Concerta Dose: Getting It Right
ByConcerta is a newer, long acting preparation of Methylphenidate – which is the medication name for Ritalin.
It has been out for several years in the USA and Canada, and many other countries in the world.
Despite the fact that it has been around for quite some time, I still see dosing mistakes in patients who are sent to my office.
Allow me to explain to you how Concerta should be dosed.
To start off, we need to go back to the original Ritalin.
Here are the dosing guidelines for Ritalin:
Recommended daily max = 60 mg
Timing: as each dose only lasts 3-4 hours, it is generally dosed 3 times daily – i.e. morning, noon and 4 pm
It is not dosed too late in the day, as it may lead to insomnia
Children would be started at 5 mg twice to three times daily, and the dose would be increased upwards as needed.
When Concerta was developed, they used a fascinating technology called OROS. OROS refers to: osmotic-controlled release oral delivery system. What OROS does, is use the water in the gut to cause the medicine to be absorbed gradually, through osmosis. Suffice it to say that this new pill takes a medicine that has to be taken 3 times daily, and makes it once per day. You can see a short video of how this works here.
Concerta comes in 4 doses:
18 mg
27 mg
36 mg
54 mg
The way to convert Concerta doses into the equivalent of Ritalin doses is this:
Take 22% of the Concerta dose, and that becomes the effective Ritalin dose, three times daily. In other words, the initial 22% is quickly released, and the whole rest of the pill supports that dose.
You need to remember that not all of the medicine is released from the Concerta pill – about 10% is not absorbed.
Why?
Just picture a ketchup bottle – can you ever get the last bit out?
So, here is a conversion:
18 mg Concerta = 4 mg Ritalin 3 times per day
27 mg Concerta = 6 mg Ritalin 3 times per day
36 mg Concerta = 8 mg Ritalin 3 times per day
54 mg Concerta = 12 mg Ritalin 3 times per day
Here is an example of how some people get into trouble:
Let’s say that a teen required 60 mg of Ritalin per day – i.e. 20 mg three times daily.
If the doctor converts the dose of 60 mg Ritalin to 54 mg of Concerta – because they seem close, this can have dire consequences.
54 mg of Concerta is like 12 mg of Ritalin 3 times per day, so there would be a significant dose drop from 20 mg 3 times per day to 12 mg 3 times per day (i.e. a 40 % dose reduction!). It would be no surprise if the people noticed a change and felt that Concerta wasn’t working.
In the recent past, there has been approval in the US for 72 mg of Concerta for teenagers if needed.
Recent ADHD practice guidelines published by CADDRA – the Canadian ADHD Resource Alliance, suggest that teens and adults with ADHD may require up to 108 mg of Concerta daily.
To put these doses into perspective:
72 mg Concerta = 16 mg 3 times per day
90 mg Concerta = 20 mg 3 times per day
108 mg Concerta = 24 mg 3 times per day
To achieve these doses, you can use:
72 mg Concerta = two 36 mg tablets, or 54 mg + 18 mg
90 mg Concerta = 54 mg tablet + 36 mg tablet
108 mg Concerta = two 54 mg tablets
What’s the bottom line ?
If you or your loved one was switched from another form of methylphenidate to Concerta, and it seemed that Concerta didn’t work, please consider the information above.
You may even want to print this article, so that you can take it with you to your next doctor’s appointment.
Concerta is a great preparation of methylphenidate, and can work very well.
Don’t give up on it unless you are sure you have had the right dose.
I have taken Wellbutrin, Vyvanse and now concerta. I am currently on concerta 36 mg a day. I find that I am up a lot at night. The concerta medication does seem to help a little with my adhd. Does concerta medication come in any form other than ER. Any suggestions?
Hi,
I am hoping you can give me some advice. I am a 39 yr old woman who was “sort of” diagnosed with ADHD in the past year. I started at my family doc, who, after talking with me and seeing my results from an ADHD questionnaire I found online, agreed that it looked like ADHD was my problem. He started me at 10mg of Ritalin. I saw a minor change. Then we went to 10mg Ritalin twice a day, then to 20mg Ritalin once and 10mg once per day. Again, minor, very subtle changes. He referred me to a psychiatrist since he said that it was hard to tell if meds were working. The psychiatrist said that this dose wasn’t high enough to be effective and switched me to 20mg Adderall XR. Not a huge change from the Ritalin. Then to 30mg Adderall (of course, this is over a period of months– one month per dose level). Still, changes were so subtle that I could barely tell, but there were some changes. She decided that maybe I should use Wellbutrin as a “booster” instead of increasing the Adderall again, so she added 300mg of Wellbutrin XR (started at 150, worked up to 300) to the Adderall XR. This actually made me depressed. SO we worked back off the Wellbutrin. Next, she suggested I start seeing a therapist to see if we could figure out if ADHD is really the problem, or if maybe I was bipolar, or something else. SO I started seeing a therapist. Preliminary thoughts from her seem to be (after about a month) that, yes, there are “focusing issues” as well as the anxiety issues I had already been aware of (have been taking 75mg of Zoloft throughout) but no signs of bipolar.
SO back to psych. I told her that it hardly seemed like it was a good idea to continue taking mind-altering drugs if the changes I was noticing were microscopic (though I really *want* this to work). She said that we should try something else before quitting entirely, so she switched me to Concerta. Started with 18mg for 7 days, then 36mg for 7 days, then 54mg for 7 days. Now, as I am finishing that last 7 days, I can say I am seeing a more noticeable reaction to the meds, and feel more focused and less distracted, as well as more confident and “internally calm” However, it is still a very minor difference. (but more than with any other doses of any of the meds)
SO, I go back later this week to the psych, but I don’t really know….. shouldn’t I see a very noticeable change? Is it possible that I need a higher dose than any of these meds I have tried? Is it possible that I have just “adapted” so well to the symptoms of ADHD over the years that medication isn’t going to work well for me?
