage of 20mg IR 3 times a day. I have read as many places as I can to see if anyone else it taking this combination and really not finding any. Did the doctor do right? Today is my first dazy to try it. Just wanting to know I am not alone out here with a doc that is maybe not familiar with dosage…..???? Any comments or help would be great!
Peace,
Jai
What doctor would put a five year old on medication that strong? I don’t agree with that at all, no kid should be drugged, I don’t think the doctor knows what he is doing….
Hello Doctor
Just quick question, will Concerta or Ritalin have adverse interaction with Modafinil? The reason I ask is because I feel that Concerta/Ritalin makes me sleepy and was considering taking modafinil along side.
Also just to make sure, does the outer crispy yellowish layer of concerta contain the drug? Again I ask because concerta gives me insomnia at night and doesn’t work well when it should, so sometime I break the 18 mg pill and only eat the white part inside and throw away the gray part, but I wasn’t sure if the coating also contains the drug.
Thank you.
Somi
For Carolin, to read about research done on medication for preschool kids, please read: http://www.addadhdblog.com/adhd-medication-for-3-4-and-5-year-olds/
For Somi – I’m sorry, but I don’t know about taking modafinil with ritalin or concerta. Best to check with your doctor or the pharmacy.
Dr. Kenny
http://www.adhdworld.com
Hi Dr, My son is 7 year old and has been in treatment with 10mg Ritalin twice a day, one al 7:30 and the other al 2:00pm, now his dr has suggested us going to concerta in order to avoid the noon pill.
He has suggested us going to 18mg concerta but from waht I read avobe it seems to be not the equivalente dose.
The question is how to traslate a 20mg total dose divided in two pills to the concerta Dose. Here in Argentina the 27mg is not available, just 18 and 36.
Regards and thanks for your help.
Hi Dr H
I’m seeing my family Dr this week to consider changing my 8 yr old son from rubifen to concerta. He presently takes 10mg as soon as he gets up, 20mg SR just before leaving for school, 10mg at lunch and 5mg at afternoon tea. Someimes he gets a 10mg after school if we have plans for later. He is another child that seems to metabolise the meds quickly. So I’m picking the correct concerta dose will be 54-72mg. Considering he has been medicated with stimulants for 2 yrs, whats your opinion on starting with a very low – and perhaps ineffective- dose, rather than initially starting with a 36 or 54 mg dose. He has had no apparent side effects of the stimulants, althugh his sleep problems that were very evident before commencing medication are starting to return and we are trying melatonin with good results.
By the way, he is a young fan of green day – and was astounded in a good way when I told him some of the members have adhd – thanks for that!
Cheers – Angelique in New Zealand
Hi there,
My son just got upped to 27MG of concerta, he was on the lower dose, but was recommended to go up as it was not enough. now he takes it at 8 in the morning and by dinner time he is not hungry at all and he CAN NOT SLEEP! He is just not tired at all. I have been up with him until 1 or 2 in the morning some nights as we get up for school every day. Please help, are these side effects? will they go away? what I can do about this?
Thanks!
Angelique: Talk to your doctor to hear his/her experience. I would generally start with a middle dose of concerta and quickly move up – i.e. I would probably start with 36 mg and quickly (i.e. 4-7 days) get up to 54 mg and see how that works.
Christy – You’ll need to talk to your doctor about this… This is a side effect of concerta, and won’t likely go away with time…
Best,
Dr. Kenny
http://www.adhdworld.com
Hi Dr, My son is 7 year old and has been in treatment with 10mg Ritalin twice a day, one al 7:30 and the other al 2:00pm, now his dr has suggested us going to concerta in order to avoid the noon pill.
He has suggested us going to 18mg concerta but from waht I read avobe it seems to be not the equivalente dose.
The question is how to traslate a 20mg total dose divided in two pills to the concerta Dose. Here in Argentina the 27mg is not available, just 18 and 36.
Regards and thanks for your help.
