Concerta Dose: Getting It Right

I’m confused. I thought that 18mg was = 5mg x 3, 36mg = 10mg x 3, and 54mg = 1 mg x 3. If 22% is released 3 times and 10% is not absorbed then that accounts for 76% (22 + 22 + 22 + 10). What happened to the other 24%? I also thought that Concerta not only had Ritalin inside but was also coated with Ritalin to get the quick release until the inside was pushed out. Is that part of the missing 24%?
Thanks, Evelyn

Hi, My 5 year old daughter was taking almost 40mg a day of ritialin, 3 times a day. This was not working for us. Our Dr. then put her on 15 mg a day of Adderall XR, then 20 gm. I noticed a real change in her behaviour. Lots of mood changes. Now she is taking 30 gm of Biphentin. What i would like to know is why does the medication seen too work well in the am but, once 11-12 PM hits its seems like shes not taking anything at all. I do realize she will need an increase. However, if this is an extended release why doesnt it seem to be working like it should?

Thank you for any time you take in this question.

Dawn

Hello Dr. Handelman – I appreciate your information on Concerta and the time you’ve taken to share your knowledge. At 36 years old, I was recently diagnosed with ADHD. Time does not allow me to explain how Concerta has truly helped me focus.

I have read some forums on individuals taking two separate doses of Concerta throughout the day. To remember one specifically, it said they take 72mg in the a.m., then about 7-8 hours later, they take 36mg. — Since I don’t believe everything I read on the internet (haha!), I would appreciate your input in lieu of asking my own Doctor.

I take my dose of 90mg at 5:00a and by 2:30p-3:00p I start to ’space out’. My wife can definitely tell a difference when I’ve taken it, but she rarely spends much time with me when the medication is flowing through my system. Originally, I thought of a Concerta in the morning and then perhaps a comparitively smaller dose of ??mg standard Ritalin for the evening. (My Doctor said that could be a future option)

I have tried taking it later in the day… My Dr recommended trying it later in the morning or even lunch time so its effects would last into the early evening. I have taken it as late as 5pm (when forgetting in the a.m.)… Had no problems falling asleep around 10p, but was ’spaced out’ all day and usually late for work those days — I definitely need it first thing in the a.m.

Do you have any experience with double-dosage and can you make any recommendations?

Thank you again for your blog,
Frank

To follow-up, thanks for your response to my query. and, I realize now (duh!) that I didn’t have a clear understanding of the term “in lieu of” …. UMMMM, what I meant to say is– I am under the care of a psychiatrist. I visit with him each month and he closely monitors the effectiveness of whatever medicine he prescribes. Since April 2006, I have tried Strattera, Wellbutrin XL, Focalin, Adderall and now Concerta. I ALWAYS take the prescribed dose given (it’s hard to deviate much, since every 30 days, no more than a month’s supply is given)… While I’m waiting for my next appt, I thought I would ask you the question from the previous entry. (doh!) I will use the term “in lieu of” in the proper context now. heh

on a side note, I remember seeing a bumper sticker that read: “My Doctor says that I have ‘Attention Deficit Disorder,’ but I don’t think the diagnosis is corr— LOOK, A BUTTERFLY!” (hahha, thnx again.. –Frank)

Anne,

Thanks for your comment.

It is possible that a higher dose would make a difference in the concentration and focus. Best to review it with the doctor to see if a higher dose of concerta would make a difference.

Hi Melanie,
Biphentin dosing goes from 10 mg to 60 mg.
You can read more about Biphentin on this blog – just enter the term ‘Biphentin’ in the search box above, and you will find a very thorough article on it.

Hi Michelle,
Ultimately, the answer is to call the pediatrician and review this possible side effect.
Sometimes (though relatively rarely), Concerta can cause mood side effects – like moodiness, getting more emotional, etc.
It can also make some anxiety symptoms worse – and you would have to review with the doctor if your son’s repetitive questions are a form of anxiety – i.e. obsessively asking, or it could be that it is just a behavioral issue.
Best to talk to the doctor, and to observe how your son does over the coming days.
Thanks for reading and commenting on this blog!
Dr. Kenny