I should also note that I have seen no real side effects of any of these meds. No decrease appetite, no weight loss, no excessive energy. (though I do find I am perhaps a little less tired on less sleep than I would be without meds) No “hyper” behavior (more than I would normally have) And, in case it makes a difference with the meds, I also am hypothyroid and am being treated for that with Synthroid.
Thanks for any and all opinions.
Karen – some adults need higher doses of the meds.
For example, some adults may need Concerta in doses of 72 mg, 90 mg or even 108 mg. Of course each of these requires two pills.
Ask your doctor about that…
Dr. Kenny
hi Dr Kenny
,Thanks for the advice. Unfortunately (?) my dr decided to switch meds AGAIN instead of upping dose of Concerta. She put me on 50mg of Vyvanse. She said to take it for a week and if I don’t see a bigger improvement, it probably means I am not adhd and should just quit. I am a bit frustrated….
Dr. Kenny,
My daughter who is 19 was diagnosed with ADHD when she was 10. She has been taking Concerta at increasing doses sucessfully since then. She is currently on 72mg daily. Approximately 4 yrs ago, she acknowledged some abuse from her past and had a “meltdown”, She became very depressed and eventually went on Zoloft 20 mg. Last summer her depression deepened and she went in patient to a clinic and they added abilify to her daily meds. In the last 4 yrs she has gained almost 90 pounds! While she has had brief periods of contentment, I do not see her sustain a positive mood for long! Currently she has been wiened off of the abilify, but continues the concerta and zoloft…and is miserable! I feel fairly strongly that her meds need to be looked at and possibly adjusted? Her doctor is reluctant to change them? Any advice?
Many thanks—great forum!!
Elaine
Elaine,
Get her to see a psychiatrist who is an expert in mood disorders for a second opinion – and see if he/she can help with the treatment.
Dr. Kenny
Many thanks Dr Kenny, I really appreciate your advice.
Best wishes
James
I am a 44 year old man who was recently diagnosed with ADHD. Frankly, given my past lifestyle, I am amazed nobody thought of this befor. Anyway, the tried Ritalin but that did not seem to work for long, and the doctor only prescribed it as a once a day thing. Then they put me on Concerta, which certainly seems to be working better. My question is how do they assess the dosage. I am over six feet and about 200 pounds and am very active (no surprise there
. Does any of that have anything to do with it? I am currently on 36mg per day, which from what I have been reading seems kind of low. Any help would be appreciated.
John
Hi John,
Generally with adults, I start low and gradually build – stopping when we have great symptom control or side effects (or we’ve hit a maximum dose). Most adults need 54 mg, 72 mg or even 90 mg of Concerta. Talk to your doctor about going higher.
Hi Dr. Kenny,
I am so glad I found this site. My 9 (soon to be 10) year old was diagnosed with ADHD/ODD. After a year in behavioral therapy, we began meds 1st being Strattera 25mg 6months. He was still very impulsive at school and home, could not complete homework etc… His PED then suggested Intuniv to help with both the ADHD AND ODD. This was not the right med for him. He was lethargic and his concentration and focus was horrible. The PED then suggested a stimulant such as CONCERTA. He began 18mg (no change) his impulsiveness was in overdrive, he could not sit down or focus etc… then he increased him to 27mg same scenario as the 18mg … I then spoke with a pharmacist, his psychologist and the pediatrician and they all suggest and increase to 36mg .. I just feel as though nothing is going to help my son. He is suffering academically, socially, and emotionally. Please if you any feedback on COncerta not working initially please let me know. Thank you so much.
Michelle, sometimes it takes a while to find the right dose or the right medicine. It sounds like you are getting good care – just give it some more time.
Hello Dr.
My 9 yr old son just started taking concerta 27mg on saturday 4/17…this is his first time taking ADHD meds..my concern is that his father who does not live in the home was completely against putting him on medication but did not have to deal with the DAILY struggles my son was having at school and getting along w/ his peers…summer is around the corner and my son will go stay w/ dad for 6 weeks and during that time he will not be taking the meds..is it safe to stop and start again…for the next 5-6 weeks i will be giving him the meds daily then he will stop taking them around beginning of june for 6 weeks..what type of side effects or withdrawals should i be concerned with? thank you in advance…your response is greatly appreciated.
Tammy – talk to your doctor about specific issues. Most people can stop the medicine without concern and then restart it when necessary. Shouldn’t be too much of an issue.
i have a 13 year old diagnosed with add and he is on 63 mg concerta. he came to us 18-24 months ago, from an abusive, neglected and stressful environment. we have found that structure, firm guidance with a lot of love and fairness has brought about dramatic changes in his behavior and his school work. on weekends, and times when there is no school, he doesn’t take concerta. i’ve asked him if he finds that he feels any difference and consistently says that there is no difference.
1)can his behavior have been the result of his environment?
2)is it advisable/possible to decrease his dose?
he has a doctor who suffers adhd and she is difficult to approach at times, hence i am looking for feedback that i may be able to take to her.
Cecile, this is a complicated scenario. Partially because of the social issues.
That said, there are many kids and teens who have great results from the medicine (as measured by parents and teachers) who say that there is no difference. They can lack the ability to evaluate whether the medicine works.
So, the real question is – what do the teachers and yourselves notice when he is on medication vs. when he isn’t. That is the issue to take to the doctor.
Hi Dr. Kenny,
I am a 36yr old mom and started taking concerta 27 mg for a month. I feel that it has helped me with my homelife. Ive been more patient with my kids, able to focus more on house chores and even able to take my husbands sarcasms…lol. My husbands notice the difference=D I am still a working progress =D
My question to you is…How can I tell if i need a higher dosage? I read on concerta’s site that an adult should start on 18mg or 36mg. I feel as though I may be asorbing the 27 mg quickly? Does my height and weight matter for the dosage? My 9 1/2 old son is also on Concerta 27mg.
Thank You! I am so happy to have found your site=D
Stef – most adults go to concerta 54 mg, or even higher.
Height and weight don’t matter. What’s important is whether it is working for you. The general approach is to increase the dose until you either have great symptom control or there are side effects which interfere.