Despite the lack of experience in prescribing 2 Concerta doses a day to extend coverage with most doctors, I would strongly recommend it as a veteran Concerta user. If you look at the pharmacokinetic profile of Concerta, it doesn’t just have a smooth ascending profile; it has a very unusual shape. From about 1 hour to about 4 hours after ingestion, it has a flat profile equal to about 20% of the nominal dosage. After 4 hours, the osmotic pump starts pushing out the second load of Concerta, which peaks about 6-7 hours after ingestion. After about 7.5 hours, the reservoir is empty, and the profile falls very quickly after that, giving Concerta an effective coverage of about 9 hours.
If you take 2 doses back to back 4 hours apart, you can effectively extend coverage by about 4 hours to a total of 13 hours coverage — just enough for most adults. Then you can use MPH IR (aka Ritalin) at night if you need to be focused for something at night.
The optimal way to stagger Concerta IMO is to think about the total dosage you need for the day and split it into a morning dosage of about 60% and a second dosage 4 hours later of about 40%. So if you need 90 mg, take a 54 mg tablet qAM and a 36 mg tablet 4 hours later. Obviously, if you need a different daily dosage, you might not be able to get a 60/40 ratio, but it should be close enough.
The reason why 4 hours apart and a larger + smaller dose configuration is recommended is because that’s the best way to combine 2 profiles so that the peaks and plateaus of the second dose immediately follow the peaks and plateaus of the first dose and maintain an ascending profile that most closely mimics the single dose original profile with minimal gaps or valleys and minimal peak overlap.
If someone can tell me how to upload or link to an image, I can post a graph of the profile so you can see what I mean.
———–
To answer a previous poster’s question on why they feel tired about 3 hours after taking Concerta, it’s because 3 hours is about how long the MPH IR (regular Ritalin) coating lasts for in adults. Kids metabolize MPH less quickly than adults, making the 4 hour wait for the osmotic pump to start delivering the second dosage just fine. But for adults, what happens is that you have a bit of a dip in effective dosage from about the 3-4 hour mark. And since one needs an ascending profile due to quick intra-day tolerance, that dip at the 3 hour mark means you’re not effectively treated for about an hour and a half until the second load starts getting released from the inner layer of the tablet.
If you need to be focused during that 1.5 hour dip, my recommendation is to take a mini booster of MPH IR (regular Ritalin) equivalent to about 5-10% of your daily dosage (so about 5 mg for most people) about 2.5 hours after you take Concerta. Since the MPH IR is only really effective for about 3 hours max anyways, it will have worn off by the time the second peak (6 hours) arrives.
My son is 16 and was “diagnosed” with ADHD when he was about 6. We have been back and forth for many years with different medications, different behavior contracts, etc… He was doing well with 25mg of Adderall XR until recently he says it makes him feel “depressed” late in the afternoon. He is refusing to take it and the doctor he goes to now says if we want to try the Concerta we should take him to a psychologist. I need to try something because I know the medication works when he takes it. The phone calls from school are at least cut in half. Does he really need to see a psychologist or do I just need to find a new doctor?
Rene,
I assume your current doctor is a GP? Yes, you should find a new doctor. Family doctors usually don’t have that much experience in or have the latest knowledge in ADD compared to a psych. And by psychologist, do you mean a psychiatrist? A psychologist is not a specialist, whereas a psychiatrist is (i.e., they have their FRCP or FACP). Ideally, you would find a psychiatrist who has significant experience with ADD patients. It’s kinda like how you would rather a cardiac surgeon perform surgery on your heart as opposed to a regular family doctor.
My child is a 7 year old with Celiac disease that has caused him to have very ADHD like tendencies. We find that with diet/supplements we have been able to really help him alot, but he still has some aggressive outbursts that he needs help with.
His pediatrician prescribed 18 mg of Concerta, and my son did great in school but after he got home he was bouncing off the walls and developed a tic.
Is there a way to give him a lower dosage just to get him through school? I have not been very interesting in trying another drug with him since the concerta nightmare, but wondering if a lower dosage of something to help him in school would be a better plan….
