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.
Dr. Kenny: My 9 and 1/2 year old son had been doing really well on 27mg of concerta. Well in school, well with his after school tutor and much better at home. However, for the last month or so it’s all been downhill. He has been on this dosage for the past year and 1/2. Is it normal for the dosage to be increased after this time? Is it because of his growth or a developing resistance? I would greatly appreciate your opinion and would also love to be refered to any articles or info on this issue. Thank you.
November 15th, 2009
Dear Dr. Handelman,
I am 48 years old and have been living with CFS since the age of 29.
I was put on Ritalin(SR) and(MR=Modified release) two months ago, and I sped up to 60mg daily after only a few days.
At that time I was also taking 275mg Venlafaxine(XR)daily, which I reduced to 150mg daily only five days ago.
I take Nimotop(nimodopine)130mg daily, and Sorbon(Buspirone)60mg daily
However, I am still feeling brain fog and exhaustion, especially between 12 noon and 4/5pm.
I take the Ritalin 40mg in the morning, and sustains me till 12pm noon, after which I take a further 20mg, but this does little to improve my fatigue.
I would be very grateful if you can give me the benefit of your experience. I read that 60mg Ritalin is the maximum adult dose, but given the fact that I am big at 6ft tall, and bordering on morbidly obese,at 260lbs(belly fat mostly), I wonder if taking 80mg Ritalin(Modified release) as the very maximum dose at 12pm,would see me through the afternoon hours.
I do wish to return to my exercise routine, and have more energy.
Thank you so very much for taking time to read my comments.
Hi Hannah,
Some doctors are willing to go above 60 mg of ritalin, depending on several factors including your health and the cardiovascular side of side effects.
Ask you doctor!
Also, one of the long acting medicines – i.e. concerta, or even metadate may cover later in the day better.
Best,
Dr. Kenny
Doc,
I recently started on concerta for ADHD. I’m currently taking 54mg but I’m having problems sleeping. My Doctor prescribed me 30mg of Restoril @ bedtime but it has no effect.
Questions:
1. What’s a good combination with Concerta for insomnia?
2. Are there any known ADHD medications that does not have a side effect of insomnia but are good as Concerta?
Hi,
EJ – for sleep – talk to your doctor about options like: zopiclone, trazodone, or even melatonin (over the counter).
Regarding ADHD medications – all of the stimulants can cause insomnia. Strattera – the non stimulant doesn’t.
Good luck!
Dr. Kenny
Dr. Handelman,
First of all, your website has proved to be an invaluable resource for me since my son was diagnosed with a signicant case of ADHD earlier this year.
My son has taking 27mg of Concerta for 6 months now, after having started out on 18 mg. The side effects have been minimal, mostly upset stomach which seems to resolve if he eats something. However, his teacher reports that mornings are still a real struggle for him, and that after lunch he seems like a different child and is able to focus and his impulsivity is controlled. She tells me that his attentiveness and behavior is “night and day difference” from the morning to the afternoon. I am giving him the Concerta at 7am, believing that by the time school begins at 8:45, the medication would have set in by then. However, after reading your posting on Concerta’s ascending profile, I’m questioning whether we need to try a different medication, one that kicks in earlier in the morning, or increasing the Concerta dose.
I’ve also thought about requesting that my physician prescribe a low dose of Riatlin, say 5mg, for him to take at the same time he takes the Concerta, because that medication is fast-acting, and it may do the trick until the Concerta kicks in for him in the afternoon. Honestly, I’m not sure what to do, and whatever advice you could offer would be mostly appreciated.
Thank you very much!!
Hello Dr. Handelman,
My 14-1/2 y.o. son who is on Concerta now for a few years (taking 54 mgs.) has been having trouble focusing for months now according to his teachers. They say that they don’t feel he is really there and very unfocused. He hyperfocuses on drawing or trying to read in class and when asked to stop he becomes very fidgety. Some teachers allow a bit of the drawing because they know that it works for him in the class. You see it depends on the class. He has a B in SS but a D in two other classes and now a F in English (RLA). I asked his Dr. and he said to try splitting his pill into 1/3′s to see how that goes for about 2-3 days or so. I have not done that yet because I just wasn’t sure. I feel like 54 mg. is such a high dose. He is a string-bean of a kid as it is – right around 100 pounds I believe. Do you think there will be benefits to him increasing? Do you advise that? We don’t really want to try him on other drugs b/c we have done that in the past. Concerta seems the best…but only taking the top layer off his ADHD – we have kind of “settled” for this med; it is not the best/not the worst I suppose. We also have him take multi-vitamins and Omega-3 supplements. Thanks for an support.
Hi Laura,
It’s hard for me to advise anything specific on a blog.
I would suggest that you consider trying other medicines.
For example – if he hasn’t tried amphetamines -they may help.
If he hasn’t tried strattera, that may help.
Talk to your doctor about options.
Best,
Dr. Kenny
http://www.SafeADHDMedication.com
Dear Dr. Handleman
Thank you so very much for your reply.
I am faced with a very desperate dilemna.
