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.
Grace,
Most of your mood problems throughout the day may well be related to lack of sleep. Try taking your pill early in the morning, before 9:00am. Keep away from caffeinated drinks for a while. There is some chatter about vitamin C or citrus/orange juice slows down the affect of these drugs. Try drinking some OJ after school.
Supplement your diet with 2000 unit vitamin D, deficiency of D causes mood issues. Take fish oil, it is highly suggested to ADHD patients and for healthier neural activity.
Finally talk to your doctor about trying 36mg instead for a while.
My 5th grade 10 year old has been on 36mg Concerta for 1.5 yrs. He also has 10mg of generic short acting ritalin he takes on the weekends instead of the Concerta to help with appetite. The Concerta is wearing off earlier in the afternoon and he seems very emotional. It is hard for him to study and work on school projects unless it is immediately after school but he needs a break when he gets home. He is forgetting things at school and quality of work is starting to slide (he is cutting corners and choosing to do what is easiest and quickest to get the work done even if it is not complete). Can I give him the 36 mg of Concerta in the morning with 1/2 or whole 10mg short acting pill instead of going up to 54 mg of Concerta?
Julie,
The formulation of concerta is intended to have a specific profile of how the medicine is absorbed, and it could potentially not work as well if a short acting MPH were taken in the morning.
You could ask your doctor about going to 45 mg – i.e. taking an 18 mg pill with a 27 mg pill.
Hi, My son has been diagnosed with ADHD, he is 11 years old his been on Ritalin 30mg slow release for about 3 years and his ped just switched him over to 36mg slow release Concerta he also takes 1mg Rispardil – since going onto the Concerta his school work has gone down terribly. He doesn’t want to go back onto Ritalin as he doesn’t like the way it makes him feel. What is the best course of action for us to take?
I am looking for a generic version of concerta ?? i have used concerta for over 10 years and have no complaints except for the price increases !!!! i was paying $80.00 for 30 54mil in 2003 now i just paid $236.00 for the same dose and i plan to see my DR on Monday to switch to a different drug even if it requires dosing 3 times a day. If you have some advise please feel free to email me at rwbutler100@msn.com
You may get an ‘authorized generic’ in May 2011 in the US, as shown by this news report: http://www.nj.com/business/index.ssf/2010/11/njs_johnson_johnson_and_watson.html
My doctor just prescribed me to take 20mg of Methylin ER X2, 3 times a day. As I read information on this it seems that she has told me to take twice the highest recommended dose. I have only been on stimulant medication for 1 week… This must be wrong? The first thing she prescribed was Concerta at 27mg once a day, then Medicaid wouldn’t pay for it without trying the others first so she gave me a script for Methylphenidate 20mg, 4 times a day. That made me feel distinct ups and downs and seemed to wear off about an hour to 1 1/2 hours before the next dosage. so she put me on 20mg of Methyline ER X2 (40mg) in the morning. That seemed to drop off in early afternoon so today she told me to take the same amount at 7am, 12pm, & 5pm…. Isn’t that an extremely high dosage? I was only diagnosed with adhd 2 weeks ago. I am 39 years old.
I guess I forgot to mention that I am three years into recovery from meth addiction and I have PTSD and anxiety… Is it because of my previous addiction that she thinks that I need such a high dose? It is because of my recovery that I am so afraid to be on the higher doses. I have two young children and I can not afford to have a heart attack or stroke from my medication….. I had previously been misdiagnosed with Depression and the anti depressants that I tried for three years caused chronic fatigue and other issues until I finally refused to try any more. Am I just being skeptic of her because of my past bad experience? Should I be on this much medication so soon? I am confused and would really like to know what you think. I will also call her office again tomorrow to ask some questions.
Dana – those are high doses – and yes 60 mg is the recommended max for methylphenidate medicines. There may be other factors for you right now… but check with your doctor…
Is there much of a difference between 90 mg and 108 mg of Concerta. My daughter has been on 90 (36 & 54 mg tablets) for a couple of years now. Last week we ran out of the 36 mg tablets so I had her take two of the 54 mg ones. She said she didn’t notice a difference but wants to take two 54 mg tablets when she has her finals so I’m wondering if it did make a difference. I’m thinking about asking her doctor if we can switch to 108 so that it will be only one prescription and therefore one co-pay. It’s been getting expensive paying for 2 different dosages.
Patty – the difference between 90 and 108 is quite simply: 18 mg
Does that make a big difference?
Probably some – but not a huge amount.
Once you are over 72 mg, it is considered to be ‘off label’ and so it is above average dosing. As long as the doctor is monitoring for side effects – including heart rate and blood pressure, then it is likely OK.