Hi,
Thanks for sharing your experience.
Ideally, you can find a doctor who is willing to talk to you, develop a relationship of trust – and also knows a lot about ADHD.
Is this doctor a psychiatrist? Family Doctor?
When you say that you are feeling scattered – do you mean in the evening? I would expect that during the day you are probably doing well with 54 mg, but I am curious.
Most doctors will increase the Concerta and not give a twice daily dose of concerta. Then, if longer symptom control is needed, they will add regular ritalin to the concerta dose at the end of the day, if needed.
Just so you know, soon there will be a ‘triple bead’ adderall xr – meaning an adderall xr that will last for 16 hours for adults with adhd. Also, strattera can work for 24 hours for people who take it.
All the best,
Dr. Kenny

Hi Jenny,
Thanks for your thoughts.
Firstly – I cannot tell you how to change doses of your medication!
You need to talk to your doctor.
When it comes to the doses of Concerta for adult ADHD, I will refer to the
Canadian ADHD Resource Alliance Practice Guidelines – found
at http://www.CADDRA.ca
These guidelines document a maximum dose of Concerta for adults of 108 mg.
Generally, the PDR lists 54 mg for kids, and 72 mg for teens. I am not sure if Concerta is indicated in adult ADHD in the US, it isn’t in Canada. It is still often used, but there aren’t any ‘official’ rules for it.
When it comes to anxiety and ADHD, if Concerta is helping to relieve the anxiety somewhat when your focus improves, then stick with it before adding another medicine.
If it doesn’t help with the anxiety, consider trying Strattera, because it is often very good at helping ADHD and anxiety symptoms at the same time, and may prevent the need for two medicines – i.e. a stimulant and an antidepressant for anxiety.
I am considering creating educational materials on ADHD Medication. If you want to be sure to hear about it – please enter your name and email address in the box at the top of this blog, or join my newsletter at:
http://www.THeADHDDoctor.com

Hi there — Can you think of any reason that two 18-mg Concerta taken together would behave differently than one 36 mg Concerta?

My son did great going from 18 mg to two 18-mg pills so we thought surely 36 mg was the right dose. Unfortunately, the 36 mg. pills seem to be more abrupt in onset and withdrawal, giving him some mood swings he didn’t have on the double 18 dose.

I am currently awaiting a call from his doctor onthis, but wondered if you had any ideas about why the delivery of the medicine might be different in those cases?

Thanks,
Sheila

Hi Sheila,
I hear what you are saying here with the Concerta dose of two 18 mg pills vs. one 36 mg pill.
The short answer is that I don’t know what the difference is.
The longer answer is that I have seen this before.
Some people are very sensitive to the delivery of the medicine, and if the Concerta dose of 36 mg is different if it is two 18 mg tablets, vs. one 36 mg tablet – well just go with the one that works.
Hopefully cost won’t be an issue – because generally two 18 mg pills will cost more than one 36 mg pill.
All the best,
Dr. Kenny

Hi,
To convert the dose of 20 mg Adderall XR to concerta – I like to go back to the equivalent dose of ritalin.
Adderall XR is like 10 mg adderall morning and noon.
This is like 20 mg of ritalin morning and noon.
To get 20 mg of ritalin twice daily in Concerta – you should likely start in the 54 mg to 72 mg daily.
Of course, you need to review this with your son’s doctor – and see what is best for your son – as he is on several medicines.
Likely – if you start at 27 mg of Concerta – this is too low of a dose, and it may result in a significant number of symptoms.
Good luck – and I hope this helps in your discussions with your doctor.
Dr. Kenny

Hi Karen,
I cannot diagnose or recommend treatment online.
What I can tell you is that 2 x 18 mg Concerta is pretty equivalent to a 36 mg tablet.
In my clinical experience, a very small percentage of people react differently to the preparations – but I have no explanation for that.
All the best,
Dr. Kenny

Karen,
This is a question for your doctor to answer.
In general, taking Concerta with Cymbalta or Wellbutrin should be a concern (though you have to talk to your doctor about your specific situation).
The only concern may be additive side effects – like getting ‘jittery’ or agitated.
All the best,
Dr. Kenny

Hi Todd,
Thanks for your comments about your experience with Concerta.
The short answer is – wait until tomorrow or the next day…
Yes, mood side effects are possible.
Yes, the medicine works quickly – i.e. within 1 hour after taking it, it is fully therapeutic on the first day.
So, it is possible that the Concerta has made you agitated, or it is possible that you, as an ‘imperfect being’ are just having a bad day.
That’s why I say – wait a few days – and that way you’ll see if it is the Concerta or just a situation.
I tend to recommend that people stick with a dose for at least 1 week to test it out – so they can see how they feel on a good day, a bad day, an irritable day, a day when they haven’t slept as well, etc.
Of course, you need to speak with your doctor before making any treatment decisions or changes.
All the best,
Dr. Kenny