Thank you Dr. Kenny! We made an appointment for next week!
I was just recently placed on 36 mg Concerta, which at first it did nothing. Then the second time I took it made me sleepy so I had two cups of coffee and could focus on my reading. Now when I take it I just can’t concentrate for instance it took me 7 hour just to write five sentences.
Hi,
It has been an intersting 13 months.
Job loss. Funny how employers get upset when you steal money to support a gambling habit.
Near family loss. Funny how wives get upset when you have spent every penny available (and then some) to support a gambling habit.
1st counsellor. Wonderful lady. Explained to me that in normal people the maind has down time. Suggested I talk to family doctor about a referral to someone qualified to diagnose me with ADHD.
Dr sends me to nice psychiatrist. He has time for a single appointment. Too busy to take me on as a client. Diagnoses ADHD and says it most likely contributed to gambling addiction. Prescribed wellbutrin. Referred me to psychologist in his office and said my family doc can handle meds.
Wellbutrin makes my homicidal. Family doc spends 20 min with his nose in great big fat book of meds and comes up with some abritrary dose of dexidrine. Psychologist smiles sadly and nods a lot. Tells me about magical gifts ADHD imparts on those lucky enough to have it. I am apparantly now in the company of great men like Churchill (a drunk) and Lincon (a failed business man and lawyer).
Itty bitty dose of dexadrine does nothing. Psychologist smiles sadly and nods some more.
Spiraling into depression. Go to Doc and Psychologist and ask for them to sign some papers for me to access benefits from EI (afterall both have told me my illnesses are legitimate). Doc says no because he does not feel that he can ethically say I am sick enough to warrent help. I say I understand (afterall he is not mental health specialist). Psychologist smiles sadly and says she would be happy to.
Psychologist calls few days later. Tells me she is very sorry but she has considered my request and cannot in good conscience sign forms. I can feel her smiling sadly. When I asked why she had a change of heart she becomes angry and claims she had never told me she would sign form. I remind her that I am a pathological gambler and have ADHD but my memory is fine. Gets madder tells me I got myself into this pickle and I needed to stop looking for bailouts. Apparantly she had discussed the whole thing with my family doc and deferred to his expertise on the subject. She decided that she no longer wanted me as a client and that her notes from our sessions would support “her position”. I don’t think she was smiling.
Few months of spiraling down into deeper depression.
Wife (separated) decides to take steps. Finds me a doc that specializes in mental illness and addiction.
Go to see him. He is entertaining. Has bad ADHD but won’t admit it. Easy to get him off topic. Confirms ADHD diagnoses.
Next visit. Starts me on lamotragine (lacimital) as a buffer against the adverse effects of the stimulant. I don’t like it. Makes me mean. Makes me irritable. Gives me really big zits. Ask to be taken off of it. He says trust me. I say okay.
Few weeks later he adds 36mg Concerta twice a day. Jumps lamotragine dose higher. Irritable again. Doc says need bigger doses to offset side effect of stimulant. Lamatragine higher. Concerta to 36mg 3x a day. Still irritable. Jumps lamotragine higher again. Gives me a quiz. Says I am bi-polar. All things I answered yes to on quiz can be attributed to pathological gambling. He says I have both.
More lamotragine. Switch to adderall. Adderal makes me feel uninterested in pretty much everything. Back to Concerta, bigger dose.
Eventually get to 54mg three times a day. Pharmacist is reluctant to fill prescription. Get a cold. Luckily pharmacist paying attention and stops me from takin decongestant.
Major anhedonia (feel nothing) but wired and super jittery. Counsellor says I have to talk to doc. Talk to doc. Want off lamotragine and on lower does on concerta. He says no. I say why. He says he is not accountable to me. I remind him he is.
He says fine. Lowers does of lamotragine and switches me to 100mg of vyvanse for 3 weeks with a jump to 120 in week 4.
Pharmacist wants to know if doc is trying to kill me.
Has my doctor gone of his rocker? He has never taken a blood test, urine sample or done a patient history with me to see if I have heart problems, thyroid condition, etc. Is it safe for a 35 year old 220lbs smoker to take 154mg of Concerta a day. Should anyone start at 100mg/day of vyvanse and then increase it prior to seeing what the results are.
Sorry to ramble on for so long but I wanted you to have the full picture. Should I be doctor shopping?
Hi,
Im a 19 yr old female who was just diagnosed with ADHD, (dominatley inatentive.) I was first prescribed 18mgs of Concerta, tried this for two weeks and felt that it did nothing for me. only thing i noticed with this dose was i felt a little more awake for the first few hours after taking it,didnt help with focus,concerntation,or any other symptoms. then as it was wearing off after only a maximum of 4 hours, it completely drained me. i felt so tired and spaced out, more than i usually do without meds. so i discussed this with my Dr and she upped my dose to 27mgs concerta. tried this for a month and honestly couldnt tell a difference between the 18 and 27 mg. Just went back to the Dr’s today and was told that maybe i would respond better to Adderall XR.. i was prescribed 20mgs but when i took the RX to get it filled they gave me a generic.. i was wondering 1.) is generic adderall xr the same as name brand? and 2.)is 27mg Concerta equilivent to 20mg Adderall XR?
Dr. Handelman,
My son’s been on Concerta 36 for two years and it’s just not working any more. He’s grown a whole foot and gained at least 50 pounds in the last two years (he’s 12) and I’m wondering if an increase to 54 mgs. would be prudent. I have a call in to his doc, but I always like a second opinion. Thanks for any help you can give me.
Linda
i was told my son had adhd after his 1st half day in nursery by a teacher with 12 years exp, was due to be statmented when me and his dad split, new school ignored reports and then they started to complain bout him runnin round like a loon not listening climbing the usual, i fought with the school and after false alligations made against me by a teacher they were told to get my son help, this was in the form of the same doc who backed the school, we saw him till my son was just over 7 and then he was put on concerta xl 18 mg, my son was 11 and on 72 mg, every time myself and school requested blood tests or changes in his meds they just put the dose up, my son developed tummy pains when stressed or wound up, head pains, sever mood swings, after another false report my son became parranoid, barrackaded us in our home shmashed things up, and finnaly tried to take a full bottle of his meds that i had hidden, i had to wrestle him to stop him, the result i sent him to live with his dad and step mum as i have 2 other children to care for, we have never had any support and when we have been offerd it they seem intent on blaming me for my sons condition, even told me its because im devorced, come from a broken home myself oh and because we dont follow a religion, due to my son being pushed into snapping but people who should be helping i risk losing my youngest, could do with some advice, anyone please help.