I presume your daughter is an older teen or adult… (this would be concern for a young girl, in my opinion).
The CADDRA guidelines (Canadian ADHD Resource Alliance) says that up to 108 mg can be used for adults with ADHD. You can find these guidelines here: http://www.CADDRA.ca.
I use concerta and I was wondering if you always have to see the doctor on a monthly basis to renew the prescritpion or can it be setup for auto renewal.
Thanks
Hi Aaron, most doctors will want to reassess someone and not necessarily set up the medicine for ‘auto-renewal’. That said – if you are stable, you could probably ask your doctor for a 3 or 4 month prescription so that your visits are less frequent. Good luck.
I have an eight year old son and he is diagnosed 2 54 mg in the morning and 2 ritilin thru out the the day. Isn’t this too much and why doesn’t someone put a stop to the doctors that are over medicating? My son weights only 49lbs and I am concerned with his weight. What do I do?
Lana – are you saying he is on 108 mg of Concerta per day and 20 mg of ritalin?
If that is what you are saying – those are very high doses, and I would ask the doctor why your son needs that. Get a second opinion if necessary.
“You may get an ‘authorized generic’ in May 2011 in the US, as shown by this news report: http://www.nj.com/business/index.ssf/2010/11/njs_johnson_johnson_and_watson.html ”
This report sounded great at first as I though that a generic coming out in May would cause the price to go way down. When I carefully read the article I realized that Ortho-McNeil-Janssen Pharmaceuticals who will make the generic is a Johnson & Johnson subsidiary, and that the other company (Watson) is only the distributer of the product for Johnson & Johnson until 2014. As Johnson & Johnson remains the manufacturer and remains a partner in the generic version’s sales – I can smell that the price will remain controlled to protect Johnson & Johnson’s profit margin — thus, we the consumer are screwed again as always….. and the price of the Concerta generic may drop a small amount to make it seem like a big deal (in order to keep people from switching to the generic version of AdderallXR which will also come out this spring). Unfortunately I don’t think it will result in a significant reduction in the price of the Concerta/Generic as long as the ownership of the generic is not seperated from the company that is fighting to keep the prices high and to keep the competition out.
Watch out for the term “Authorized Generic” as it will never have the same effect on the price as a true “Generic” because the orginal company is still manufacturing and/or profiting from the product !!
My 7 year old son has been taking 27mg of concerta for 1 month now. He went to the dr. Today for a refill and I mistakenly told the dr. He was taking the 18mg concerta. The dr. Wrote the prescription for the 18mg. I didn’t realize the mistake until after I had purchased the meds. What will happen if I give him the 18mg. Instead of his normal 27mg? Will it still work as effectively? Or will it wear off sooner while he is at school? Or will it not work at all at the lower dose?
Thank you,
Alvin
Alvin – It likely won’t work as well – but it will probably partially work…
Dear Dr Handelman
Sorry my earlier message was accidentally sent off before i could complete it. I will start again. My 16 year old diagnosed with ADD was started on 18 mg Concerta which was built upto 54mg without any effect. Therefore she was started on Adderall 20mg XR by her psychiatrist,but it seems that she is now moody and seems to be depressed, again without a positive effect.
I am not happy to continue her on Adderall, do u think it is best that I increase the dose of Concerta instead to 72mg?? Please answer me at the earliest as we are desparate with exams around the corner.
Thank you
Jamee – Concerta at 72 mg may help – however, if it did nothing at 54 mg, then it may not help at 72 mg.
The only way to find out is to try it (if your doctor agrees that it is OK in your son’s case).
Talk to your doctor and see what he/she says.
My sign is 9 years old and started concerta er 18mg 5 days ago. This is the first time we have tried medication and it is a BLESSING! We saw a difference right away. His temper and emotionally outburst have been nearly non existant. The only two things I noticed is #1 It wears off between 6:30 and 8:00 pm this being said even if he gets angry his tantrums are still half of what they used to be. #2 Some days he is in control of his anger all day and some days he is still reacting but he will go in time out easily as a consequence but will yell or occasionally throw something on his way there. Are these things that I should be concerned enough to up dosage or should I stick with it considering that he has improved so drastically. I dont want to seem like Im looking for perfection (believe me Im not) I just want to make sure that even though he has some rough moments thats normal no matter what dosage.
27 yrs old, Just started taking 18mg Concerta felt very spaced out for 2hrs after taking my dose and then slept for 3hrs and then felt sleepy with a mild headache for the rest of the day, is this normal when starting this type of med? any advice greatly appreciated !!