I have CFS, and to make matters worse, I live in the Middle East, where the maximum dose of Concerta is 54mg.
I complained to my doctor, that the daily 60mg Ritalin SR dose was not meeting with its full potential, and asked him if he would prescribe me daily 80mg Ritalin SR.
My doctor refused, as in his opinion, a daily dose of 60mg Ritalin SR is already a very high dose, although he did say that its efficacy is for an 8 hour duration.
Consequentially, he put me on 54mg Concerta daily,
hoping that the 12 hour sustained effect of this dose, would improve my state of well being.
My doctor told me not to take Ritalin SR with the Concerta.
However,the daily 54mg Concerta has not made a significant improvement.
I still suffer from brain fog and fatigue, which led me to take matters into my own hands.
For three days now, I have been taking daily 54mg Concerta and 20mg Ritalin SR, which does meet with a marked improvement in my health.
I am no longer tired in the mornings, and my daytime fatigue has been somewhat lifted.
To my great dismay,my Pharmacist told me,that 72mg Concerta and Strattera are both unavailable in my country, but he said I could try and ask my doctor if he would be willing to tirate my Ritalin SR to 70mg daily. I will also ask my doctor about the Metadate, to assist with daytime fatigue.
Dr.Your blog is a lifeline of hope for me, and I would be very grateful to know, if this combination of daily 54mg Concerta and 20mg Ritalin SR is a safe dose to take,in your opinion.
The reason I am asking, is because the 54mg Concerta has a 12 hour duration, and the 20mg Ritalin SR lasts for 8hr hrs.
I take both drugs at the same time about 9am each day, and my heart rate is about 73-74 beats per second, although I do suffer from insomnia now.
I am quite confused, as I do not understand why Concerta causes insomnia whereas I had no problems sleeping whilst I was on the daily 60mg Ritalin SR.
Thank you very much indeed for your very helpful time, and thoughtful attention. Your feedback is most important and welcomed.
With best regards
Hannah – we don’t have concerta pills that go higher than 54 mg either.
When it comes to the concerta – to get to 72 mg – you need 2 pills of the 36 mg.
Why do you have insomnia with concerta whereas you didn’t with ritalin sr? Because concerta lasts longer – so it is interfering with your sleep.
I hope that helps.
Regarding dose – if you look at this document – from the Canadian ADHD Resource Alliance (i.e. Canadian ADHD experts) on page 8 – they recommend going as high as 108 mg of Concerta per day. Of course – your doctor has to agree!
http://www.caddra.ca/cms4/pdfs/caddraGuidelinesChapter06.pdf
All the best,
Dr. Kenny
p.s. I’ve just uploaded a free video on safety with ADHD medication here: http://www.SafeADHDMedication.com
Doc,
How early & late should Concerta be taken to reduce insomnia?
Thanks in Advanced!
Dear Dr. Kenny Handelman,
I have an 11 year old stepson who was on 36mg Concerta + 1mg respirdol. Recently my husband just got him for a weekend visit and he told us that he has to take 2 36mg Concerta + 1mg respirdol. Is it safe for him to be taking that much Concerta and for it his dosage to be raised that high the next day?
I want to know can concerta cause heart problems and if there has been any deaths regarding concerta or concerta like medications?
Hi,
I am a 20 year old college student, who has been taking medication since I was 7. I have been on Concerta since about 7th Grade, and my dosage was increased once when I got into High School. I am on 54mg right now, and I have noticed that it is not functioning as well as it used to. I am considering raising my dose, but I only weigh between 110 and 120 lbs (depending on the time of year), and I am worried about the side effects Concerta will have if I increase my dosage. I already have trouble getting to sleep at night if I take it past 9 AM, and I often get very shaky as well. Does weight have any effect on the dosage, or is it an irrelevant factor.
Thanks
Alice
Alice – with respect to weight – it does and it doesn’t matter.
Basically, you can usually ignore it – and just go up with the dose based on the response and the side effects. You are having some side effects, so you’ll need to be cautious.
Ask you doctor about a higher dose, vs. trying something different (i.e. an amphetamine medicine like Adderall or Vyvanse).
Best,
Dr. Kenny
http://www.SafeADHDMedication.com
Hi Dr. Kenny Handelman,
I’m giving my son Concerta for narcolepsy. Do you know anything about doses to control cataplexy. He’s taking 18mg now, but occasionally he still falls asleep when in the car or bored. I am more concerned about his cataplexy. Concerta diminished the amount of cataplexy but he still seems to have one once a day. Do you think If I up the dose to 27mg. it would better control cataplexy. My son’s doctor is out of town, and I need some advice.
Thank you,
Lynn.
Lynn – sorry, I don’t have experience or specific knowledge of concerta dosing for cataplexy.