Thx
my 14 year old son has been on 36 mg Concerta for a few years, when we attempted to increase the dosage to 54mg per doctors recommendations my son said he had horrible stomach cramps all day, after talking with teh doctor we backed off the dosage to 36 mg and wish we hadnt, he was recently expelled after a second fight at school, He seemsto have developed ODD as well as ADHD, Previous MD has said that 54 mg was largest dose she would prescribe. my son is 6 feet tall and about 150 pounds so the 36 mg dosage just doesnt seem to be enough, we are making an appointment with another MD in the morning to see what his recommendation may be., do the stomack symptoms associated with teh increased dosage subside with time or is it something he will have to get used to
My 17 year old has been taking 56 mg. of Concerta for about one year. We pay out of pocket and just learned that there is a generic long acting ritalin that is much less expensive -methylphenidate CR 20 mg. Do both have similar effects and would you think it worth talking to our dr. about a trial? Are they equally safe and what would be the dosage conversion.
Thanks so much.
just diagnosed 2 weeks ago with ADD at 30 years old. started with 27mg concerta less than a week ago and it makes me mostly tired after an hour or 2 of taking. seems like a roller coaster between feelin unmedicated to constant yawning. my question is if u think my dose is to much or not enough. talkin to my doctor this week and would like an educated oppinion.
thanks,
corey
My son was just diagnosed with ADHD and is almost 7 (next month) and was on 18mg of concerta for 1 week. He had trouble the first night sleeping and was agitated and thrashing about in bed and coulding seem to control it. He called it jiggering! He was on that dose for 1 week with no additional problems the following nights and then the doctor doubled it to 36mg. He has had the trouble sleeping and “jiggering” for the past three nights. Is this a normal side effect. The doctor doesn’t seem concerned and said to continue for the next week. It’s very disconcerting to watch him go through this. During the day he seems to be fine and is doing much better at school.
Hi:
My 19 year old daughter was just diagnosed with ADHD minus hyperactivity. We suspected a learning disability for years but because she was in a supportive private school all her life and had a very close knit helpful family, we never sought a diagnosis. After a year of great struggle her first year in college, she was diagnosed. her doc is recommending Concerta. This is all so new to us. It is good to read so much info.
My question is – how much counseling and help will she need after she bgins medication to make lifestyle changes and break bad habits that have developed over years? How dramatically does Concerta work? Will she be able to make the changes on her own? She is probably a moderately severe ADD girl.
Liz:
First, this should be a huge turning point for your daughter. I started taking Concerta (which is just a time release of methylphenadate aka Ritalin) in 1996, 3 years out of college. It changed my life, my career took off. I struggled to no end in school and from the 7th grade through college ALL I DID WAS STUDY; I was determined to learn but focusing was really hard. That being said, I hope this gives you hope.
To answer your questions. I needed no counseling at all, I just needed the medication. Lifestyle changes and breaking bad habits are not necessary at all as was my case — again, all I needed was the ability to focus. If her bad habits consist of working hard at school, don’t break those.
The only warning is that having the ability to function can be a little exhilarating and one may get ahead of themselves in social settings by blurting out thoughts and answers — this is typical of ADD and learning to relax and take it easy takes some focus unto itself.
Adrian — your child should only be taking the Concerta first thing in the morning (lasts at least 12 hours for me). Concerta/Ritalin/Methylphenadate can give some people tics. I suggest giving the medication time, at least 5-6 weeks unless it is really interfering and creating such things as social stigma.
Corey — yes, sounds like you may be over medicated. Originally I started off at 5mg then slowly and eventually went up to 54mg and took that for years. But then, years later now I dropped down to 36mg.
Maureen — Concerta is Methylphenadate. Concerta and Ritalin are just name brands. I suggest trying it; you can always go back. There should be no to little difference. My old rx prescriber swore by the brand name Concerta (and Ritalin before Concerta was available).
David — a 1 day stomach ache could be something else, no?