My son is soon to be 17 years old. He has been on 54mg of Concerta for 4 years plus. Before that he was on Ritalin, both for ADD. This medication treatment was recommended some time ago to help him academically and I must say, it has not really helped all these years. He continues to struggle in school and has trouble with depression so I am writing to request some clarity.
Recently, his doctor has recommended a higher dose of Concerta. My son does not exhibit over-hyperactivity or OCD behaviors, but simply a mild attention deficit and sometimes, in the morning mostly, he’s very excited and energetic.
I am very much against the doctor’s recommendation and want to clarify that the research I have obtained encouraging my son’s ability to conduct life without ADD meds at this age is realistic.
Christina,
Using or not using medications is a complicated choice, and all revolves around how your son is functioning, and what level of impairment there is.
If the lower doses of the medicine didn’t help enough, and there were no side effects of concern – most doctors would suggest trying a higher dose. And if it worked, that would be great, and if it didn’t, or gave side effects, you would talk to the doctor and likely stop it or lower the dose.
By no means can I say that I know the best answer for your son, just giving my 2 cents…
My daughter is 14 and has recently been switched from Adderall because she said it caused her to have headaches and unable to sleep. She was first prescribed 18 mg of Concerta and he just recently bumped it up to 2 18 mg in the morning. My daughter says that she feels annoyed and irritated with everyone with the new dose. She’s only been taking this dose for not quite 2 weeks, Does her body need time to adjust to the dosage or is her body telling her it is too much.
I currently am on Ritalin 30mgs/day – 15mgs/2x. At my last Doctor’s appointment I told my Doctor about how Ritalin only lasted for around 2.5-4 hours for me so he wrote me a script for Concerta… I’ll be on it next week. The thing is he prescribed me 36mgs 1x/day.. Am I going to have problems with it next week? Will I most likely need to be upped to 54mgs? I usually only take 10mgs/2x/day on weekends and it helps, but not enough.
BUT Ritalins peak at where it is most effective is very, very, very short, and I’m guessing Concerta feels like the peak of where Ritalin is most effective for a good 8 or so hours straight..
Is this not enough for me?
Also is there a way to take my Ritalin till next week in doses so that I’ll know what the 36mgs of Concerta feels like?
Like 10mgs at 9am, 2.5 mgs at 11am, 5mgs 1:30pm, 2.5mgs 3:30pm, 5mgs 6pm?
I’ll take less and hopefully lower my tolerance over this week if I have to.
I normally take 30mgs/day, and I have generic Ritalin 10mg pills.
Brad, you will probably need higher doses of concerta to match ritalin 15 mg twice a day. You probably need in the 54 mg to 72 mg per day doses.
Im a 21 year old male going through college. I have always been add but never diagnosed. I also have never been treated. The dr today prescribed 36mg of concerta and told me to take it twice a day after like the 3rd day. This seems like a lot for someone who has never taken anything more than a multivitimin! Thanks in advance!
Hi James,
That may be a lot to start – but maybe that’s the right dose for you.
How has it worked out?
Dr. Kenny
Thanks, I took it today, and I agree – though it still helps, and I think it is more effective than Ritalin. For me Ritalin seemed to peak really fast and than lose effectiveness shortly after. The Concerta felt more gentle and relaxing.. These both have the same ingredient, but the Concerta feels much smoother and less rough and nasty like Ritalin did. Hopefully it keeps working and I might suggest trying the 54mgs to my doctor, as though I feel it would be perfect if it were just a little stronger.
Day 1 on Concerta = Relatively Satisfied.
My granddaughter is 6 years. She has ADHD and ODD. She is taking 27mg. of Concerta. It was working at first but, now it is not working for her. She has been taken it for 4 months. Should her dosage be changed to 36mg.? She weighs 78lbs. Please get back to me as soon as possible.
Thanks
Sheila
hi Sheila,
Of course, that is up to the doctor and you to work out.
It makes sense – if there are few to no side effects to increase the dose.
(but only with your doctor’s direction and approval).
Best,
Dr. Kenny
My 7 year old son who weighs just 45lbs is on 36mg of Concerta. Each dose increase he has had has made a huge difference in his behavior at school, but only for a short time, then he is back to having trouble and not being able to focus. Should he be on a higher dose or is it possible that Concerta is not working for him? I do not want to put him up any higher because his eating and sleeping are already very difficult.
Jennifer
Jennifer – when you say ‘short time’, do you mean the effects only last for 5 or 6 hours? Or do you mean that it works great for 2 weeks and then it stops working?
Depending on what you mean – there would potentially be a different answer…
MY 9 year old daughter was just diagnosed with ADHD. She is overweight and her doctor put her on Vyvanse and he said it would help with her weight by surpressing her appetite. it worked but he changed her to Conerta because Vyvanse made her jittery and nervous. I dont see the same results with Concerta. What do you suggest??? She is taking Concerta 18mgs once a day.