Dr. Handelman,
I have an 8 year old son that has been on ADHD medication for almost 3 years. He started with Methylaphenidate, then Methlyn, which caused him to pick his skin terribly, then back to Metadate CD, and is now on Concerta. He started his dose at 36mg in the am, his Dr. upped his does in July to 72mg (2x36mg in the am). My question being, he seems to do great on his dose, and then literally OVERNIGHT, it seems not to work at all. I recieved a call from his school nurse today, wanting to put him on a health review program because they thought we were not giving him his meds in the morning. Of course we are daily, but his symptoms have returned OVERNIGHT, he cannot do his homework, function in class with the other children, etc.
I am concerned because of course it is the familiar scinario of needing a dose increase, but from my understaning, 72mg is pretty much the high dose for his age. ALSO, he WILL NOT EAT. He looks grossly malnurished. After begging his doctor, they put him on an appitite stimulant, but that seems to work no better than a sugar pill.
Please help with any suggestions, I am considering pulling him out of school to home-school him, as the ups and downs just seem SO severe, and his frustration far outweighs eveyone elses as well.
Thank you in advnace,
Mindy
My son is going through the same thing. The meds do not seem to work at all! I have even tried the intuive to extend them. Nothing is working! We tried the aaderal family of drugs but that made him so moody, one minute laughing the next crying hysterically! I am at my wits end
I am sorry, I forgot to add my main question to the above comment. Is it common for the symptoms to go from total control to not being controlled in that short of a time frame? Overnight? And if so, why such a variation? We know he takes them, as we watch him ingest both pills daily.
Thanks again,
Mindy
Mindy – while I’m not sure why this is happening – here is one thing to consider.
When people take the ADHD medications with anything acidic – it can make the medicine ineffective.
For example – taking vitamin C (or any juice with vit C, or even cereals with added vitamin C) can make the medicine not be absorbed properly.
Also – foods with citric acid as a preservative (most ‘bars’ that are in foil wrappers and can sit on the shelf for a while have this) can do the same thing.
Usually when I hear of such an immediate drop in effectiveness, it’s because a parent starts vitamin C to prevent a cold or something like that.
See if that helps.
Best,
Dr. Kenny
p.s. I’ll soon be relaunching http://www.safeadhdmedication.com which will have great tips as well.
Hi Dr.Kenny,
Thank you for trying to answer my prior question.
Can you explain the acidity theory, ’cause my son has juice and cereal every morning (and a health bar at least 3 times a week) -will that affect the medication for just that hour or all day long????
Thanks,
Lynn (son with narcolepsy).
Lynn,
The ADHD medications are mildly basic. When combined with mild organic acids (i.e. vitamin C, citric acid), they get ‘neutralized’ and then do not stay in the blood to do their job.
It is best to avoid these foods 1 hour before and 1 hour after taking the medicine. This may help to improve the absorption and reliability of the medication.
I hope that helps.
I interviewed a doctor about this, and will soon have that video up on the ADHD.tv video podcast. If you are subscribed to my newsletter, you’ll get an email about it.
Best,
Dr. Kenny
Dr. Handelman:
My 14 year old son is currently on 40mg of Focalin and 10mg at lunch. The medication is not working for him. He previously took 72mg of Concerta but the doctors do not want to go higher on Concerta. What can I do. The pediatrician will give me 90mg but is afraid to go higher. He is doing terrible in school and his progress report for the 2nd nine weeks looks the same. Can this be happening because his body has outgrown the dosage? He weighs 130 pounds.
Nivia,
These are the standard dose ranges.
Talk to your doctor about trying a different medicine if the methylphenidate medicines (i.e. focalin, concerta, ritalin) aren’t working anymore.
Best,
Dr. Kenny
Dr. Handleman:
I used to take Ritalin for a year (from 13-14 years old) but don’t remember how many mgs, but I stopped taking it because I told my doctor I really felt that I did not needed the medicine anymore as I was doing great, so yeah I stopped and continued doing very good until I was like 18-19, when I started again with a lot of problems in college and developed mild social anxiety. Now I am 22 and after struggling a lot in school and life decided to go back to a psych to treat my ADD again (I believe my mild social anxiety is linked to my ADD), I started taking Strattera with no effects other than sleepiness.
After trying Strattera for two months without success, I switched to Concerta, I started with 27 mg and after 4 days of not feeling any effects other than a little bit of trouble too sleep, I increased to 36 today, but still no effect at all, this time I even feel sleepy, my question is if its ok to ask my dr. to upgrade tomorrow for 54 mg in order to get something from it, as this is finals week? do you think is dangerous to do this as I only have been 1 day at 36 mg?
Thank you very much for your help to everyone, you have an excellent blog.
Diego – I think it is reasonable to talk to your doctor about quickly finding the effective dose. This can be done with stimulants like Concerta.
Good luck with finals!
Dr. Kenny
Doc,
I was taking 18mg of Concerta now I’m taking 20mg of Ritalin but sleepy throughout the day now…is that normal?
Dr. Kenny – Just had a kid last night on 35mg of concerta and they were thinking of increasing it due to kid acting out in school in afternoon, he is 3rd grade. I suggested that they give him half in am and half at noon. I see concerta is extended release. Can they still do that? Is there another med that would be better for this? Thank you.