Hi,
This is a great question.
It is one that you will have to follow up with your doctor about.
There are some treatment guidelines that talk about using 108 mg of Concerta daily for adult ADHD. In teens, there is recognition that 72 mg can work well as well.
The issue is that the higher the dose goes, the bigger the risk of increased heart rate and blood pressure.
Talk to your doctor about it and see if he can help you out.
Dr. Kenny

Dr. Handelman,

Our six year old son has been taking 18mg Concerta for the past 2 months. He was diagnosed with ADHD without Hyperactivity. He has been doing quite well. We are now considering raising the dose to 27mg, but are concerned because he has difficulty falling asleep at night. Will raising the dose to 27mg make this problem worse? It takes him an hour to get to sleep at night, although he doesn’t seem to be exhausted the next day – still gets 9-10 hrs of sleep each night. We have heard about Melatonin to help him get to sleep, but haven’t tried it. What are your thoughts about this?

Anne

Dear Dr. Handelman
I am a 40 year old female recently diagnosed with ADHD and just started medication. I began with a low dose, taking 5mg of Ritalin and noticed a big improvement immediately in my focus, motivation and follow through but I got terrible headaches as the dose wore off. My doctor switched me to 18mg Concerta to make it last longer and avoid the headaches. My question is: I realize these are the same dose of the same ingredient and now on the Concerta I feel spaced out like in a fog and my memory is worse than before but my focus, motivation and follow thorugh are still much better. The first few days I felt it lasted 12 hours, now I feel it wear off after 8 hours. While on the Ritalin, aside from the headaches, I felt fine. Does spacieness and the memory issue result from too low a dose or could regular Ritalin just be a better fit for me?
Thanks,
Pam

Thanks for your quick reply.

Are both of those formulations available in Canada?

Another question if I may: Is there a link between ADHD and sleep?
I have experienced excessive daytime sleepiness since my teens which all medical tests indicate is not related to any health issue. I was then diagnosed with sleep apnea syndrome and put on cpap which helped somewhat. Since taking the ritalin I have slept better and deeper, awaken feeling more refreshed and have less daytime sleepiness and more energy without using the cpap and my ADHD symptoms are under control.

Greetings,
My son was dx with ADHD w/hyperactiviey and ODDabout 6 months ago. we have tried adderall, straterra. the straterra is great so far.

We have recently increased his dose to 36mg a day for straterra from 25mg. when he was on the 25mg, he was pretty normal for a child with his level of energy and degree of ODD. when we increased his dose, he started to be a bit more fidgety and restless and alot more talkative (not in a good way…he hasn’t stopped in 2 days) .

Is it possible that increasing his dose by just a little could cause him to have a stimulant effect instead of curbing his outbursts and controlling his hyperactivity?

I would appreciate any thoughts.

Hi Lacey,
This is really one to go through with your doctor in detail.
It may be a direct side effect of the methylphenidate, causing you the palpitations. In that case, a different methylphenidate (i.e. other than concerta) – in the form of ritalin LA, or metadate CD, or other types may in fact be the same. However, trying Adderall or Strattera may be different. As Adderall is also a stimulant, it is more likely to cause this side effect than strattera.
But as I say, you will need to work this out with your doctor.
All the best,
Dr. Kenny
p.s. to learn more about medication for ADHD, get a copy of my free special report here: http://www.medicationmastery.com

The short answer is: talk to your doctor about it (especially the neurologist who is lookiing after the seizures).
The second short answer is: yes and no.
For some people, methlyphenidate can increase the risk of seizures.
For others, it won’t.
Talk to your doctor.
Dr. Kenny
p.s. Here is the summary of one study:
http://www.addadhdblog.com/adhd-concerta-and-seizures/

Hi,
The main difference is that Biphentin is 40% immediate release (vs. the 22% that concerta is) and that it only lasts about 8-10 hours.
To convert the biphentin back to a ‘regular ritalin’ equivalent, you would multiply the biphentin dose by 0.4 and then consider that dose in the morning and noon and then relate that to the concerta.
For more info on biphentin, visit here:
http://www.addadhdblog.com/biphentin-the-newest-addadhd-medication-in-canada/
Dr. Kenny