Candice – I suggest you continue with Concerta.
It’s not clear if the results that aren’t as good are for the adhd or the appetite.
If it’s the appetite – don’t worry so much about that (aim for activity, healthy snacks, etc.)
If it is the adhd – ask the doctor about adjusting the dose.
makes me sad to hear about all of these really young children on such powerful amphetamines. You guys should just parent your kids rather than throw them in the ‘ADD’ box… Uppers are simply a cop-out; everyone above 16 knows it, and thus they are abused all the time. You have no clue how many high school and college age kids fake ADD/ADHD just to get adderall to help them study/ deal with how fuckin boring school is
WE NEED EDUCATIONAL REFORM, NOT AMPHETAMINES FOR 5 YEAR OLDS…
yes, many fake it. and all they are doing is driving their own life into the ground. concerta changed my life and i am so grateful to my parents for having put me on it. I went from flunking school to being at the top of my class. Concerta helped me reach my full potential. I seriously hope that your children are not born with add or adhd, since it is clear you will never allow them to reach their full potential and will insist that they are simply not trying hard enough or think they are just plain stupid. I always thought I was just a stupid person. I was very wrong. Get your head out of the sand sir, and see the world for what it really is.
i have read through your information, very informative. I would like to know though where you came up with the 22% figure? i have read through the Concerta PI and cannot find that information anywhere. I am trying to better understand your math. 22% x 3 is 66% of release. 34% is quite a lot of ‘ketchup’ left in the bottle. and you also mention that 10% is not absorbed but this is typical of many medications and I would assume a percent or Ritalin passes through unabsorbed. I look forward to your further insight.
My Son is 11 years old and has been on adhd medication since 6 hrs old. He is on the daytrana patch during the winter months but we use concerta sometimes during weekends or when he is off from school. Then we switch to concerta during the summer because we have a hard time with patches staying on when he swims and is sweating. He takes 90mg of concerta but it stops working around 3pm or so depending on what time in the morning he takes the meds. Is he too young to have 90mg or even 108mg? He weighs around 95lbs. We also have 20mg of short acting ritalin to supplement. Is he getting to much methylpehnidate for his age and weight?
Shelly,
That’s really up to your doctor to monitor and see.
Monitoring of heart rate and blood pressure are important when the dose of MPH is higher.
Dear Dr Handelman
When I say a “short time”, I mean 2-3 weeks. He seems to “adjust” to it very quickly. He has a very hard time in school that is all based around him having no focus at all and getting frustrated. This is when the bad behavior comes out….rolling around the floor, throwing his pencil, crumpling up paper..ect. He is a very smart boy and it is so sad to see him not be able to accomplish things.
Dear Brian
I used to agree with you for the most part and still do think they are alot of “lazy, under-educated” parents out there that would rather get their kids medicated then take them outside for excercise and fresh air, HOWEVER, please do not lump us all together. My first born was born with Bacterial Menengitis, which he contracted through delivery. He spent the first 6 weeks of life in hospital, in an incubator, having seizure after seizure. He was given massive doses of antibiotics as well as antiseizure medication and had to be brought back to life twice. He underwent a ton of therapy as a baby to make sure that there were no diabilities but unfortunately some things are not apparent until they start school. He is on medication, which was an extremely hard decision for us, and it has helped him greatly. He is a happy, healthy little boy whos intelligence knows no bounds. I am a happily married, stay at home mom, whos husband works very hard to support his family. We have everything but the white picket fence, ours is brown. So before you go judging everyone, why don’t you pull your head out of your ass and open your eyes. It’s people like you that make it hard for children like my son to feel good about themselves and grow into sucessful adults..
My son has had multiple problems with developmental delays. Since he was four they diagnosed him with ADHD/ODD. I asked multiple times for autism testing due to his delays and strange ticks and multiple sensory problems. The school asked me to test him because of the problems he was having in kindergarten. My son is now 6 years old and this week after a long road the doctor agreed with the school test results and changed his diagnosis to Autism with ADHD characteristics. He is currently taking 15mg of Ritalin at 7am & 11am, then at 3 he get’s 10mg. The school is having trouble because it was wearing off about an hour before he was due for his next dose. When his dose wears off his sensory problems seem exaserbated. We have tried exended release meds in the past but my son could not sleep on them, isolated himself (more so than normal for his autism) and wouldn’t eat. We finally tried ritalin and it was amazing. He had a personality and would eat. However we keep having to increase his dose. His doctor didn’t feel comfortable increasing it anymore and we are having a difficult time with him in school. He gave us 5 pills of 18mg concerta to try on weekends before we switch up his meds while he’s at school. While we could see some difference in him, it’s definately not enough. He went straight to sleep tonight and ate a ton today. So far sleep is not a problem but it’s obvious this dose will not work for him. Should we even try to give it to him tomorrow or should we try two pills (36mg) and from what I can see from the charts that’s still below his ritalin dose. Thank you in advance.