Dr. Kenny,
My 8 year old son is on 10mg Adderall XR daily for his ADHD. He seems to be doing better in school, but when it comes to playing with others he does not like to lose and throws a fit just about everytime. We have been seeing a Psychologist for over 2 years for his ADHD and his moods are much better, but I am wondering if he needs to take a higher mg daily or should we think about changing meds all together?
Thanks
Paula
Hi Dr.
I just found your website. This is my story -
I have a 19 year old son in college. When he graduated from high school, he had a 3.8 GPA and 33 college credits from AP classes. We always knew he had “something” but several meds he tried over the years didn’t seem to make any difference. So we relied on “behavior modification”. Long story short, he got a 1.8 & a 1.5 his first 2 semesters in college and was asked not to come back. An official ADHD diagnoses got him readmitted. He was only home for one month on his meds – 27 mg Concerta & 18 mg Strattera. It’s impossible to get answers from him as to how he feels on the meds. But after reading se of these blogs, I’m impresses with your knowledge and I’m wondering what you think of the Concerta/Straterra combination. It doesn’t seem like the does are enough after reading some of these blogs. He is 6’4″ 175lb. Any thoughts?
Thank you
Jody
Jody,
It is totally fine to combine concerta and strattera. They work in different ways and have (mostly) different side effects.
The thing is – he is on very low doses of both. Unless he’s getting a great response – i.e. 80% or more of symptom reduction, he likely needs more. Average doses for his age would be around Concerta 54 or 72mg, and Strattera 80 mg. These could be slightly lower because of being on both, but he is in the low range. Talk to the doctor (or have him talk to the doctor) about this.
Best,
Dr. Kenny
http://www.SafeADHDMedication.com
Dear Dr. Handleman
Just wanted to know when the ADHD patch will be available in Canada. I believe it is called “Dytrana”?
Dear Dr. Handelman
My 9 year old daughter was diagnoised with ADHD and her pediatrician started her on 27mg of Concerta a day this worked well for about 6 weeks and then we noticed alot of the behaviors were coming back. Her pediatrician then increased her dose to 54mg a day and again it has worked extremely well so far. She has been at this dose for almost 2 weeks now and iam concerned as she has started with extreme insomnia. She is running on about 3-4 hours of sleep a night.
My question is whether there is anything i can do to help her with the insomnia as i would hate to take her off the concerta because it is working well with the behaviors.
Thanks
Sher
Sher,
Talk to your doctor about considering a lower dose of the concerta – i.e. 36 mg, or even 45 mg (i.e. 18 mg + 27 mg). A lower dose may still work well and not interfere with sleep.
Also, you can try shorter acting methylphenidate product. In Canada, that could be Biphentin, in the US, Metadate CD or Ritalin LA.
For sleep, talk to your doctor about melatonin, or even a different sleeping medication.
Best,
Dr. Kenny
http://www.SafeADHDMedication.com
I have 5 kids, 3 on them as well as my self suffer from adhd. I also see adhd behaviour in my husband but he is in complete denial. So I have given up on trying to get him to see a doctor but this is what I would like to say. The dose that I am taking 36mg seems to work fine for me, my son 15yr old is the same his dose of 54mg is working well for him. Now my 9 yr old son is on 18mg is working fine for him too. But my 8 yr old daughter is full of the beans even with her taking her concerta daily of 18mg. Shes still flying & bouncing off the walls. Do you think maybe it time for her to take 27mg? She isnt doing well in school and she was diagnosed over a year ago.
I will say that I do swear by this medication & I dont like to take medication for anything but it has helped me & my family a lot. I just wish they had of diagnosed me many years ago maybe things would have been a lot different.
Shannon, By all means consider a higher dose with the doctor. Your family seems to be on relatively low doses, and it may be that your daughter just needs a little more.
Dr. Kenny
http://www.safeadhdmedication.com
I read a previous post about not consuming anything acidic within an hour before or after taking Concerta. Is it not wise to have a cup of coffee to down the medication? Even decaff?
Hi,
Yes, it is advisable not to have something acidic within an hour of taking the medicine. I don’t believe coffee is on that list. It is more organic acids – i.e. vitamin C, citric acid, preservatives, etc.
Dr. Kenny
I have a 14.5 years old son who weighs 56kg and has been on Ritalin LA 40mg for the past 2.5 years. As his weight increases and he is now in high school, we are finding his concentration lags badly in the late afternoon when he is meant to be revising his school work etc.
What is the correct dose of Concerta is he was to switch over ?
Thanks
My 9 year old son who weighs 60 lbs was on 5mg of Ritalin 2x a day. We didn’t notice a significant difference. His doctor just switched him to 36mg of Concerta and says that this is the equivalent to what he was taking. Everything that I read on line says that this is not the case. Interested in your guidance and how to handle this with the doctor if he is incorrect.
Thanks!
Melissa
Melissa,
If your doctor is incorrect, you can consider printing this article and taking it with you. Other than that, I’m not sure what to say…
Dr. Kenny
Hi Dr Hanelman.