My advice to people with ADD (in order of what I think has biggest impact):
1) try liquid vitamin B12 daily (brain function)
2) Try Colosan in powdered form (this helps me to absorb my food [energy] better, and I believe it removed toxic plaque from my system). I take it ever 4 to 8 weeks. Initially taking this gave me lotts more energy and ability to work/focus for longer hours. Search on Amazon for it.
3) get exercise at least once a week. This goes right along with good study/work habits like taking breaks, going for a walk (especially outside where you can look at distances).
4) go to sleep early and at a regular time daily (I sleep from 10:30pm to 6:30 am); the ADD brain needs more rest (even 1 hour more makes a difference)
5) drink a glass of water (a whole glass!) first thing in the morning. Don’t dehydrate your brain!
6) take high quality fish oil (nordic naturals) daily (high GLA and DHA are good for brain)
7) avoid caffeine (try tea’s like redbush and yerba mate)
9) Avoid all food with preservatives (yes all junk food).
10) Kill your television if you can; don’t waste your brain use it! The brain is like a muscle, if you use it it gets stronger; doing something that takes focus helps decrease distractability. The internet is alot more interesting and so are books then bad acting, poor plots and weak editing. Yes, I know this is y opinion but I’m just sharing the things that have worked for me.
11) Keep a sense of humor. You will be ok in social settings as long as you keep your sense of humor. I know what it feels like to not fit in but a sense of humor is akin to being a relaxed person and I have learned the hard way that people don’t want to be around people who are going a million miles an hour — it freaks them out.
Alot of these things I learned from a doctor; see his presentation here — around the 40 minute mark it gets interesting. http://www.youtube.com/watch?v=2utqmVGPCt0&feature=PlayList&p=9055A044429A5DC2&index=0&playnext=1
I think I have been able to cut my use of Concerta in half because of doing these things and I have been taking Concerta since 1996.
I would like to add… I am approaching 40 and have tried all the ADD medications; in my experience nothing works as well as Concerta (Ritalin, Methylphenadate) in terms of targeted effectiveness and little to no side effects. Methylphenadate has been around the longest probably for good reason.
Hi My 5 year old son just switched to Concerta 18mg. He was just diagnosed w/ ADHD. He was on Vyvanse for a little over a week. When he first took the Vyvanse he was able to be still but talked non stop for 3 days and had trouble sleeping. That finally got better and he started doing much better in school for two days and then he started cying and whyning all day at school (he has never been a cryer or whiner) He also was becoming very anti-social which really worried me as he’s usually wonderfully outgoing. The doc suggest the switch to Concerta it’s only his first day so my concerns probably aren’t valid yet. It seems to be doing well it’s def. not stimulating him too much like the Vyvanse. It made him somewhat sleepy and lazy all day. Is this normal at first? On the positive he did go right to sleep tonight. Should I be worried he will have the same emotional problems he was having on the Vyvanse? I really hate the thought of making my smart funny happy child into a crying, irriated mess. Sorry as you can tell I’m a nervous mommy who is very nervous about him being on meds, but nothing else is working and this seems to be the last option. Any advise would be welcome. Thanks!
Hello. My son is 13 and weighs approx 90-95 pounds. He has just started taking 25mg of Biphentin (1 10mg and 1 15mg). He has been on concerta recently but was having difficulty swallowing it so his doctor recommended the switch. I have noticed on both meds that it is lasting about 15 hours. He does not eat at all and falls asleep way after midnight. If I give him 15mg only will it do its job during the day and wear off by suppertime. He does not need the benefits of the meds after school time. The medication works well for him during the day but I find it lasts too long into the night. I was also wondering if I decrease the mg will he be less focused but still last the same 15 hours?
Thanks so much!
Hi Marla,
If the Concerta and Biphentin are lasting too long (i.e. 15 hours), then you could talk to your doctor about taking a shorter acting form of methylphenidate. That would include: Regular Ritalin, or Ritalin SR. Alternatively, you could try another medicine – such as dexedrine or Adderall XR. Talk to your doctor about your options. Lowering the dose of biphentin may decrease the duration of action, but it will also decrease the effectiveness.