My son has been on concerta for about one year, we switch between other meds just because of price sometimes, the concerta seems to be working, but the first time we put him on it we noticed some ticks that he was having that same day. they have went away since he has started taking it again on a regular basis, but we would like to up the dosage a little, i know he is on a little dose now. my question is, what are the odds of the twitches coming back if we up the dosage?
I’ve been taking Concerta for 2 weeks, I’m on 54mgs. I’ve noticed my heart Rate is usually around 100bpm when I’m on it and even for 6 or 7 hours after it’s wore off.. I also get chest pains from it, even if I take a day off, my chest hurts the next day (not terribly, but enough to bring up concern).
Should I keep taking this? My doctor and pharmacist both said it can take up to 2 months for your body (including your heart) to get used to it. What I want to know is this won’t give me an enlarged heart, or ruin my heart or anything like that will it?… I don’t want to risk dying or anything… I might sound a bit paranoid, but it’s my heart, and I feel that this is a bigger issue than my doctor or pharmacist are making it out to be as they seem to just brush it off, and act like I worry too much, when I bring it up.
The Concerta helps tons, and I’d take no breaks ever if it were not for the chest pain..
What do you think I should do? IF I give it 2 month
s and things do not improve, does that mean I just damaged my heart?
(Sorry about that I clicked submit on accident)
Your son’s symptoms sound EXACTLY like what my son went through. However, we went to a naturopath and continued doing alternative testing to find his issues. Our son was dxd with Austism Sensory Disorders, ADHD, etc .
After additional testing we found our son had Celiac Disease. Now that he’s been gluten free for over 2 years he is excelling at school and frustrations/behavior, etc. has improved TREMENDOUSLY.
You may want to ask your physician to test him for Celiac. Our son was initially diagnosed by a naturopath with Celiac and we did go to a Gastroenterologist to have his scope performed and it was DEFINITELY celiac disease.
The teachers and his former pediatrician were so quick to label him ADHD and Autistic and it was amazingly frustrating. I wanted to know the cause of the behavior issues. He is not on any medications and within weeks many of his symptoms that he was experiencing that were ADHD and Sensory issues had all but disappeared. The former ped put him on Concerta and we tried it but it gave him ticks and was a horrible experience for all of us. Worked to get him through the school days but the nights weren’t very good… We gave up on the MD’s we went to see until we found the Naturopath (who also has a medical degree and his current gastroenterologist).
We are now with a good/knowledgeable pediatrician who was also irritated that early on they just wanted to medicate our son and not figure out what the cause was for his outbursts, frustration, neuro type issues, and much much more…..
Don’t give up, but you might have to go outside the normal channels to find out what’s going on with your child.
I am not saying that medications aren’t a necessary thing, but they weren’t the avenue we chose. I am just throwing this out there as it seems many of the kids that we know that were diagnosed with ADHD and Autism (sensory disorders, etc.) turned out to have Celiac Disease or other food sensitivities that were causing the behaviors.
Best of success to all!
Hi-
I have a 6 year old who was diagnosed with ADHD in Dec. 2010. She has has both the hyperactivity and the attention deficit disorder along with speech delay. She was started on a low dose (10mg) of Vyvanse. All it did was wind her up and make her even more hyperactive. The doctor then switched her to Concerta 18mg. We are now up to 36 mg and we do not see any change other than the fact that her speech has improved and she can eat like a horse. Hyperactivity and attention have not changed at all. Should we stick with the Concerta and see about uping the dose or should we try a different medication like Strattera?
Any info would be appreciated. Thank you.
My daughter was put on Vyvanse switched to Concerta and back to Vyvanse. We realized that the Conerta was horrible, she was alwys hungry and developed a severe case of acne. My doctor put her back on Vyvanse and its working better the second time. She still seems to be overly hungry….it wouldnt be an issue but she is overweight already. Her doctor wants to put her on an appiete surppressant. Im not sure if good idea so young and do you recommend a specific surppressant ? Any thoughts would be greatly appreciated.
Wow Brian you really need a reality check. There are some of us that spent years working w/ the medical community before we gave in to any kind of drug therapy for our children. A friend of mine spent 5 years working through medical channels before she found out what was wrong with her ADHD/austistic son…. He wasn’t ADHD or autistic he had Celiac disease.