Hi

9 months ago I went to a psychologist and had some pretty extensive testing done. He said I seemed to meet the criteria for ADD not the hyperactive type, which he said was why I was probably never identified. Part of the reason came out in my IQ testing. He said I probably compensated pretty well. I don’t know about that, but he also I had some minor anxiety issues and also labeled me major depressive disorder. I had found my way to Wellbutrin as an antidepressant a few years before after finding that SSRIs just made me pretty disinterested sexually. So I got off Wellbutrin and on Concerta and for a few weeks I was quite noticeably more engaged in life. After that, not as much but no significant depression until the 36 SR wore off about 5:00 at night, so I started taking 18 mg at noon and that seemed to help with the depressive thoughts. But now I seem to be having some sad or hopeless thoughts even in the midst of the Concertal dopamine feel good. So I am wondering if perhaps I should drop the Concerta and I just go back to Wellbutrin or perhaps look into an antidepressant to take as well as the Concerta. Can you give me your opinion? Doesn’t Concerta affect my depression very similarly to Wellbutrin? I’m sorry to ask this of you, but I haven’t been going to a psychiatrist because where I live there is such a very long waiting period. So my local physician has been reluctantly walking through this with me. I thought perhaps my depression was just the result of the ADHD but I am thinking now they may just be two comorbid problems. Any thoughts you have on this would be very much appreciated. Perhaps I should just increase the Concerta, but I know that can raise blood pressure and heart rate. Thank you for your consideration of this situation.
M

I thought that was an odd use of the word “moderation”. Perhaps a few of these could be left out??? This is giving me a mildly depressive thought.

My 11-year-old son has been diagnosed with add in November, 2006 He begin taking ritalin 5 y10 milligrams. The psychiatric change the medicine for concerta. He is taking 27 miligrams but his behavior is the same. The teacher said to me that they know that he tried very bad but he don’t pay attention in class like always ; his grades are very bad. I would like to know how long take to the body adjusts to the medicine and how long the doses lasts.

Sorry this is so long. I hope to hear back from you….thanks for your time.

Hi. I’m worried sick about my 18 year old son. He was officially diagnosied with ADHD (inattentive) this past summer. He was tested because he was finding his lack of ability to concentrate debilitating. He was initally prescribed Concerta but because he felt extreme agitation and mood swings, our doctor then prescribed Ritalin. He loved the Ritalin and one day described it as being “addictive”. I immediately took it away and we went to our doctor again. Since he also exhibits symptoms of depression our GP presribed 300 mg of Wellbutrin XL with no noticeable benefits. I’m wondering about the effect of the Ritalin. Since it made him feel “high”, does that mean he doesn’t really have ADHD – because that’s what I’ve read? He has a very addictive personality so I’m very worried.

I have an 11 yr old daughter who has been on 108 mg (taking both pills first thing in the morning) of Concerta for over a yr. During this time she has been in and out of the hospital due to the following:

* Stomach pain
* Extreme Fatigue (24 hr of not moving from her bed at all… This would occur one or two times a month, sometimes more sometimes less
* No appetite (zero, she would take one bite of food and claim that she was full and her stomach hurt)
* Weakness
* Glassy Eyes
* At times over active and was disrespectful, spoke back (argued) to her dad & I very often
* Weight loss in the beginning, now maintains
* Did not grow in height for 2 yrs.

Every time I spoke to her Pediatrician, and asked if the medication could be causing all of the issues, he said no… He claimed that it was all due to depression and had nothing to do with the medication… Last summer (June) he thought it be in her best interest to add 40 mg of Strattera in with the 108 mg each day… I refused to add the extra medication considering all of the medical problems she was already having…

After much research I found, (what I 100% believe) that the reason for all of her medical problems was due to being over medicated… She has now been off of the medication for almost 3 wks and has gained @10 lbs She is showing many signs of improvement with each day… She is very well behaved and actually much calmer and more relaxed off of the medication… She is now being home schooled and doing very well…
I only wish I had obtained this knowledge long ago, to prevent all of her hospital test and sickness.

Connie,
It is relatively common for teens with ADHD to lack the ability to reflect on themselves. A doctor will ideally be aware of this, and take into account parent, teacher, and family feedback, as well as the teen’s feedback.
In so far as dose, generally, if there is room for further improvement, and there are few or no side effects, it is worth trying a higher dose, in my opinion.
Speak to your doctor about it.
Dr. Kenny
http://www.MedicationMastery.com

Hi Rick,
Talk to you doctor – but generally there is no drug interaction between the ADHD medicines and the newer antidepressants.
Dr. Kenny

Thank you for Concerta dosing information, especially the CADDRA guidelines. I am an adult and a big guy (>100kg). My current RX is 72 mg/day with a limited RX (not enough for daily use between visits) of Ritalin 10 mg to be used PRN (max 3/day).