Best,
Dr. Kenny
I am 22 and have been struggling with daytime sleepiness for about nine years now. I manage to confound every physician who examines me, and no therapy has been helpful except Provigil, to which I eventually became tolerant. Recently my doctor theorized I might have ADD and prescribed me Concerta 36mg. The first day I took it I felt much more energized and was able to go a full 16 hours without a nap. On the second day the pill stopped working, and hasn’t made a difference since. Could I be experiencing tachyphylaxis? I’ll be seeing my doctor again soon and any insight you can provide would be very helpful.
Hi I posted about a week ago. My 5 year old son has been on Concerta for a little over a week. It’s def. helping with the hyperness and impulses but he is still very emotional at school. We switched from Vyvanse b/c of this same problem. He’s seems to be getting upset anytime he is having to change activities. I have also noticed some anger not an alarming amount though. Should we stick w/ the Concerta for another week or is this something that is likely not going to go away? I am also wondering since he’s had emotional trouble w/ two diff. meds is this going to be a problem w/ all the ADHD meds? Any advise would be very helpful Thanks.
Hi, i’m a 22 year old male who’s currently on 54 of concerta. i’m considering going for a higher dose but also, i notice the pills going through me quicker then they did before (was on it back in early ’06 with great results.) and i almost feel/think that my body’s not getting the chance to digest/absorb the medicin as much. could it be that or is the dose too low? if not then is a way to make stuff not go through you so quickly? please help, thanks!
Chris,
Do you mean that it doesn’t last the entire day? I find Concerta only really lasts for around 9-10 h, so if you want say 13+ h of coverage, you’re going to have to split up your doses. For example, take 36 mg when you wake up and then take 27 mg 3 h later. This should extend you coverage by 3 h. The reason I say 3 h is due to the 2 phase distribution with a small peak at 2 h and a bigger peak 5-7 h in. You want to stagger the dosing so that the
Anwar,
“so that the…”? haha, looks like the you got cut off there.
but no i’m not looking to extent the coverage i’m just looking to see how to make it more effective. when i combine a 54 with a 36 it’s pretty good but for some reason it’s still not great and it used to be GREAT even when i was only on 54mg. i just find it strange, puzzling and it sort of gets me down because i KNOW that i can be performing so much better. it’s lasting as long as i’d like i just want it to be more potent. it seems like i’m not digesting enough of it, it’s just going right through like a bad taco bell meal.
what to do??:( thanks.
note: when i said “it used to be GREAT even when i was only on 54mg”, i was talking about when i first went on concerta back in 2006. the 54 mg isn’t that good at all now and is only ‘good enough’ when combined with 36. *sigh* i just don’t know what my body/brain wants me to do for it.
Hey Doc did some searching and read this post and I thought I would chime in and ask you a question. Approx. 18 months ago I suffered a serious head injury and I now see a neurologist. I have never taken any medicine similar to that of ritalin, concerta, adderall but I am now forced to take one to help me concentrate. I started taking 10mg of ritalin about 2 mos ago and they worked great but did not last as long as I needed it to so that pushed me towards the long acting ADD medicines. Instead of a long acting ritalin, ritalin CR? He prescribed me 27mg of concerta. The concerta helps me get through the day but when I need to do work for school it does not help me nearly as much if I were to take a Ritalin. I had some left over 10mg ritalins so I would take 1 in addition to the concerta when I needed to do work and that worked great for me but when in asking him to prescribe me both he told me that the insurance company would not be liking that. Now I am wondering if this is true, if there is a long acting ritalin that works differently than concerta? I will do some more searching and check back for your response, thank you so much for taking my question.