With great sadness and many a night of tears I have had to go back to medication for my almost 10yr old child as she is not coping at school. I am heart broken to have to do this. She was on concerta 36mg but may start again with 27mg. Do not know if the 27mg will be too light? A silly question. Once they have taken the concerta is there a certain time in the day thereafter that they feel up to eating- I want to ensure I can catch some time where she will eat. Loss of appetite was my biggest problem. She is already so thin. I am so confused what to do.Everyone has different opionions about meds, Strattera vs Ritalin vs Dex. Do you know of Natural Medication, THAT REALLY WORKS!!! Thanks for your time.
Hi Dr. Kenny:
I am in a bit of a predicament. I currently take 72mg of Concerta in the morning and augment it with 15mg of methylphenidate IR once it starts to taper off in the afternoon.
I take it at 8:00 am when I leave for work, in order that it is working when I arrive at the office at 9:00 am. Unfortunately, it starts to noticeably taper off at 3:00 pm and is nose-diving by 4:00 pm. I try not to take the IR until 5:30 pm when I return from work, in order that I have some symptom relief around my kids and wife in the evening. However, I find that I am taking the IR while I am in rebound and that it really only gives me relief of my symptoms for about two hours and then sends me into an even worse rebound.
The problem is that I am driving in the morning and evening without decent symptom relief, and these concerns me somewhat, especially because I have my children with me. I also don’t have decent symptom relief around my family which isn’t ideal.
Therefore, in total, I am only getting about 8 hours of therapeutic effect a day, even with the IR. I am drinking approximately 3 large Tim Horton’s coffees daily to compensate. And I hate the hate of coffee!
Yesterday, when I picked up my prescriptions, I made an off the cuff complaint to my pharmacist that it would be nice if Concerta really lasted long enough. He said that he is seeing allot of adults who are taking their dose first thing in the morning and another equivalent dose in the early afternoon. They seem to like it much more.
Yesterday I decided to give it a try. This was a difficult decision for me because I don’t like deviating from my psychiatrist’s directions. However I have the distinct impression that they would not approve of such a treatment plan. It stresses me out to entertain the idea of proposing it to her. However, I thought that if I were to propose such a change, I would like to have a pretty good idea whether or not it will be an improvement first. I am in excellent physical shape, so I knew that the risk factors were low; with all of the coffee that I drink and the medications that I take (Strattera and Effexor as well) I have borderline hypotension and a resting heart rate of approximately 45 bpm.
I took the second dose of Concerta at 1:00pm and it was smooth, very smooth. It was such a relief to have consistent symptom relief into the evening. It wore off by approximately 9:00pm and I was sound asleep by 10:00 pm. This morning I felt as if I had the best sleep that I have had in years. This is good news, but it also makes me sad because I can’t see my psychiatrist approving such a treatment strategy.
I am an accomplished professional, with a young family. I also think that my two kids also have ADHD, so life if challenging to say the least. So, anything to make it a little easier is nice. Also, I want to get completely off the coffee because it really is an unpleasant mode of self medication.
I am really not sure how to approach my psychiatrist. She was upset at the fact that I still drank coffee. I think that she has the impression that I am trying to overdo things. In fact, I feel as if I am trying to adapt to her treatment plan, instead of adapting the treatment plan to my requirements. She has been quite successful in making me think that was as well.
In short, I am just trying to have a quality of life. I have been quite successful, professionally, but the ADHD has taken its emotional toll. I feel as if I have aged decades more than I am.
Any recommendations would be appreciated.
I am 32 yrs old. I was a ritalin child but it has been years since I was medicated. I also have anxiety and have been prescribed kolonopin. I just started my first semester at the community college. I am looking for something to help me with my extreme at times ADD. Because of insurance my options are Ritalin La and Concerta. My question is which is nicer on people with anxiety and would it be safe to take kolonopin with it?
Carol – I’m not sure which will be best for you – but klonipin shouldn’t cause any concerns with either.
Dr. Kenny
Can Concerta be absorbed through the skin?
Steve – no, concerta cannot be absorbed through the skin. There is a methylphenidate skin patch – called Daytrana.
My 12 year old (104 lb) son was upped to 36 mg Concerta from 27mg a month ago. He has a “lock-in” this Friday where he and 39 other children stay up from 7pm to 7am at the church playing organized games, eating pizza etc. We are concerned that since he takes his meds at 7am, that it will be worn off and he will get too excited and hyper, causing him to be sent home. Could we give him his medicine at 6 a.m., then again at 7pm before the lock-in? Obviously I would not give more medication the following day (Saturday), allowing it to leave his system. He is really looking forward to this event.
Sheralee – I strongly encourage that you speak to your doctor before this lockin.
Dr. Kenny
Hello,
I was diagnosed with ADD 3 weeks ago. I was prescribed 54 mg of concerta,worked wonderfuly for 4 days and then I noticed the medication kicked in later in the afternoon around 3pm when I am taking it a 8am. I talked to my doctor and prescribed a higher dosage. Now I am on 72 mg for the past 2 weeks, I did good the first week, now it is starting all over again…I don’t get the effect of the medication untill later ( only last for 3 hours max and drop and very tired after)so it the mean time i have no energy in the morning where I need it the most. I was wondering if it was something common with Concerta? I find it pretty odd that I can feel the second wave of it and not the first one.