I found I needed at least 3/day with Concerta to do well at least on working days but was beginning to feel like an “abuser” since I wanted to take them every day but had limited supply and believed I was exceeding the dose range.
Is there any literature supporting up to 108 mg other than CADDRA documents – I did a quick search of PUBMED and didn’t see anything.

Thanks,
GG

Hi,

I am an 18 year old currently taking 50mg of Ritalin morning, lunch and evening. For a total of 150mg per day. I was just wondering what the concerta equivalent would be.

Thank you..

My daughter, who is now 15 y.o., has been taking ritalin since the 3rd grade, for ADD. She is presently taking 54mg. daily of Concerta. She takes it only on school days. Goes off the medication completely on week-ends and over the summer. She takes Concerta mainly to better focus in the classroom. She has grown each year and has not lost any weight. But she does seem to talk of being depressed more often lately, which I realize could also be some what normal at times for a teenager. She does not want to be off the medication, because she says it helps her day, so we continue to give it to her. My concern is long term effects and what types of blind studies have been conducted that are NOT sponsored in some way by the pharmaceutical industry. Is in good or bad for her to be off the meds for week-ends etc?
Thank you.

Thank you for your advice. I will speak to my doctor about these issues. I also would like to know how many people write to you with comments of depression from teens on Concerta? My daughter has cut her self a couple times, partially in cry for help, I believe, as it was a superficial cut to the wrist horizontally. Do other teens on Concerta act this way also? My daughter has seen a psychiatrist twice in the past, but i could not convince her to continue. Also are you in anyway affiliated or compensated by any pharmaceutical company? I am sorry this needs to be asked, but the fingers of this industry reach so many more places than people realize.
Thank you.

I started on 11mg of Concerta (my first time on any ADD drug as I was just diagnosed). I’m 30, a little overweight (5′4 and 160 lbs) and also taking lamotrigine for bipolar disorder 2.

The 11mg dose made me lose my appetite and feel full of energy. I was able to focus better and get things done. I still felt the does began to wear off around 5pm and asked if i could go up to 36mg.

Since being at 36 I am tired ALL THE TIME. As in, I’m yawning, have those dry/cloudy eyes you get when you first wake up (but all day) and the focus/energy is totally gone. Also, my appetite came back.
I don’t understand…I guess I should go back to the lower dosage? Or maybe I don’t have ADD after all?

We live in England. Our 22 year old daughter and takes a total 120 mg of Ritalin per day (30 mg every 3.5 hrs – 4 times a day) which covers 14 hours. So this means she would be taking 103mg Ritalin to cover 12 hours.

We are hoping to transfer to Concerta XL and would like to know the equivalent dose. We used the information on this website to take to the consultant who passed it on to the pharmacist to investigate, but she said that in the UK Concerta XL is different to the Concerta in Canada.

They seem very unsure what to prescribe and we keep getting conflicting information. We are concerned that if she drops the dose it will have a huge impact on her life. Sammy also has Learning Disabilities.

Can you throw any light on this for us please as yours is the only information we can find that is clear and concise?

Many thanks
Glynis

Hi! I am 24 yrs. old was recently diagnosed with ADHD. My PDr. started me on Concerta 27mg and it worked ok for a couple days but I noticed that the medicaton was giving me headaches and I wasn’t really motivated to do much. It was also wearing off quickly(2-3 hours) and making me tired by 5pm. I explained all of this to my Dr.. He decided I need a higher dose so he moved me up to concerta 54mg. I have only been taking it for 2 days but I already find myself even more unmotived and tired than before. My question is, do you know why concerta is causing this effect? Is this normal? Before the medication I could not concentrate, was unorganized, and had a horrible time memorizing anything, but at least I had enough motivation/energy to get stuff done.
I just don’t know what to do! I think I would like try another medication but I think my Dr. believes that its just a dosing problem not the medication.

Thanks,
Ashley

Thank you so much for all your efforts with this! I have forwarded it on to the hospital pharmacist for her information – unfortunately the consultant dealing with Sammy’s case has left rather suddenly and so we await a replacement.
Hopefully it won’t be to long before we can get things sorted.
Thank you once again.
Glynis

Hi Mackenzie!