Hey Doc did some searching and read this post and I thought I would chime in and ask you a question. Approx. 18 months ago I suffered a serious head injury and I now see a neurologist. I have never taken any medicine similar to that of ritalin, concerta, adderall but I am now forced to take one to help me concentrate. I started taking 10mg of ritalin about 2 mos ago and they worked great but did not last as long as I needed it to so that pushed me towards the long acting ADD medicines. Instead of a long acting ritalin, ritalin CR? He prescribed me 27mg of concerta. The concerta helps me get through the day but when I need to do work for school it does not help me nearly as much if I were to take a Ritalin. I had some left over 10mg ritalins so I would take 1 in addition to the concerta when I needed to do work and that worked great for me but when in asking him to prescribe me both he told me that the insurance company would not be liking that. Now I am wondering if this is true, if there is a long acting ritalin that works differently than concerta? I will do some more searching and check back for your response, thank you so much for taking my question.
Dear Dr,
I am 41 and was just diagnosed with ADD (no hyperactivity, just impulsivity). I was consulting a psychologist for a burn-out caused by family problems and work. I’ve been at home since Jan 2009. One complaint was that my 7 year-old son is failing in school, not being able to read. So he did some tests and he thought I should do them too as he had his suspicions about me having ADD too. He was right. He suggested Concerta, which I started at 18 mg 4 days ago. This dose seems way enough for me. I weigh 170. I feel good, but I wouldn’t add more. Is this normal? Is it possible I don’t need this medication?
Also, I have my reservations about medicine. I’m a smoker (8-10 a day) and I like a glass of red wine after dinner. I also excercise every day in order to get over this burn-out. It helps me feel better. I walk 40 minutes, do abs for 15 mins, and mild aerobics for 30 (but not every day). Am I in danger of heart problems by adding Concerta? If such a low dose does enough for me, maybe excercise alone could resolve all the issues in my case ?
My son was prescribed Ritalin twice a day.
Thanks for your help!
Fanny
I am 14 and I have been taking Aderal every morning through the week since I was 7 or 8. I’m never hungry. I’m a vegiterian but I don’t even really eat wegtibles. I do not eat school food. I do not eat breakfast or lunch and barely anything for dinner. I can last 18 hours without out using the restroom. And through the day I feel like I could pass out. And my weight changes through the day, practically every 3 to 4 hours. But I never go down or up more than 4 pounds in the day. And it takes me like 5 to 6 hours to go to sleep. And when I do go to sleep I always wake up and it takes another few hours to go back to sleep. And I don’t know why. And I want to lose 5 pounds. Any docters or someone know why or have any advice? what do u mean Ive already said THAT!
Hi all,
I have a 10 yr old son who was dx with ADHD 5 yrs ago. He started on Concerta 18mg. He has since been upped to concerta 27mg and now his dr. has added 5mg ritalin for the afternoon because he could not concentrate on homework. My question is if he takes 27mg of concerta in the morning, and 5 mg ritalin in the afternoon, do you think it would hurt to give him melatonin before bed because he is having the toughest time going to sleep? He will lay there for up to 3-4 hrs before falling asleep. I put him in bed at 8 and at 12 when I go check on them he is still awake alot of the time just laying there saying he cant sleep. I cut out the afternoon ritalin dose but then we started having problems in the afternoons again. I am at a loss. someone told me melatonin would help him and that it is all natural, but I need to make sure it is safe to add this to his other medications. Please help.
some times i do good without my concerta 72mg do i need a lower dose of concerta. concerta makes me sleepy in the morning but not in the afternoon.
Hi Jenn
I have a 9 yr old, taking 54mg concerta, and occasionally 10mg ritalin depending on schedule in the afternoon.
We have used melatonin with a great deal of success, particularly with sleepovers etc. I would try it, we have certainly had no ill effects from the melatonin.
Angelique
Hi my daughter is 6 yrs been diagnosed with ADHD she was on Ritalin 10mg morning 5mg arvo and i had to change doctors and he changed her to the concerta 18mg and its like it dosent work i found the ritalin had a better effect when she on the concerta their if no difference at all to when she not taken anything at all.