Would you committ to 24/7 round the clock working on trying to find what was wrong with your child? This child had SEVERE behavior issues, neuro issues and much more. It was exhausting to watch her but she never gave up and after 5 years finally found out what was going on. She is fortunate in that her child is not on medication, but what about the rest of us who spent years and have still NOT found the reason for our child’s discomfort.
BEFORE you start judging why don’t you borrow a child for a while and figure out what parenthood entails. NOBODY wants to put their children on medications and it is normally a LAST resort not a FIRST.
Dear Dr Handelman
My Daughter is 10 1/2 she has been on Concerta for 4 years now and we never had any side effects from it. Recently it started wearing off by 3:00 and she was having a very difficult time focusing in ballet lessons and doing homework. Our Doctor switched us to Vyvanse because it is longer lasting. She has been on that for two months now and the dose of 3o mg is not high enough. Since she started taking it she has also started having vivid nightmares several times a week. Before I upped her dose I wanted to find out if we could do something to switch back to Concerta but make it last longer. These are the only two ADHD meds she has been on. Thank you for your site and time.
Taylor – It’s really hard to say anything about this specifically.
For some people, if they have mildly acidic foods/drinks within 1 hour of taking their medication in the morning (i.e. Concerta, or any other stimulant), the medicine won’t be absorbed well. Things like: juices (which have citric acid), any snack ‘bar’ that sits in foil wrapper has citric acid as a preservative.
If the concerta stopped working as well as it had been – maybe she changed her breakfast?
Apart from that, I have no specific suggestions – you’ll have to work on it with your doctor.
My psychiatrist recently switched me from Ritalin 20mg one at 8am, one at 12pm, and 1/2 at 400pm to Concerta 54mg primarily because after 8 months on this therapy, I began experiencing extreme crashes at work. I was unable to concentrate, focas on my patients, and became extremely lethargic. I also, besides having these up and downs, was seeing increases in my blood pressure at rest and after the Ritalin. I have been on Concerta for two days now and am really exhausted and irritable. I attribute this to not having the proper dosing conversion as mentioned in the article above and having withdrawls. I took 1/2 a Ritalin in the afternoon yesterday and that seemed to help. My question is is it safe to add a small amount of Ritalin with the Concerta while I am adjusting to reduce withdrawal symptoms? The Concerta seems to help so far regarding the highs and lows I was experiencing but the concern is the inability to focas and fatigue and irritability. Should I just wait and give the Concerta time to work? Thank you in advance.
Taryn, Yes – the dosage conversion would likely be Concerta 90 mg AM to match the 20 mg Ritalin you were taking.
Yes, people can add short acting ritalin at the end of the day with concerta – but I don’t advise you do that until you talk to your doctor.
Good luck!
Dr. Kenny
Currently I am taking Ritalin SR 20mg once a day, plus I have Ritalin 10mg, PRN up to 2 tabs.
I take the SR + 5mg of Rit in the morning, say 8:30am. Then at 1330 take another 5mg. Then another 10mg at 1630. Its very confusing! 15mg Ritalin TID was working great, but I wanted something longer acting. My doctor figured SR is the way to go because Ritalin is working well and its cheaper. I wanted Concerta because I tend to forget when I take my first dose, and then take too much and am a wreck, plus the Concerta lasts 12 hours. She said I can take Concerta if I want, but figured I should try the SR first.
According to you I should be taking 72mg of Concerta a day? That seems like a lot, well in comparison to others on ADD forum I am on.
Question, I am confused on what is going on with the dosage for my son. I know what to tell my doctor as far as things my son and I are experiencing but when she quickly explains the plan of care for his medication I get lost. So I am hoping you can help me. He started out over the summer on 18mg of concerta due to the fact his impulsivness is not that bad. Then after not noticing much of a change the doctor increased him to 27 mg which after a few weeks I notced increased irritability and he was very emotional and hyper with that. So then the doctor decided that dose was too much and put him back on 18mg Concerta and 2.5mg Ritalin Morning and after lunch at school. He had some problems at first getting to sleep but that went away after a few nights, which was his body adjusting I guess. So It worked great! I even got to where at 4:30-5pm with dinner I gave him another 2.5 mg to get him through sport practice. So now its been almost a year and during this past month of March he has had some irriatbility mostly in the morning and later in the evening. So I decided myself to up him to 18mg Concerta with the 5 full tablet Ritalin which she had told me previously I could do and gave him that a.m and at lunch. I still was having emotional rollercoaster rides and decided to call the doctor. So I told the doctor this and she decided (now this is where I get confused becuase I do not want him to be on medication if its not needed and if needed then the lowest dose possible that he may need, plus I was not sure if this was result of puberty) so put him on 27mg of Concerta (we had bad experience with before) and wrote a script for 5mg (same as what I was giving him) but for am noon and 3:30 which this recommendation was what I was doing already just she decided to up the Concerta. However wouldn’t we just try the increase of the Concerta and see how he does first before adding in the Ritalin? If the Ritalin just adds a spike doesn’t that make the Concerta pointless? Since the Concerta is long acting with its own spikes or gradual increases. What mg of the medication was he on in the first place with 18mg Concerta plus the 5mg Ritalin? To now, what is the dose with 27mg without Ritalin and then what is the dose with the Ritalin? I just want to make sure I am thinking correctly and doing what is needed for my son especially when I have the school assesing him and the nurse at the school medicating him. He tells me all the time I don’t need the medicine, but the years previous without it were so hard for him and he hated school and now he gets all A’s. The psychiatrist told me when he first evaluated him before medicine that he may even be gifted. Any advice would be much appreciated!