Hi All,
I share your frustration, as if there is no exact science to getting the dose right. Drug companies web site are helpful either. They are avoiding the liability. Couple of things I figured through my journey:
1. 18 mg is a starter’s dose, it will probably not help you at you but it will let the doctor know if your body can tolerate the drug.
2. Do not take citrus with the drug. Keep away from orange , grapefruit juice or the fruit itself in the morning. They still don’t know how it affects but it does. Drink you OJ when you are don’t need to see the results of the drug, I drink it before bed or after dinner.
3. Suppliment your diet with fish oil and L-Tyrosine. There is no solid fact about their affect, help but I feel they help me. It won’t hurt you.
Dr. Handelman,
My son is 13, and he has been on 36 mg. of Concerta for about 1 1/2 years now. It doesn’t seem to be helping him much now, he has been getting a lot of F’s on his report card ever since last Nov. 2009. He also stays up very late at night, he has always had a problem with getting to sleep at night, ever since he was an infant, but once he gets to sleep he stays asleep. He will get up and go in the kitchen and get something to eat, or watch TV. He is pretty moody in the early evening and yells and has like temper tantrums, I beleive because he is coming off of the medicine. I’m going to speak to his Dr. about this, but can you give me your opionon/advice?
Ray,
I’m not sure which city you’re in, but I think it makes sense to get a second opinion from an expert. Most medical schools have a department of psychiatry where there are experts in Adult ADHD or Mood Disorders. If there is one near you, try calling the Department of Psychiatry at the university and asking them who works in one or the other of these areas.
You situation sounds complicated, and I do believe another opinion (or two!) could make a difference.
All the best,
Dr. Kenny
My 16 1/2 year old son is on 18 mg of concerta and he has been having some real major mood swings. They usually occur late in the evening after the concerta has worn off. He starts crying and seems real depressed. His dad and I talk to him about this and he says he doesn’t know why he is feeling this way. We are concerned that maybe he needs to be on a different type of medication of something. We have taken him to his peditrician and she said he was having anxiety attacks and needed to work on them, but didn’t think his medicine needed changing, but we have been working with him and he is not getting better. I do have a family history of depression/moodiness and I am currently on effexor. So my question is is there another type of medication he could possibly try that will not make him moody but help him in his focusing. He has such a great personality but on this medication he is not “himself”?
Thanks
Concerned Soccer Mom
Hello Dr. Kenny,
I am a 24 years old male. For a few months now I was prescribed Prozac (40mg) and Seroquel (150mg, a pill and a ‘half) for depression and ‘insociability.’ Also, I was diagnosed with Asperger’s when I was 15. Recently Concerta was added to the family, starting at 18mg, for ADD. These medications were prescribed to help with the debilitating side effects of my problem.
My question is, do these medications, in the combination laid forth, negatively cross-react in any way? Also, does this amount of Concerta (18mg) cause any dependence or ‘addiction’? Because I know that I am prone to addiction, I smoke cigarettes, but I do not drink nor abuse drugs, and my doctor is aware, but at the same time I cannot dismiss the debilitating side effects of ADD.
Thanks.
Hi ‘Curious’,
It is fine to take a combination of Prozac, Seroquel and Concerta – of course under a doctor’s supervision and direction. These medicines don’t have bad drug interactions.
Concerta is not ‘addictive’ like a street drug is. It will not make you develop tolerance or dependence, and it won’t make you want to ruin your life to feed your ‘habit’. There is no reason for concern there.
Talk to your doctor if you need more info about this. All the best,
Dr. Kenny
Hi Dr. Handelman,
I’m in my late twenties and am of average height and weight.
I have severe ADHD and atypical depression. I’ve been taking 70 mg of vyvanse with no relief — I can barely tell that I’ve taken it, and it often makes me fall asleep. Last week I accidentally took two doses — I took one when I woke up, I fell back asleep for 3 hours, then I took another without thinking when I got up the second time. That day was probably the best day I’ve had in the last 6 months — I was able to get out of bed, take a shower, and I was able to work on a single task for more than about 15 minutes. And it was the first time in a while that I felt relaxed and not anxious. The normal dose of vyvanse only lasts like 3-4 hours now, and with two doses it lasted 6 hours which was much nicer. Ideally I’d want it to work for 12 hours, but even 6 would be life changing.
Does what I’m experiencing make sense? I know vyvanse is only approved up to 70 mg, and I’m afraid my doctor might not feel comfortable raising the dose. Years ago I used to take 108 mg of concerta, and I’d be happy to switch to that or daytrana if my doctor doesn’t want to raise my vyvanse dose.
I’m asking this b/c my doctor isn’t an adhd specialist, he mostly focuses on mood disorders and schizophrenia. I’m his only patient on vyvanse (at my request a couple years ago), and he’s got a couple others on adderall xr. I feel like what I want is an extremely high dose, and I have no idea why the normal doses don’t work or if this means I have something else wrong with me. I’m just worried b/c I feel like if I don’t have a higher dose soon, my life is just going to fall apart with unpaid bills, incomplete work assignments, disorganization and clutter and being late to everything and forgetting obligations and losing things.
Thanks for reading and for any advice you might have re whether my problem makes sense at all.
Hi – if your doctor gave you twice the recommended max does of concerta in the past – i.e. 108 mg was twice the 54 mg recommended max (back then, now it’s 72 mg)… Then it doesn’t seem a big stretch to take 2 x the recommended max of vyvanse.