Larain,
I find it hard to believe your weight changes 4 lbs a day. Perhaps it is the clothes you are changing from and to? Look, your body needs nutrition! You need to eat. You can inflict irrevocable damages to your metabolism and I have seen this with several female friends I have known since I as 15 (I am now 39 — which you may think is old but it really is not). One friend is unnaturally thin and the other obese — neither of them are happy about this either way. It is not attractive to be too thin or too heavy, everything should be a balance. You need to feed your body because your body is precious; don’t forget that your body and mind are inseparable and you need to support the body for the brain to work. I could go on and on about this because anorexia scares the hell out of me.
Angelique and Rebecca. I used to take 54mg Concerta. Now I take 20mg of Metadate CD. Concerta stopped working on me and I had to cut way back and start over again. It is possible to be taking too much and it is possible for it to stop working. Be aware of this. The critical years in education are definitely not 9 years old — personally I think they are just before and during college. Here is some food for thought:
http://www.nytimes.com/2009/09/06/magazine/06FOB-wwln-t.html?_r=1&ref=magazine
I take magnesium (with lemon water at night — has activation element to it). I go to sleep at the same hour every night. I get exercise. These things have allowed me to cut my medication in half. I am not as on-point or sharp but I am relaxed and in my body and no one knows I take medication — whereas before they suspected it because I was too on game. It may sound like I was simply over medicated but taking less did not work — it seems these other elements were needed.
There is no quick fix, you and your child need to be in this for the long run so don’t over do the meds. This is an opinion but an experienced one — been taking meds since 1996 when I was 26 but for a stint when I was 12. The first step is to relax. There are far worse things a child can grow up with (like autism and epilepsy) so don’t take ADD/ADHD and learning disabilities (challenges) to be a huge deal. I too have a child and know how much you want your child to live a normal life. Taking meds for ADD/ADHD is a very new development in the history of time. I would under medicate since medications can stop working over time. Stay in this for the long run.
If your child need melatonin, it is possible they are taking methylphenadate too late in the day. But then again I know plenty of people, including my wife, who just don’t sleep well.
I don’t mean to sound judgemental or fatalistic, my intention is to give some food for thought.
Hi there,
My daughter started taking 18 mg of Concerta in June 2008. It has been very effective (increase in attentiveness, more impulse control, etc). Her last year of school was her best ever
All of a sudden this past month it seems like the medication is no longer working. Is this possible? I have heard that some people metabolize the medication faster than others, but if that were the case…wouldn’t this have happened sooner? It’s so “out of the blue” (she hasn’t had any changes in health, habits, etc and does not take any other medication other than a daily multi-vitamin for children. She just turned 9 years old.). Any advise/information you can provide in this area would be appreciated. Thanks!
Fanny,
Exercise is a good antidote for ADD/ADHD (I too have just the impulsive and inability to focus). Edward Hallowell who wote the seminal book Driven to Distraction uses (or at least used to, not sure of current status) exercise as an antidote for his ADD. It helps me but is not the only picture of the puzzle.
I don’t know if the amt of meds you take is really such a function of weight (it’s just what your brain needs). As far as heart issues — read the side effect / warnings and speak with a competent doctor; relevant questions/concerns include do you have a history or a family history of heart problems…
Taking this could really help you with your burn out. My sympathies there. Give it some time, it could really help you move on.
As far as your 7 year old failing in learning to read. If it’s any consolation my learning really didn’t initiate until the 4th grade and really even the 7th grade and I went to a well regarding college and work for a “prestigious” company.
I’m a proponent of under-medicating as these meds can not work over time and I would rather see it work as long as possible.
I’m a proponent of taking magnesium also. Esp with fresh lemon juice and water (or apple cider vinegar). This has helped me significantly but is not a cure-all for me.
Marlaa,
Metadate CD does not last as long as Concerta, falls off more rapidly and according to studies is more effective in the earlier hours of usage than concerta.