I tried to up my dose on Concerta to see if the side effects would go away but it just made things worse. I would at least try it once to see what it will do before switching because everyone is different.
My Dr. actually switched me to Metadate CD, 20mg. He said I can go up or down with the dose depending on what is right for me.
The first few days I experienced the same symptoms I had on Concerta(headaches, unmotivated, irritable). But after a week of taking Metadate CD the symtoms went away and now I feel great. I take 30mg in the morning and 10mg in the afternoon. It works out perfect. I can now focus, multi-task, and drive safely!lol! What I like most about Metadate is the fact that you have control of the medicine, not the other way around like Concerta. It comes in a capsule that you can undo so you can take some of the medicine out if the entire dose is too much. I know that some parents love it because they can pour the medicine(tiny beads) on a spoonful of applesauce and have the child take it that way if they can’t swallow pills.
Anyway, I have not tried vyvanse yet, but if for some reason the Dr. wants to switch my med. then I will ask to try that one. There is a coupon on Vyvanse’s website to try it Free for a month.

Let me know what you decide to do.

Good Luck!
Ashley

Hi,
I’m just trying Concerta for the first time after about four years of adderall and then dexedrine (most recently two spansules of 15 mg spaced out). I always felt that ritalin worked better for me than dexedrine but that I seemed to metabolize it very quickly and the run off was very ugly (worse than without any medication). This time I’m trying twice the dosage of concerta that did last time and after reading your discussion about dosing that seems about right. Last time it just didn’t cut it. That and not being on a plan to cover it meant I didn’t try it again till now. I have high hopes for it as the only alternative I can see on the ritalin horizon is the Daytrana patch which I’m told won’t be in Canada for a while.
Thanks,
Mike Craig

Mackenzie,
My heart did speed up a little bit but not bad enough to make me worry. I think the biggest things to look out for are chest pains, shortness of breath, and high blood pressure. If the increased heart rate make you worry, you might want to call your Doc’s nurse or call your pharmasist. I always call the nurse if I worry about a side affect. My problem now is that the Metadate CD is not as affective as it was the 1st 8-10 days. I have tried higher doses and taking it at different times but nothing seem to work. I’m starting to think that it’s just the type of stimulant my Dr. Keeps prescribing and I need to try something different. How’s everything going for you now? Are you still thinking of switching?

-ashley

Danielle,
You are a very brave person… Keep up the great work!
I will make a couple of comments, but the best thing to do is to talk to your doctor in detail about your circumstances.
1) It sounds like you are developing motor and vocal tics (similar to Tourette’s). These can be worsened by Concerta (or any stimulant). If this is the case – talk to your doctor about adapting your medicine, or taking another medicine that helps to lower the tics.
2) Regarding depression, it is possible that a) you’ve developed a depression – which is common for people with ADHD – and it needs treatment – i.e. therapy or medicine, or b) that the concerta is contributing to your depression. You’ll have to review that in detail with your doctor.
3) If you can do well without the medicine – it may be worthwhile to try a time without it (again – talk to your doctor about this).
Good luck, keep strong, and ask your doctor for help in getting your mother to see your perspective.
All the best,
Dr. Kenny

Hi Dr. Handelman.

I was reading most of the questions and couldn’t find something that answered my problem.

I was diagnosed with ADHD a couple of weeks ago. The psychiatrist prescribed the following:
27.5 mg ritalin X 2 a day
80mg Ritalin LA
90mg Concerta

Now 90mg concerta as mentioned in your blog is the equivilant of 20mg ritalin 3 times a day (or, the equivilant of 20mg ritalin PER dose). My single dose was 27.5 (given twice). How come she only gave me 90mg then? Shouldn’t it be higher than 108mg? I know Ritalin works for 4 hours give or take, and 2 doses or 3 doses will only make it longer. Increasing the dose changes the effects but not the effect period … Was she mistaken?

And another thing – Ritalin LA 80mg?? meaning I get 40mg Ritalin per dose? (2 releases, one imidiately the other after 4 hours). Its almost 1.7 x 27.5 ! Was she mistaken again?

TOVA had a score of +4.3 with Ritalin 27.5mg. I felt a great change! But it had dire concequances and nasty rebound effect. Ritalin LA I believe works well but makes me feel as if I get butterflies in my stomech (as if I’m thrilled about a special occasion that doesn’t really exist). I prefer Ritalin LA for Ritalin but the dosage frightens me!

And concerta? I had very high hopes for Concerta. 36mg, 54mg, 72mg, 90mg and even self prescribed (I know, I’m a bad boy) 108mg didn’t do ANYTHING regarding my concentration! I dont get it :/ It helps with the impulsiveness and hyperactivity – but I still can’t read or study properly (well, not atleast like I can do with Ritalin and Ritalin LA).