Thank you
Nathalie
Jed,
Sorry that I missed your comment earlier.
I know that many doctors who treat adults with ADHD have used concerta 2 times per day (as you described). Depending on your doctor’s comfort level and knowledge, your doctor may be fine with that. If not, then you could search for a new doctor…
You can also try the new Vyvanse – which is supposed to last 13-14 hours in adults.
Good luck – please come back and update us on the progress.
Dr. Kenny
Hello Dr. Kenny,
My 5 year old son was recently diagnosed with ADHD and was put on 5mg of Ritalin 2x’s daily. I have noticed that he is a little more emotional. Cries when he is upset when he never did before. Seems a little aggitated at time but for the most part has good days and has improved with his implusiveness. Its the crying thing that I wonder about. Is he crying now because the medication makes you “think” or realize what you did where before he wasn’t really thinking about it like when he is yelled at, or put time out)Or is it a bad side affect of Ritalin that is causing him to be more emotional? Does the crying thing eventually go away as the children get older?(
Second Question – I want to switch him from the 5mg of Ritalin 2x’s daily to the Concerta 18mg once daily(release 4mg 3x’s daily like you explained above). Reason being, I notice that there is about an hour where the first dose is leaving and the 2nd dose is coming in and the school isn’t always ontime when dispersing. During this time he is a little irritable which is a common thing for people on Ritalin but I’d rather him be irritable at home and not school. So my question is, is there any rebound during the day while on concerta? Is there a period where the meds are leaving the system and the next dose is waiting to come in?
Third Question – If he is crying on the Ritalin 5mg 2x’s daily will he be more emotional on the concerta 18mg? I don’t want to make the situtation worse.
Laurie –
Usually when someone is crying – it is simply a mood side effect from the medicine.
Often preschoolers have a little more side effects with ADHD medications. See: http://www.addadhdblog.com/adhd-medication-for-3-4-and-5-year-olds
Concerta is longer acting, and much smoother in its delivery – so it is much less likely to cause any mini-withdrawals during the day – and it is also much less likely to cause a rebound at the end of the day because it is more gradual.
Could concerta worsen the mood side effects? I don’t really know. It may make them less of an issue – because of the smoother delivery – but only time can tell (and of course – talk to your doctor about all of this!).
Dr. Kenny
Can Concerta be cut in half? My son is taking 18 MG of Concerta, however, I feel that needs to be increased. Is it okay to give him 1 1/2 tablets instead of just 1 to see if the increased dosage works better?
Angie – concerta cannot be cut in half – but it does come in a 27 mg tablet. Talk to your doctor about this.
Dr. Kenny
I’m a 28 year old female and I recently started taking 36 mgs of Concerta twice a day. I have tried several medications (SSRI’s) for years with no improvement of my symptoms. I decided to switch Psychiatrists and the new one believes that I was misdiagnosed as Bipolar when I actually have ADHD. So, he put me on Concerta and I IMMEDIATELY noticed an improvement in impulse control, restlessness, joy for life, etc. However, the medication makes me EXTREMELY angry and irritated, almost violently. To combat this negative side effect and stay on the medication for the positives, my doctor allows me to break the 36 mg tablet in half and take one in the morning and one in the afternoon. I know that you mentioned earlier that you can’t break Concerta in half and my doctor said this as well, but my pill cutter is able to break them, so my doctor has allowed me to do this so I don’t have to waste the 36 mg tablets I already have. My doctor also added 0.5 mg of Xanax 3 times a day to calm the agitation. So, my questions are:
1. Is it OK to break an extended-release pill in half or does it totally negate the extended-release properties? For instance, would I need to take it more often?
2. Where is the aggression coming from? Is it happening because the medication is wearing off too soon or because this is just a side effect for some people?
I want to give this medication the best shot that I can because it is the first thing that has helped me, but I am married with two small children, so I can’t be in a violently angry mood for any period of time!
THANKS!!
Nicole,
Cutting concerta in half completely negates any of the its long acting properties.
An increase in anger and agression could just be a side effect of concerta – though it could also be related to bipolar (i.e. if someone with bipolar took stimulants, they could have an increase in their anger level), or just other side effects. Explore these issues with your doctor!
Dr. Kenny
My almost 14 year old son was recently diagnosed with ADD. He stared with 18 mg then 27 mg and now he is on 36 mg. He is doing better but still on and off, some day better then the other. His doctor said: I should only can expect his behave get better from med about 80%. How do i know that he reach 80%? Can he try a higher doze then go back to a lower doze? and how long should he try and be able to recognize it?
He did not want to eat. Can he take the pill with ENSURE PLUS in the morning and only eat dinner in evening? Is he get enough nutrition?
Thank you very much. and sorry about my poor English.