You’ll have to talk to your doctor about the safety side of taking high dose – i.e. heart rate and blood pressure – but it’s worth the discussion…
Oh also one more question, hopefully this falls in your area of specialty. My antidepressant (mirtazapine) does nothing for me anymore besides make me hungry. If I quit taking the stimulant and the mirtazapine and switched to Parnate, do you have any reason to believe that might treat my adhd? I don’t want to bring this to my doctor if it doesn’t make sense, especially given the side effects of an MAOI, but I’ve read that it is stimulating and works really well for atypical depression.
Thanks for taking time to look at this. I know this is above and beyond the requirements of your practice, to offer advice to people on the internet, and I really appreciate your site in general.
Paul – to your second comment.
Firstly – thanks for the compliment – much appreciated.
Regarding the question of an MAOI – the short answer is that I don’t really know.
A quick search of pubmed revealed these relatively recent studies:
http://www.ncbi.nlm.nih.gov/pubmed/16958566
http://www.ncbi.nlm.nih.gov/pubmed/12921918
Those aren’t definitive answers for you… but I just don’t know the answer.
Dr. Kenny,
I am 24 years old. I have struggled with ADD certain times of my life(usually times of high stress), and was recently diagnosed. Remarkably I was a pretty good student in high school, however this was mostly because I chose classes that truly interested me, rather than ones I would find too boring and get distracted from as easily. Anyway… here I am now, working as a legal assistant. It is probably one of the single most terrible jobs for a person with ADD, because I am working on corporate and commercial law. It is far from interesting.
After years of having chosen to note medicate— I finally gave in when the problems started mounting. I just started 27 mg of Concerta a week ago, thinking it would help. I am certainly less impulsive, but I still cannot focus “where I need to”. I take my pill at 8 am and notice an increase in my productivity from approximately 1-4… but the morning is still the same mindlessness and difficult task avoidance. I try and try…but my brain fights me. I don’t know how taking any more Concerta would help, and I’m not really “impressed” with Concerta yet either. If I increase the dose, not much will really get to me in the morning anyway. Can I take a booster of something else in a very low dose that will release quickly? While I believe in personal responsibility, and nothing will be “magic”… I just can’t seem to get any relief in the morning. I want to keep my job. It is the only skill I have worth the pay that I need to sustain my modest standard of living. I also have this hope that one day, I will get experienced and the job will become “easier” so that will help me perform normally, like a non-ADD person. My boss knows about my problem and is wonderful, and he is trying to be accommodating…so we both want to see this succeed…but I’m just at wits end some days and my self esteem is plummeting
Alysia
Alysia – you probably need a higher dose of concerta for it to work. It will work better in the morning with a higher dose.
Dear Sir, I’m currently in med school and know how to check for increase in systolic/diastolic blood pressure at school, and various other increases associated with CNS stimulants but my question is related to Concerta 54mg. My Final papers are starting up on friday(june 18-26) and I can honestly say that i’m abusing the “hell” out of my body! Currently I’m taking 2 54mg in the morning(8-9am) and 1 54mg at around 2pm. For the previous week I was only taking 2 54mg a day, and the week before that i was only taking 1 54mg a day, and before that I wasn’t taking the medicine at all. I refrain from consuming any ascorbic acid throughout the time i take my medicine but I still felt a need in increasing my dosage due to my bodies metabolism. I checked my BP 3 times in class exactly 3 weeks ago, and it read 120/80 exactly each time, and my vital capacity was 2.1(I’m 6’0 and 155lbs and play alot of basketball) but since starting the concerta “binge” before finals I haven’t exercised and on top of that I started smoking cigarettes(a pack a day). My weight is still consistent but my real question is that: if I up to taking 4 54mg a day will I survive? Smoking cigarettes combats any increase in BP, and after finals I will quit taking concerta and smoking cigarettes completely. I just want to know if it’s theoretically possible to consume that much concerta for about 3 days, and not end up a corpse. I start my finals on friday(Anatomy, Physiology/Biochemistry, sunday break and then DA on monday) so a response before then would be greatly appreciated! Thank You For Your Time
Aman – I cannot give you medical advice on a blog. It sounds like you are using large doses of Concerta without medical supervision. See a doctor to review the safety and risks of doing what you’re doing!
which drug is more effective vyvanse or concerta why can’t you tell me
Darrius – the answer to the question of vyvanse vs. concerta really comes down to how YOU respond to each medicine. There is no way to say that one is better than the other – they are different.
my nine year old tried to kill himself. He was diagnosed with adhd. under went cleft lip and cleft palate and brain surgery. Could all of his health contibuted to him wanting to kill himself? His father and me also divorced
Angle Eye – yes, those factors could play a role. I hope you will go to the doctor right away to deal with this issue!
My son is 6 years old and has been diagnosed with Mood Disorder-NOS and ADHD. He is currently taking Concerta after trying Focalin XR. He is having serious issues with enuresis and encompresis during the day. We have had ALL the usual culprits checked for the causes of this, and none have come back with a reasonable explaination for why he is having these problems. IT IS NOT BEHAVIORAL. (We have EXHAUSTED this avenue for over a year and a half. If I hear one more suggestion of a sticker chart or reward system, I will scream.)
He does not seem to notice at all that he has soiled himself. He does it several times a day, sometimes back to back. We had one doctor suggest that he is so distracted that he doesn’t realize he has to go until it is too late. I feel there might be some validity to this, as he is VERY distractable and has MAJOR attention issues.
To get to the point, we started Concerta in the hopes it would help focus him a little longer during the day. His accidents coincide with his decline in attention as the day wears on. Usually, he appears to lose it around 2pm and things go downhill from there. I don’t want to assume the Concerta isn’t working, so maybe there is a dosing issue. Is it typical for a 40lb child to need a higher does of Concerta? Also, is it possible to add another shorter acting ADHD med later in the day to help him throught the afternoon/evening?
Thank you for your time! Reading this post has been extremely informative and helpful.