I’d really like to hear your thoughts about the prescription “flaws” and inconsistancies. I’d also like to hear what you think about Concerta. Could my body be immune to concerta? Do I have any other long-lasting choice other than concerta? LA works best for 6-7 hours, and thats not enough. I dont wanna overdose methylphenidate with extra pill taken afternoon. I live in Israel, and Israel hasn’t got ANYTHING else for adhd other than the 3 mentioned drugs (no adderall, no straterra, no dex).

Thanks.

Hello Dr. Handelman,
I am somebody who was diagonised with ADHD when I was four years old and that is when I started taking Riddlen. I took that for 8 years and I had the usually side effects loss of appitiete, sleeplessness, stomach craps which didn’t bother me too much. I then switched to Addrell which worked a lot better for two years. At 14 I stopped taking any medication all together because I felt different and got very fustrated that I couldn’t be all I could without aid for an outside source. That is when I hit puberity so I had the normal inscurities of a young teenager. Not a good combination.
When I stopped I felt fine physically I did gain a little bit of weight but that’s normal. Though I noticed I was always in a slump, you know I couldn’t achieve my potenial no matter how hard I tried and that was even more fustrating. I can make close to straight A’s but I was very close to a C average. Not good at all.
One month after my 17th brithday I went to a doctor and asked to go back on Adderal it has worked great. I will be 18 in one month to come. My grades are great my weight went down so I feel good about myself. I got in to National Honors Society best of all if I want to do something I know have to drive to do it.
Going on medication can be hard and even when your on it. I ask myself all the time am I the medicatied me or the unmedicatied me. It’s tough to watch other people do things so easily and think, ” It’s hard enough to do on meds but off it be close to impossible.” On the flip side though never let your ADD/ ADHD get in the way off doing what you want to. And never let it be an excuse for not doing something. It may make life harder and emtional upsetting but it’s an out. You just feel ten times better when you do achieve something that is difficult to you.
So aside for that little tid bit for those who are unsure. Dr. Handelman I do have a question for you. When they say the meds go quickly in the body as they do out of the body. How long do they normally mean. I know from taking Adderall the effects of the medication are almost immediate and I can tell when it wears off but how long does it linger in your blood stream? Days, weeks, months?

Thank you for your time,
Heather

Dr. Handelman,

I am 32 year old male, started 18mg Concerta last month, and moved up to 36mg last week.. Fortunately inattentive ADHD, I didn’t have behavoral problems but needed to boost the attention and focus.

I am not noticing any effects, additionally my appetite did not changed at all. I still feel the urge to snack and eat meals at regular intervals.

It is hard to say the effects in quality of attention and given that I am not observing the most common side effect (loss of appetite), is this mean Concerta is not working for me, or should I until my dose goes up to 54mg ?

Hello,
I have a 9year old son who was diagnosed with adhd since he was in kindergarden. I had tried to work with him based on tutoring, the Y, sports, martial arts. I even went to nuts and berries and tried the fish oil and all those vitimins to no avail. Third grade came and crcts here in georgia you must pass them to pass the grade. I broke down in april of 08 and finally put him on stratera (I did my research I wanted to put him on some nonstimulants ) He was on 18 mg well it worked ok, teacher said he was doing better. He went to summer school to retake the test but he still didnt pass. After me calling and going to the school almost every day they passed him to the third, well his attention as gotten worst again after him forgetting his homework in school 4 days and the teacher saying he would answer a question and walk around the classroom I decided to go to the doctor to see what we could do. She prescribed Adderal 20mg and 2.5 mg of focalin for after school. Today was the first day, I gave him the Adderall after much trepedition, I looked it up online and I didnt like the side affects or the reviews. At 8:30 am I got a call from the school nurse saying he was crying and hyperventilating. I rush to the school and hes crying and twitching and scratching his arms so I rushed him to the doc and he was just having a panic/anxiety attack which she said wasent very common. When I looked it up online it said the recomended dosage is starting at 5 mg – 10 mg especially since he hadnt been on any stimulants. I know that after reading all of thes blogs that seems like very little but, after the scare I got today Im very worried about putting him on anything. She gave me a prescription for concerta now 18 mg so can you tell me what equivelant is to adderall? Is adderall more concentrated than concerta? If my son had an adverse reaction with adderall should I even try the concerta? She said the last resort was to put him on straterra on a higher dose, I would preffer this one but Im trying to rely on my pediatritians knoledge. Any bit of ideas, thoughts or advice would be apreciated
Thank You
A very concerned and frustrated parent
angelica

Dear Dr. Handelman,

Can you please advise me. I am at risk of losing my job and I have a daughter with special needs (seizure disorder); my wife works with her full time to help her develop.