Sorry my email was a little confusing. I was trying to put a lot of information in as few words a spossible. I gues I am needing to make sure he is being dosed properly.
Summer 2010- 18mg Concerta
No change
August 2010- 18mg Concerta plus 2.5 mg Ritalin a.m. & 12:30 and occassionally before evening sports worked great till
March 2011- ? Puberty/hormones shows irritable A.M. & evening teacher commented on the mornings being difficult sometimes.
March 2011- kept on 18mg up ritalin to 5mg A.M. & 12:30 & prn for sports in evening but noticed still irritable and very sensitive/emotional so I called doctor to get clarification on if puberty or medication
April 2011 Doc decided to increase concerta to 27mg and keep Ritalin dose the same at 2.5/5 mg A.M. & 12:30 and prn for sports. I have done this change yet I am nervous due to previous experience with the 27mg and wondering if it was really a need to change medication dosage because what if its just hormones because this week has been better. So I wanted to run this by you and ask your opinon on if the new dosage of 27mg Concerta with 2.5-5mg ritalin 3 x a day is what I shoudl do or leave it be with what I have been doing.
Today 4/7/11 I gave in to my fears and gave him just the 27mg of Concerta and no Ritalin. Just to see how he would react to the 27mg, figured I would do this through the weekend when I am with him all day instead of the school. If he does ok then should I do the morning and other doses of Ritalin, I read your article on combination of Concerta and Ritalin and wanted to know your thoughts. And is this the correct dosage change from the combination he was on that worked so well for the past year before this March.
S – just clarify – apart from the side effects does the medicine seem to help him a lot or no?
Yes it helps, except when we went to the 27 the first time, but I kept my fingers crossed and then Thurs, Fri I tried just the 27 at school teacher said he was fine. She is a very awesome teacher. Later that afternoon on Fri I gave him the 5mg Ritalin since he was going to a baseball game with friends. Same on Saturday gave him the 27 and the 5 in the a.m. since he was going to play his babseball game that morning. He was at the game with his dad because I had a mother daughter conference to go to, but dad said he did well. Sunday I gave him only 27mg and then we needed to finish his project so I gave him 5mg at 2:00 but decided to run some arrands first and around 4ish noticed he was very off task then very over quick to over react to simple requests. Which he was prone to doing before meds and when we moved up his dose the first time. Now I know this was 3 hours or so after I gave him the 5mg so it was probably him coming off, I wish it was not so drastic when he comes off. So for today I gave him only the 27mg and will not be giving him the 5 mg until I notice that it helps. So I guess I need more time. Let me know what you think. Thank you
So I guess the issues we have been experiencing is when he starts to taper off the Concerta/Ritalin. Noticed its more so when he has had the ritalin in the eveneing and then the taper off is harder on him. I just was not sure if the 5mg during the day at school or evenings was even nessecary after reading the way Concerta was made to work in the body with the spikes of the Concerta through the day and the conflicting results that happen when giving the Ritalin on top of the of Concerta. The Concerta does help. I notice a quicker response in the mornings with the 27 like I mentioned ealier it is the end of the day that is so emotionally hard for him (and myself.) He gets so emotional and then I get emotional and we are all a big mess. Wondering if the taper off is too much with both the 27 and the 5 for him especially with the perfectionist in him ( gets very hard on himself if not at the top of his game with his behavior/grades/sports) I think it may just be too much for him.
I have a 7yr old boy and I went through all the testing for him and he has ADHD. I have the prescription for Concerta 18mgs…but im terrified to give it to him. I dont want it to hurt him.