Marci
Marci,
Does your son notice this when you point it out? And does it ever happen at night? When I was his age I had an enuresis problem and it never occured to me before that it was related to ADHD but that makes some sense to me. (I am a patient not a doctor/expert). I know some of the tricyclics are used for nocturnal enuresis — e.g., here is a study where imipramine was effective: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1511665/
But not having expertise in medicine, I have no clue if it would also help for daytime enuresis. I have heard of ADHD people being prescribed tricyclics as an adjunct to a stimulant. I’m very interested to hear what Dr. Handelman thinks about this.
Oh also, have you checked to see if it is a urinary tract infection or some other organic illness? I ask b/c I just noticed they were exclusion criteria for the imipramine study I linked.
Also take a look at this if you haven’t: http://www.msdlatinamerica.com/ebooks/ChildandAdolescentPsychiatryAPracticalGuide/sid125500.html Apologies in advance if you’ve done all this research. And apologies to Dr. Handelman for junking up your message board, feel free to delete my posts if they are inappropriate.
Paul – thanks for sharing these resources.
Tricylcic antidepressants like Imipramine can help with enuresis, and can help with ADHD as well. The issue is that they can cause irregular heartbeats, so most doctors working with kids/teens are reluctant to use them as a regular medicine. DDAVP can be helpful for enuresis, and Strattera helps ADHD and can have a minor urinary retention side effect to it.
wow, reading most of all these post has made me hopeful, my 8 1/2 year old was just increased to 54 mg of concerta..he was 36 for a little of a year and his school noticed a change in behavior about february of this year..now that camp has started, he has been getting in trouble. i try not to get as frustrated with his behaviors and also try to keep him on a schedule..he plays hard so rarely has problems with insomnia, rarely complains of headaches, but does get aggressive toward object (ripping books) when he doesnt get his was in class. i hope this dose works for him and that he will start to do better again..Thanks Dr. Kenny for all your answers to the many questions.
Hi Dr Handelman
What an impressive blog!
My son was diagnosed with ADHD and responded well to Concerta. I recognised all the same symptoms in myself based on my childhood and also my adult years. My child’s doctor diagnosed me with ADD and I started Concerta two days ago.
I am a regular blood donor and would like to know the implication of donating blood whilst on Concerta – for myself and for the recipient.
Many thanks
Alan,
I don’t know the answer to that question – regarding blood donation. You would need to ask the agency that collects the blood. I’d love to know what they tell you (if you’re willing to come back and share).
Hi there. My 9 year old son was dx with ADD back in March 2010. We started on Conserta 18mg and within days noticed a drastic change both at home and at school. He slowly started to revert back to some of his old habits (impulsivity etc), but overall the change was still much for the better. After 60 days on 18 mg, we reassessed at the dr and increased his dosage to 27mg. I didn’t notice a drastic change with this new dose…things are still “ok”, but he is still having issues with his behavior.
I was just wondering what the “average” dosage is for a child with ADD? Are we still at a relatively low dose? I guess I am wondering if a higher dosage would be beneficial?
Your thoughts would be much appreciated.
For kids, the average dose is probably about 36 mg, and for teens, it is between 54 and 72 mg.
My son is 14 today and is 5’9″ and weighs 130 lbs. He had been on a 36 mg pill as well as a 54 mg pill for several years know. I feel he know needs as increase or another drug. I was told from his Dr. that he cannot take 108 mg. They want to add Stratera, which did nothing for him when we tried it with Ritalin several years ago. Is it safe to increase him to 108 mg. or should we look into another medication?
Sandy B – these doses are above average and are ‘off label’. You need to listen to your doctor about the safety aspects of the medicine. I can’t advise you to go higher than your doctor is comfortable.
I am a 56 year old male that was diagnosed w/ ADHD at 39 years of age. I could not take the traditional stimulant meds because of job sensitivity and tried wellbutrin for a while with which I have had limited success.I have since left that job and decided to try the stimulant meds about 2 yrs ago and started out on the smallest possible dosages of adderal, vyvanse and concerta—all gave me a feeling of jumping out of my skin even after a few days hoping it would settle down to no avail.I stopped the meds. About 6 weeks ago I saw the bottle of 18mg Concerta in my medicine cabinet and decided to give it one more try. To my amazement it started working immediately. For the first time in my entire life I was able to meditate for 5 minutes without several thoughts going on at once with no nervous feeling. After 2-3 days the positive effects wore off and I consulted with the neurologist and we went up to 36mg with the same results and then to the 54mg. Now I have the “nervous feeling” with no benefits and I do not want to go any higher in dosages. Any suggestions?
Hi Dr Kenny:
I have been taking Strattera for approximately four years now. Last fall I started to have pre-ulcer conditions and my GP advised me to quit coffee in order to rectify the problem; I was consuming approximately 600 mg/day of caffeine in order to augment the Strattera sufficiently that I could focus at work. When she realized how much caffeine I was consuming, she started me on Concerta and titrated up to 72 mg/day. Subsequently, I was able to reduce my caffeine intake to approximately 300 mg/day. Unfortunately, my stomach issues have returned and I have had to eliminate my caffeine all together. That is good news for my stomach, however it has left me with deficit in focus. My GP will not increase the dosage irrespective of my impairment. Therefore, the way it appears to me, I am left with the option of resuming my caffeine intake and having to take Nexium for an indefinite period of time, or just learn to live my impairment and its consequences. I feel as if I am in a corner.
Two months ago my son 5 year old son was diagnosed with ADHD and prescribed Biphentin. When the paediatrician was determining his medication approach, he asked me what and how much I was taking for my ADHD. He commented that in his experience, someone of my size would usually require a higher dose (108 mg/day of Concerta) in order to get optimal efficacy and that I should seek a second opinion. He told me that the best titration approach is to increase the dose until symptom control or intolerable side effects. He reasoned that the patient, especially adult patients, have difficulty evaluating efficacy because they are not aware of what “normal focus is”. He likened it to increasing the prescription for eyeglasses until the point at which the vision was corrected to the equivalent of a person with cataracts. If the person is then told that this is normal, they will not realize that they are still impaired. Therefore, because adults have spent a lifetime being acclimated with very low level of focus, unless you increase the dose, as he proposed, they will never be able to objectively state the efficacy of the medication.