I am a male in his late 30’s who has been taking medication for ADD since 1996. I had been taking Concerta at 54 mg since it first came out successfully for several years. About 1.5 years ago it stopped working. Up until this point Concerta was miraculous in that I could focus and execute my work seamlessly and I felt confident, able to learn and achieve. Then it stopped working; the best way to describe it is I felt like I was on a plane that was taking off indefinitely.

I have tried a number of medications but none work as well as the Concerta did. I had been warned and afraid that Concerta would stop working and have to go up and up on dosage; it all stated at 15mg or Ritalin in 1996, then 27, 36 and finally 54 mg of Concerta. After trying many other medications, I would consider returning to Concerta and increasing the dosage if advisable.

To give you a complete picture of what I tried:

Adderall XR 20mg — 3 months (made me very cranky)
Strattera 20mg — 3 months (it helped but my mind never really turned on, it was nice to be relaxed but I was never focused)
Vyvanse 30mg — 1 month (made me VERY cranky)
Focalin XR 20mg — 8 months

Focalin has been better than any of these besides Concerta but I don’t get the clarity Concerta offered me. Focalin drops off after 7 hours severely, and is quite noticeable at 5 hours. I think 20mg is an overdose as I do better on smaller amounts.

Getting the dosage on Focalin right is tricky however. It seems that approximately 12mg at the start of day (7am) is good, then 5mg at 12pm allows it to last until about 7pm. However 10mg is too little in the morning and above 15mg becomes too much. By 7pm I’m quite unfocused and cannot do much; Concerta kept me productive during most all my waking hours.

To curb the duration of effectiveness of Focalin I experience, I tried taking Focalin (up to 20mg) + Strattera (10mg) for about 2 months. This made me feel dizzy. In fact, Focalin compared to Concerta in general makes me feel dizzy. As an aside, I wish that Strattera allowed my mind to engage, it was nice to feel relaxed.

Please help me!

Hi there, I am 20 years old, and have just been diagnosed with add. I have been taking 18 mg of concerta the past few days, and have found myself to feel very sleepy. would this mean my dose is too low or high or what?
thanks so much!,
Emily

Dr. Handelman,
I’m 32 and have been taking concerta for about 2 years now and it’s been helpful. For most of that time I’ve been on 36mg. I’m also a recovering alcoholic (2.5 years sober in AA). I am concerned that some of my ADHD symptoms might have been from being newly sober, since I was diagnosed with ADHD around the time I got sober. I’m interested in trying a “drug free” period to see what my mental function is like now, and was wondering how to best discontinue concerta. Towards this end, my psychiatrist decreased my concerta dose to 18mg about a week ago. I have felt very fatigued, and have been sleeping a lot. Is this Concerta withdrawal or “discontinuation syndrome”? How long should I expect these feelings to last?
Bob

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.

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

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

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 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!

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.

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?

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 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.

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.

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)

squeeze 1/2 or a whole lemon in warm water and drink 30+ min before dinner (this is to balance your PH).

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.

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!

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’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!

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.

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

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.

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

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.

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!

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.

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

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

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?

Hello,

I was diagnosed with adult ADD this past summer. I have been taking Concerta now for about 8 weeks. I initially noticed a slight difference in that I was able to focus more and I was able to gather my thoughts better. This positive effect seems to have dropped off gradually even though I have not missed a single dose. Can your body get used to the concentration and demand more to uphold the same effect? I am just afraid to increase the dosage (and of course I would never do so without consulting with my physician) to a point where I will take 108mg per day and then not get any results. A brief history: I started on 18mg for the first week and then went up to 36mg which is the dose I am currently taking.

Can an individual run the risk of maxing out on the dosage and lose the effect Concerta has?

Thanks,
Trent

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,
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!!

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

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?

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

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

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.

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

Lynn – sorry, I don’t have experience or specific knowledge of concerta dosing for cataplexy.

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. 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

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.

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

Dear Dr. Handleman
Just wanted to know when the ADHD patch will be available in Canada. I believe it is called “Dytrana”?

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 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?

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

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

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.

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?

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.

Steve – no, concerta cannot be absorbed through the skin. There is a methylphenidate skin patch – called Daytrana.

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

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.

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?

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!!

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

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

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.