My son finds the Concerta makes him “hyper-focussed” (to use his words) during sports and hurts his performance because he’s not looking at the whole playing surface. His games are 2 1/2 hours long when he plays. However it seems to be helping his schoolwork and concentration at school.
Can he take it on non-game days and on those 5 schooldays in a month when he has a game just not take it?
Hi, Doctor
I’m a 23 year old female college student. I was diagnose with depression about 2 month ago, and since then I have been taking Cymbalta 60mg as I was very emotional and edge, cried extremely easy wile being tired all the time before.
Since Cymbalta it has helped me improve a lot. I was no longer tired and became a much happier person over all and felt like myself again. Except, I was still unable to concentrate. My doctor has known me for many years and he believes it’s because I have ADHD. So he put me on Ritalin 10mg as well with the Cymbalta. I took it for about 2 and a half weeks love it and I was able to focus better. But it did give me crashes throughout the day. So from taking twice a day I switched to it 3 times a day. Witch gives me better results.
Later my doctor switched me to Concerta 36 mg. I’ve been taking it now for 3 days. It defiantly made me concentrate better. Except that I am always tired. My doctor thinks it’s because the dosage is too high, but I was taking the 10mg Ritalin 3 times a day doesn’t that = 36mg Concerta.
I would like to know why I’m always tired. I talked to my doctor and he believes it’s because I am very sensitive to Med. And decided to move to down to the 18mg Concerta and see how I will do I haven’t started it yet since I only get the med today but I will update you.
The other thing was both meds. Give me the jittering feeling and Concerta made feel really lazy. And cant’ even motivate myself to clean my room. I really need to get better as this is effecting my life and I need to get a part-time job. Working as a bartender, but with this jittering feeling I’m worried that I won’t be able to work proberlly as I had problems before on caffinee where it made me all jittery too and I was unable to poor drinks with out spilling and felt lost. And unable to cope with the fast demand like I was before.
Please give me any advice you can as it will be really appreciated.
Thank you
Rhonda
In response to Heather O. Our teacher noticed just this month that something had really changed. Our child too had been doing great on the Concerta 18mg and very suddenly changed. The pill looks slightly different than it did before which is interesting. Images of the two different looking concerta 18mg are available on drugs.com throught the pill finder option. This doesn’t solve the ultimate problem of the lack of efficacy now but may provide a clue as to the change.
I have a 22 year old son (6’1″/ 245 lbs) who started with generic 10 mg ritalin X2 at age 6 and has been on Concerta 36 mg since 7th grade. At this time he works nights (9pm-5am) he takes his Concerta about a 1/2 hour before going to work; I think it takes him through but not really sure as he feels the need to drink 1-2 Mountain Dews to keep him going. I really would like for him to not drink the pop for several reasons, but I don’t want him not to be able to function. Does he need a higher dose? Is it even good for him to drink a high caffeine drink? Are there alternative ways?
Sue
I started take concerta 18mg, and i dont notice anything besides drained and tired alot.
I just wanted to know if its safe to take two dosage of concerta to help me concentrate.
Concerta is extremely inefficient then, no?
Concerta is inefficient, then, correct? CADDRA recommends a max daily adult dose of 100 mg/day of mph ir. To not surpass that total daily mph dose, the max OROS dose one can take is 108 mg…yet this is equal in efficacy to 72 mg ritalin ir take three in a day. So you’re essentially losing 98 (total absorbed mph with OROS 108) – 72 (effective dose) = 26 mg of efficacy?
Or am I missing something?
Also, can intense focus/stimulation ‘knock out’ mph?
mph is a dopamine reuptake inhibitor, correct–it attaches itself to dopamine transporters?
adhd-ers often pursue stimulating situations to make up for their poor dopamine regulation.
if an individual is on mph, and floods their brain with dopamine via intense stimulation or hyper-focus, can that ‘knock off’ the attached mph, or render it less effective?
I find my OROS mph (which I’ve been on a couple of weeks, now at 72 mg), dies on me when I get really overfocused on something or intensely stimulated…sometimes after 4 hours!