Therefore, I think that it is time that I got myself a second opinion. Does this seem like I am logical conclusion to you?
Regards,
Jethro
Jethro – this is very sound logic, and solid advice. Take a look at this excerpt from the CADDRA Guidelines (the Canadian ADHD Resource Alliance Guidelines) http://www.caddra.ca/cms4/pdfs/caddraGuidelinesChapter06.pdf Particularly look at the 8th page, where the recommended max for Concerta in adults is 108 mg. Print this off, and take it to your doctor, if you’d like.
Dear Dr. Handelman,
My 17 yr. old son recently switched from two 30mg daily Daytrana patches to two 36mg + an 18 mg concerta pills.
The patches would fall off or he would just take them off. However, the medicine seemed to work very well for him.
On the concerta, he still seems very distractable and impulsive. His driving skills are scaring me to death.. I refuse to let him drive unless he has been medicated for at least 1/2 hr. I am concerned about a maximum dose. From all the posts, I’m not reading that anyone is taking as much as my son. Should I ask my Dr. to up another 18mg?
Hi Dr. Kenny,
I seem to have reached a dosing issue, but I am not sure. Medication, in general, is very new to me, I have to admit. I wasn’t brave enough to admit and be properly diagnosed with ADD until I was 24. I took a mind-over-matter stance for years and when I became a legal assistant, my stubborn stance fell apart and after 3 years of off and on struggling throughout my new non-ADD friendly career, I got the help I needed.
About 6 weeks ago, I started on Concerta 27 mg and was on this for one month. All in all, I had a few random, very painful headaches that came quickly and went quickly, but I had noticed some positive improvement, and then after 2 weeks the headaches subsided. However, the positive effects (particularly, better ability to organize, and easier time tackling long projects) wasn’t kicking in and assisting me until close to 11 am. Due to job, I REALLY needed improvement to begin quicker than just before lunch time. Every hour counts. So I left a comment here, to which you gave me a wonderful response and said I would probably need to increase the dose, and then I spoke to my doctor, and he said I should follow through for another few weeks and come back at the 30 day mark when my prescription was up for renewal. At that point we would further discuss dosing, and see if an increase would be beneficial after those 30 days were up.
So—I saw him again at 30 days, and we agreed on 36 mg. This was about 2 weeks ago.
On 36, my mornings are now… odd. At 36 mg, I feel a little… panicky, anxious. The medicine kicks in sooner but not in a way I would deem “positive” or helpful. Until 10 a.m. or so its actually bad. I can focus on things, but I am almost paranoid and its not necessarily the things I need to focus on. For instance, instead of taking 3-4 minutes to craft a few paragraph email to a client explaining something, I will keep editing what I’m saying over and over. I feel like…obsessive…if I don’t say something right or explain something right by my ridiculous standard at that moment, I will undo it and begin again. It takes 20 minutes to hit send, and then I realize I feel like a mess.
On the one hand, I have only been on this new 36 mg dose for about 2 weeks, so I don’t want to prematurely go back to see the doctor and ask him to set my dose back to 27 mg if I haven’t given it a shot, like he thought the last time I wanted to increase my dose– but what are my chances that this will improve?
And more importantly, if I did want to go back to 27 mg for a while and maybe just…wake myself up in the early early morning hours (i.e. 4:30 am) to take my medicine and go back to bed so it would kick in around 9:00, would it even work effectively, having been on 36 mg and then going back to 27?
I hope this makes sense.
Thank you so much. I love and cherish your advice.
Alysia
Alysia – you have laid out the options perfectly. Now it’s just a matter of making a judgment call and deciding what to do. I can’t really say, because I don’t know you. You and your doctor will have to decide. Either stay with the 36 mg for longer, or drop down to the 27 mg. It is worth working this out, so you can see if Concerta can work, before trying a different medicine.
Dear. Dr Kenny Handelman
Thank you for a very knowledgeable and informative website. I would greatly appreciate your advice. I am a 22 year old male (80kgs) and have been on 50 mg of Ritalin a day for the past 4 years to great results.40mg LA in the morning and a 10mg booster in the afternoon. Recently I switched to concerta 72 mg. I have noticed that it seems to focus me very well but there are things that are different. For example it does not give me the so called “kick” of the IR Ritalin. This kick used to help me get more things done and be a more productive person but I could still focus on academics when needed. What is your opinion on this? Is the kick I liked healthy for my body and mind? Should I persist with the concerta and learn to live with it? Or switch back to the LA and IR Ritalin. I am seeing my doctor in a few days and it would be a huge help if I had your opinion to discus with him. Thanks again.
Michael – yes, you will get less of a kick first thing with concerta, though concerta presumably lasts longer. There is no right or wrong here, just what works for you…
Dear Dr. Kenny
I have started on Concerta for almost a year, and it had been wonderful until now. I have started off at 27mg for maybe a week, then increased to 36mg for 8 months and it has been mostly rewarding. However, it seems like the medication has lost it’s usual effect last month. And since then, I was prescribed with 72mg Concerta, but sadly, I cannot restore the concentration level experienced before when I was still all happy with 36mg. I feel extremely tired, confused and inattentive after 2~3 hours in taking the 72mg or the 36mg Concerta. The feeling of fatigue remains until the medicine leaves my body maybe after 9 hours of taking it. Do you think my body has built a tolerance against this medicine? Why isn’t it working anymore? Please provide me with some advice and suggestion, I will not been able to meet with my psychiatrist for another 2 months.
Dr Kenny
I have a teenaged son who is on Concerta 54. He is doing well on it but at times he is shy, anxious and socially awkward. He has matured slot and I am wondering if it is possible to no longer need the medicine or to outgrow it. I do not want to mess up his school success, but I want to see if he still needs it. What can I do?
Hi Wendy – talk to your doctor about trying a brief time without the medicine (if the doctor and your son agree) to see how your son does. This will give you an answer pretty quickly.