I had terrible adhd as a kid but in those days it wasn’t understood by most people, so I went through life undiagnosed, through miserable school years, six unsuccessful college attempts, dozens of short-lived jobs, an adulthood cast in the iron of a moment’s impulse, and finally came to suspect it after my child was diagnosed. In my thirties I grit my teeth and just decided I was going to go to college and finish it this time, used my hyperfocus curse as a studying advantage, and ended up getting a second degree in psychology alongside my major. Many professors at one point or another did bring up adhd and asked if I had ever been tested for it. Maybe college wouldn’t have been such a struggle if I had, but I just couldn’t devote the time, attention, or money for a doctor during semesters, and couldn’t remember to do it during breaks. So I was not diagnosed until my forties and after many years of doctors trying one antidepressant after another, with no results. After a specialist finally decided to do extensive testing, it turned out there was virtually no depression in my personality at all, and I had been misdiagnosed for years, possibly due in part to some personal mannerisms that medical schools teach doctors that are hallmarks of depression! I am quiet and reserved, eager to please, and have a lot of “closed” and “minimizing” body language, which the specialist said can fool most doctors into assuming depression, including herself until after the testing and getting to know me. Finally, a tentative diagnosis of adhd, and appropriate medicines tried. Strattera had some benefits but some escalating side effects. Concerta seemed to help a bit with no side effects. We worked with the dose very slowly and at this point it does help, it’s not magic, but there are definite positive effects and no bad ones yet. I am now taking a 36mg in the morning, and an 18mg at noon, so for a couple of hours in the slumpy part of the afternoon, it’s like the 54mg dose. Then the 18mg wears off last so it’s an easier letdown in the evening than the 36mg by itself. If I forget my medicine I usually realize it by noticing I am not getting anything done except some unproductive amusement thing… like now! Right now!!! I did forget my dose today, ha ha! And I haven’t done most of the tasks I’m supposed to get done today, oops! and it’s 4:55pm!!! Can I get like 7 hours of work done in 5 minutes? If I work super super hard??? maybe, well sometimes it’s amazing what I can get done really fast if I’m motivated by enough adrenalin… or the fires of hell… or bosses… i think that’s the same thing – i better go
Dr Kenny,
I read different people with their dosing how is it that my 5year old son can take 18mg of concerta and then I read that adults are on 18mg of concerta. Some times he seems a little mellow like he is high or something but he is still with us just seems a little too melow at certain times of the day. I like the concerta it does work but I wish it was maybe a lower dose. How is it that adults and children are able to take the same dose?
Laurie – sometimes kids take higher doses than adults… It essentially comes down to the sensitivity to the medicine – not just the actual dose. Concerta doesn’t come any lower than 18 mg – if you want a smaller dose, you may have to try a different methylphenidate preparation.
Dr. Kenny:
My eight year old daughter has been taking focalin xr 10mg. for the last two years. Her doctor wants her to switch to Concerta 27. The doctor feels that the Concerta will give her another hour or two to complete her homework and will have a slightly better crash. I have heard that Concerta causes serious appetite suppression and am concerned as she is a little girl to begin with. Please advise.
Matthew – any stimulant can cause appetite suppression. It may not be any different than the focalin. If it is, speak to the doctor.
Hello Doctor:
I just started on 36mg of Concerta 2 days ago. The first day I felt great until about 3:00PM, then I experienced a headache much like a migraine. Today the same thing happened, however it happened at about 1:00PM today. I usually take my does at 6:30AM along with 20mg of Celexa. Any idea as to how to stop these splitting headaches.
On a good note I am ultra productve right after I take concerta for abou five or six hours, so I know it is helping.
I’d be interested to near your thoughts.
I should try to get to bed, been having a hard time sleeping.
What is the conversion table of Concerta vs Biphentin?
FOr example is 18mg Concerta = to 10mg of Biphentin?
Is 27mg COncerta = to 15mg of Biphentin?
DO you believe 36 mg of concerta is too high for a child of 7 yrs old weighing 45 ppunds?
thanks
Hello Dr. Handelman,
do you know of cases where someone with ADHD required exceptionally high dosages of methylphenidate resp. Concerta? Above 200mg for example? If so, what do you attribute that too, changed metabolism, praoblems with uptake and/or blood/brain-barrier… or these people just need it? I found one scientific article about a teenager requiring 3,6mg/kg… other than that I cant find very much.
Would appreciate any info!
Ed
Edward, I’ve been aware of one or two doctors who have used ‘mega doses’ of MPH, and I have generally considered that a concerning medical practice. I have gone up to 108 mg of concerta in adults, but generally if the medicine isn’t working at that range, I would try a different one…
The biggest issue with high dose is cardiovascular. If you do go high dose, you need to monitor for heart rate and blood pressure…
I am 17 years-old. I have been diagnosed with “Severe ADD + Hyper activity syndrom”
I was on Concerta 36 for two months and it worked well for my hyperactivity, frustration, anger and impulse. However, it did not work well for my concentration and focus. my doctor then perscribed concerta 54 once per day. The 54 works VERY well to calm my frustration and helps me stay on one thought at a time but does’nt seem to work for anything else. Does this mean I should go up to 72 or back down to 36? My doctor would not perscribe two concerta a day (one in the afternoon) nor would he perscribe a ritalin booster to help me when the concerta runs off. Also, are these gains I’m having all i can hope for? or could the medication be working more effectivly?