So I have not heard back from you yet, but I am still concerned on the dosage change. He was on 18mg Concerta with 2.5mg generic ritalin (yellow pill) 2-3 times a day. Now she switched him to 27mg concerta and 5mg generic ritalin (this thime its a white pill, fille dit at Wal mart was not white before) 3 times a day, but I have not given him the 5mg because I thought 1.) different looking pill 2.) was not sure if it would be too much or how the mg broke down. Especially after reading the article on combining ritalin and Concerta and how Concerta works alone in the body.
S – so your main concern is rebound at the end of the day.
This can happen to some people when the medicine is wearing off.
You obviously need to work with your doctor. My general approach would be to stick to the Concerta alone – i.e. without the short acting ritalin – so that the absorption of the concerta is gradual through the day – i.e. I’d rather use Concerta 36 mg, or 45 mg (27 + 18) in the morning rather than adding the short acting to it through the day. This may lower the rebound at the end of the day. And then, sometimes, a small dose of the short acting at the end of the day smooths it out. I hope that helps.
(and if you are in Canada, make sure that you have the name brand concerta, not the generic!)
Hi Dr Kenny,
Thanks for your info. The 72mg concerta wears off for me a bit to quick (6-8 hours) so I’ll speak with my doctor about upgrading the dose. Would 2 54mg pils in the am be safe for a 25 year old male weighing 180lbs?
I exercise daily and my heart hasn’t had any issues even with very intense sprints (which does show that exercise doesn’t help ADHD as I was annoying the heck out of everyone all my life yet running in races all the time and weight lifting)
not to mention my diet consists of only 100% whole wheat/whole grain foods, multi vitamins, fruits, veggies, no sodas or sugars and fish oil supplements so I don’t appreciate people who say diet cures adhd (tell that to every friend who’s cut me off due to being random and annoying and hyperactive/rude without trying to be rude)
Great site
Brent – some doctors will go up to 90 mg concerta (i.e. a 36 mg + a 54 mg), or 108 mg/day ( 2x 54 mg). Your doctor will have to review your health and decide if it is appropriate.
Hi.. I just had a question not sure if its in the right spot.. But here goes.. My daughter, who is 6. was diagnosed with add/adhd last wensday and her dr prescribed her the concerta 27 mg tab. to take in the am. SO thursday we gave her the med, and Im not sure when but at some point during the day she started talking really fast, and moving her tongue in and out of her mouth excessivly and had a stomach ache.She herself said she felt fine and upon speaking with her counselor at school she said she seemed to focus fine and listen and pay attention.. She didnt seem anymore aggressive at home just maybe a bit more hyper.. I called the dr immediately and was told that her dosage was too high , and although this effect is very rare it does happen. I suggested switching her to something else, and her dr said he felt very hopeful that the 18 mg would work and be very effective that the 27mg was just too high of a dosage for her.. does this sound right, anyone else ever heard of this. Now to clarify before I am put on the chopping block, being diagnosed with add/adhd was a last option for us . We had tried ways at home to help her concentrate and calm down. and sit down sessions with counselors trying to find anything else it could be.. And i wasnt suprised when dr diagnosed.. ITs been a constant struggle for the past few years.. Any advice at all would be great.. THank you Jenn
Jenn,
It makes sense to try a lower dose. How has it gone?
I’ve been taking a total of 90mg Adderal, 45mg am & 1:00p 45mg. I break 1-30mg and take with a 30mg-45mg, It’s a high dosage, however considering my tolerance is high and the longer Adderal taken,the less effective may become. After taking for a few years it’s effective, no matter the dosage was like taking nothing. Side effects caused were terrible, heavy eyed, my eyes were sleepy and hurt but I wasn’t sleey or tired. This was the worse not to mention no motiveation.
I started Concerta XR 54mg today, hoping it works, Ritalin put me to sleep.
It’s been 3 hours since taken and have seen or felt any increase of being able to focus nor do I have energy. I’m sleepy but that may due to a nap I took after taking, which thought would wake and ready to dive work I’m months behind on.
Has anyone had these are simialr side effects or no of anyone. Whats the normal time frame for getting into your system and noticing changes with xr’s.
Any comments would be greatful, I’ve tried about everything and my doctor sais were running out of choices. The Adderal regualr has always been the best, unfortunetly the side effects have now would choose never to take again.
Hoping the Concerta 54mg works, if not may ask for higher dosgae. I’m 43 if that makes any difference and dealing with extreme stressful circumstances right now.
Thanks.
My 12 yr old son is taking 27mg concerta in the morning and takes an additional 5mg ritalin at noon to get him through the afternoon. Because of the financial strain of Concerta, the doctor has changed his prescription to 20mg ritalin SR bid. is this the correct dosage to stay in line with what he was taking?