Hi, Dr. Kenny.
First of all, thank you so much for taking the time to put together this blog. So helpful!
Secondly, my 8 year old son has been on Concerta previously, but not consistently enough to get solid results. We are ready to put him back on it, but I am cautious. He is an extremely lethargic child – low energy all around. He is true “ADD” without hyperactivity. I find lots of info about ADHD, but every little for the child who struggles with low energy and sustained focus. My husband and I are both teachers, so we understand the position of both the child and the school. I am also a bit of a health nut, so we eat lots of whole grains, get exercise, fresh air, and I make my children go to bed super early. I feel that, given the multiple steps we’ve taken, we are ‘stuck’ with the medication option.
Would you still recommend that we proceed with medication?
Thanks for your time!
Jeannie
Hi Jeannie,
Medication is certainly a reasonable option here. And because stimulants can increase alertness, they are likely the best option for your son.
When it comes to alternatives, I’m not sure what you’ve tried specifically. I recently created a product which reviews the research for many different alternatives. You can take a look at it here: http://www.alternativesforadhd.com
What a nice web site. Grandsom is on concerts. Thanks for all the information.
I love Concerta….I can focus and it also seems to take away my depression or focus on sad things. The problem I have is that it makes me want to EAT all the time. I had been told that it would do the opposite…I have not seen anyone else have this issue so I am kind of worried.
Hi dr Kenny
My son is 12 he started on concerta for his adhd 2 weeks ago. He is on18mg. I don’t feel like it has made any difference and this morning initially he refused to take it and said I dont see the point it doesn’t make any difference. I was quite shocked by this as i wasn’t aware he felt the same. He is still having all the same problems with regard to concentration focus ability to sit still organizing himself etc. He has been having quite extreme mood swings also and has been very miserable stroppy and irritable – much worse than normally. I wondered whether I should ask the doctor to increase the dose or whether we should try something else? his appetite appears to have decreased but he is an extremely fussy eater anyway and doesn’t eat that much, he knows one of the side effects is loss of appetite and I wonder if maybe he is using this to his advantage? Your advice would be greatly appreciated.
Emma
I used to be on ADHD meds. I stopped taking them for awhile, I want to start taking the Concerta (or Adderall) I have again. Do I need to step up to it or can I Just take it “as usual” again? Sorry if this was asked before, I didn’t notice it in my limited time to search. Thanks. I have Straterra left too but that made me sick.
Andria – some people are able to go right back to the previous dose, and some people need to step it up. Review this with your doctor for your particular case.
HI my son is 10.The public schools do not really have the time to teach adhd kids.These kids have so much energy sitting down for a long time is very hard for them.My son was on concerta he is now on hokimega3 very high DRA 540 mg.He is waiting for his appointment at the hutt hospital nz because he has had two heart attacks he will never go on drugs again.I am building a school in lower hutt for these kids .I know these kids can be very demanding but we must try another way.Thank you rod.
Hi! I’m 14 soon to be 15, I have ADHD and I have known this since before I started school. I’ve been on concerta for a few years, I can not remember when I started taking them, my dose is 54mg. Before I started taking Concerta I had already been on Rubifen and earlier Ritalin, I do not remember what doses because they changed so many times. The Concerta worked for a little bit but then I started to feel no difference. There’s days that I deliberately forget to take my Concerta and on those days, I feel no different than if I had taken it, except that, when it’s not in my system, I feel like actually eating, but when I have the tablet, any thought of food makes me want to vomit. I have pains in my upper abdomen, I feel like passing out every so often throughout the day from lack of food or because of the drug itself, I find it more and more difficult to focus in class, I have had trouble sleeping, I used to be able to just fall asleep and stay asleep, now I lie awake until the early hours of the morning and when I do sleep, I have nightmares, I have constant mood swings and I find it hard to stop myself from snapping at people when all they say is ‘hey!’, I keep thinking I see things move when they don’t and I keep thinking I hear someones voice in my head, I feel depressed a lot of the time and I have to force myself to not self harm, I also find it hard to stay seated for long periods of time without being able to at least stretch. I have told my parents that the Concerta is not working, they tell me I can’t be the judge of that because I do not see how I act throughout the day, well neither do they and they do not have to take the damn thing. The only real give away when I have not had my tablet is that I eat and I never seem to be full and because I seem happier and less asleep. The Concerta is not working, it’s destroying my appetite, my sleeping and my body! My mum has told me repeatedly to look at my cousin, she’s also ADHA and out of control at that, and ask myself if I want to become her because refusing to take my tablet is a one way trip to that! I don’t want to become my cousin but I don’t want to take a tablet that is not working and seems to be causing more harm than good! What should I do?
hi
I am so worry, honestly I was having problems since my child was in 7th grade, I switched her from a private school to a public school but at the same time, i worked in an office where it will be easier for me to drop my children before i went to work, my frustration was i thought that it was her teenage years or it was me not to be a good parent, but i recall that when i was growing up i used to be very responsible and tidy on my actions, even to learn math, or english i did it on my own. Problem is she went to public school even in first year of high school, she did it owful academically, i used to yell, her chores at home, there was none, her tantrums on yelling back was horrible, to the point that i took her for doctor consultation and i also requested to take her to a neurologist, and he stated she has mild ADD attention deficit, i am frustrated concerta was prescribed for her as 30 mg and she is not on it yet, doctor suggested that she should have on school year, what do you think, is it addictive? i got to know that the father has dislexia, and is it genetic? also he and her are alike when they get frustrated they get into tantrums and yell back instead to handle a conversation, what should i do, at the moment i am so worry because we moved to a new country and the socialist way of handling doctors and prescription and a new language will be a problem for her? Please I need your guidance on this, i am so frustrated as a parent, she gets distracted when i try to talk to her then watch the tv or the dog or… it is just driving me nuts, after i clean did the laundry and her bedroom is organized, boom her bedroom is upside down, i know is a combination of unorganize neither the father has rules for her, i don’t know if i am wrong but i need your professional advice.Thank You. Mona