It can take over 2 weeks to get an appointment in ontario so I thought I’d ask you.
I combine medication with healthly eating habbits as well as cycling 25 -30 kilometers per day and weight lifting.
I’m an honour student at my high school, so I would like to obtain the correct doesage before college.
i also just realised i have slight but constant muscle twitches while on concerta 54. Going to call my doctor when i get home.
Correction – i only have muscle twitches when I extend my limbs. it causes my arms and fingers to shake
Hi Doctor,
I am 54 years old male currently being treated for depression. I was recently prescribed 15mg of Ritalin three times a day to counteract the drowsiness and lack of focus caused by 50 mg of Paxil and 0.5mg of Rispiridone daily. The paxil and rispiridone have been the best combination for combating my depression but they also make me very sleepy. I began taking Ritalin about two and a half months ago. At first it worked wonderfully but now it often seems to make me very irritable and tense, thus defeating the purpose. I wonder if you would have an alternative that I may bring up with my doctor.
Thanks
Francisco – Concerta is a long acting form of the ritalin. If ritalin is making you irritable, you could try concerta. Also – modafinil (provigil) can help with alertness. An alternate are the medical amphetamines – i.e. adderall and vyvanse.
Good luck.
Hi Dr Handelman,
Is it ok to take Concerta tactically? Can I take weekends off taking the drug, or even weeks if I am on holiday?
Many thanks
James B,
There are some people who take stimulant medicines (concerta included) just on days they need them.
So, some people take weekends or holidays off.
I generally recommend that people take medicine 7 days per week because ADHD affects them 7 days a week – and the impact of ADD/ADHD goes beyond just home or school…
Dr. Handelman,
My son is 14 years old and is on 54mg concerta. He has been on that dose for a year. Recently he has been complaining that his friends are calling him ‘boring’ and ‘not fun’. He states that the medicine is causing him to lose his ‘fun personality’. Would a smaller dose be appropriate or time to switch medications? Can gets grow out of the need for medication with increased external supports for add? Any help would be appreciated. Thanks!
Ken,
If there is personality flattening as a side effect, it is worth trying a medicine from another category. So, if your son is taking concerta, ask the doctor about trying an amphetamine medicine – i.e. Adderall or Vyvanse, or the non-stimulant Strattera. They will hopefully work without flattening the personality.
Wow. This thread is chock-full of useful information. I was diagnosed with ADHD back in December and didn’t pursue medical management until February. I started on 18mg of Concerta for three days, it did nothing for me so I started taking two — I was supposed to wait a week first, but was quite impatient and my psych was ok with that.
The 36mg was great for about a week and then basically just started working like caffeine — waking me up, getting me moving, but not helping me focus much. By noon I was pretty sleepy. After eating lunch I’d get a pick-me-up (which makes a lot of sense now that I’m aware of the ascending profile) and was far more productive than I usually am in the afternoon, but I was bummed out by the fact that I’d crash around 5:00PM.
But my psychiatrist is concerned that I have a mild form of bipolar disorder where I’m dysthymic during the fall/winter and hypomanic during the spring/summer and is hesitant to give me 13-16 hour coverage because she doesn’t want to trigger any cycling. I was aware of these symptoms for quite some time but had a really strong feeling that treating underlying ADHD would make a bigger improvement than targetting the depression.
I was hoping to get a “booster” IR preparation for the evening but she wants to hold off on that.
This week I bumped up to 54mg. Yesterday was my first day on that dosage and it helped me quite a bit. I took it around 6:30AM and was quite groggy at 11:00AM. I found this thread on my BlackBerry during lunch and it explained a lot. Will have to explore your site more! I noticed that the 54mg dosage caused me to “crash” at 7:00PM which is a definite improvement, but I would like at least another hour or two of coverage because I do get quite impatient with my kid and don’t feel like doing much at home after work. I definitely notice the “rebound” where I’m suddenly far more aware of the symptoms I experience when the meds wear off.
Depending on how the next four weeks goes, I might ask to have my 54mg split into 2x27mg doses or possibly bump up to 2x36mg tablets, taking the second one three or four hours after the first dose. I will definitely bring this information to my psychiatrist as she actually made a comment that “not even 108mg of Concerta will cover you for 13-16 hours, you’re pretty lucky to get coverage until 5:00PM.” She recommended taking it later in the day, even as late as 2PM because I have no trouble sleeping, and I will give this an honest try, but during the work week I really need to be on top of my game throughout the day.
She may not be aware of the stagged dosing techniques, but I hope the information here helps me explain it to her. I find it hard to talk to the psych (I’ve only seen her twice) and maybe I’ll have to write something out. I’m a much better written communicator. The meds do help me speak articulately, but when I see her I just kinda go BLABBERBLAHBLAH and feel like a silly kid all of the sudden.