Concerta Dose: Getting It Right
Concerta 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.
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Written by Dr. Kenny Handelman - The ADHD Doctor
To find get a FREE special report on ADD/ADHD Medication, visit: Medication Mastery
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October 16th, 2006 at 1:52 am
I’m confused. I thought that 18mg was = 5mg x 3, 36mg = 10mg x 3, and 54mg = 1 mg x 3. If 22% is released 3 times and 10% is not absorbed then that accounts for 76% (22 + 22 + 22 + 10). What happened to the other 24%? I also thought that Concerta not only had Ritalin inside but was also coated with Ritalin to get the quick release until the inside was pushed out. Is that part of the missing 24%?
Thanks, Evelyn
October 16th, 2006 at 8:51 am
Evelyn,
Thank you for your comment.
1) When people say that 18 mg is 5 mg 3x per day, that is basically ’rounding off’. The accurate amount is written above.
2) Yes, there is a fast absorbing outer coat of medicine, which is 22% of the total dose.
3) The whole rest of the pill is set up to support that initial 22%. That is how the math doesn’t work, and this is where many people - and doctors - get confused. The point is that one needs to forget ‘real math’, and instead use the ‘concerta math’ that I explained above.
Allow me to explain one other concept. Researchers found that to have a long acting stimulant work well, it needed to have an ‘ascending profile’.
What’s an ascending profile?
Many people know that ritalin SR is not a great preparation. This is because the medicine gets to a certain concentration in the blood and then stays there. i.e. the concentration at 11 am is the same as it was at 10 am, and it is the same as it is at noon. Researchers found that people may develop tolerance to the stimulant within the same day. That means that the tolerance to a stimulant happens and resets within the same day. This is called ‘acute tachyphylaxis’.
How they developed concerta was that as the day went on - the amount of methylphenidate released would gradually increase - for about 6-8 hours, and then it would gradually decline. This would cause an ‘ascending profile’ of medication concentration in the blood.
This means that the concentration in the blood at 10:30 is higher than it is at 10 am, which is higher than it is at 9:30 am.
What does this mean with respect to dosing?
It means that we don’t use regular math, as you suggest in your post (i.e. 22% + 22% + 22% + 10% lost in the gut), but we need to use the ‘concerta math’ that I described above.
Quite simply that means that you need to take the immediate release portion (which is 22% of the dose) and consider the rest of the pill to support that dose through the rest of the day.
Thanks for the great question. You made me get more technical than I intended too :-), but I hope that it is clear.
Dr. Kenny Handelman
October 16th, 2006 at 8:07 pm
Hi, My 5 year old daughter was taking almost 40mg a day of ritialin, 3 times a day. This was not working for us. Our Dr. then put her on 15 mg a day of Adderall XR, then 20 gm. I noticed a real change in her behaviour. Lots of mood changes. Now she is taking 30 gm of Biphentin. What i would like to know is why does the medication seen too work well in the am but, once 11-12 PM hits its seems like shes not taking anything at all. I do realize she will need an increase. However, if this is an extended release why doesnt it seem to be working like it should?
Thank you for any time you take in this question.
Dawn
October 16th, 2006 at 10:33 pm
Hi Dawn,
It seems that your main question is why doesn’t a long acting medicine last into the afternoon when it should?
There are a couple of main reasons why a long acting preparation of a medicine doesn’t work as long as it should:
1) It is too low a dose - and a dosage increase will help with this
2) Some kids/people have a high metabolism, and their bodies may metabolize the medicine more quickly than expected.
In this scenario - it seems that it is probably a dosing issue. Best to pose this question to your doctor.
Dr. Kenny Handelman
November 24th, 2006 at 9:55 pm
Hello Dr. Handelman - I appreciate your information on Concerta and the time you’ve taken to share your knowledge. At 36 years old, I was recently diagnosed with ADHD. Time does not allow me to explain how Concerta has truly helped me focus.
I have read some forums on individuals taking two separate doses of Concerta throughout the day. To remember one specifically, it said they take 72mg in the a.m., then about 7-8 hours later, they take 36mg. — Since I don’t believe everything I read on the internet (haha!), I would appreciate your input in lieu of asking my own Doctor.
I take my dose of 90mg at 5:00a and by 2:30p-3:00p I start to ’space out’. My wife can definitely tell a difference when I’ve taken it, but she rarely spends much time with me when the medication is flowing through my system. Originally, I thought of a Concerta in the morning and then perhaps a comparitively smaller dose of ??mg standard Ritalin for the evening. (My Doctor said that could be a future option)
I have tried taking it later in the day… My Dr recommended trying it later in the morning or even lunch time so its effects would last into the early evening. I have taken it as late as 5pm (when forgetting in the a.m.)… Had no problems falling asleep around 10p, but was ’spaced out’ all day and usually late for work those days — I definitely need it first thing in the a.m.
Do you have any experience with double-dosage and can you make any recommendations?
Thank you again for your blog,
Frank
November 24th, 2006 at 11:44 pm
Hi Frank,
Thank you for taking the time to comment.
One thing I need you to be clear on - you cannot ask me in lieu of your doctor. I cannot give you anywhere near the level of specific information that you can get from your doctor about your ADHD care.
It is pretty common for people to take a concerta dose in the morning, and then when the medicine is wearing off toward the end of the day, taking a short acting Ritalin to ‘top up’ the end of the day. So, if Concerta is going from 8 am till 7 or 8 pm, some people may take a Ritalin dose (10-20 mg) at 4 or 5 pm to prolong the benefit of the medicine.
Regarding taking Concerta in the morning, and then again at mid-day to boost the length of coverage - frankly - I haven’t heard of that until now, and I have no experience with it.
My impression is that it would likely work for some people, and may not work for others.
Why?
Well, the way concerta is absorbed yields a blood concentration that gradually increases until about 6-8 hours after the pill is taken. If the second dose is taken after the 6-8 hour mark, then theoretically, it should work, and would problong the benefit. The side effect to watch for is insomnia, and decreased appetite. Of course you want to be monitored for cardiac concerns as an adult taking stimulants.
If the second concerta dose is taken before the 6-8 hour mark after the first concerta dose, then it is possible that some people (who are more sensitive), may not get as good a response.
You raise a fascinating question. I hope this answer helps.
If you do end up trying it two times per day (after review with your doctor, please!), please come back here and let us know how it goes.
Warmly,
Kenny Handelman
p.s. Glad you like the blog!
November 25th, 2006 at 6:09 pm
To follow-up, thanks for your response to my query. and, I realize now (duh!) that I didn’t have a clear understanding of the term “in lieu of” …. UMMMM, what I meant to say is– I am under the care of a psychiatrist. I visit with him each month and he closely monitors the effectiveness of whatever medicine he prescribes. Since April 2006, I have tried Strattera, Wellbutrin XL, Focalin, Adderall and now Concerta. I ALWAYS take the prescribed dose given (it’s hard to deviate much, since every 30 days, no more than a month’s supply is given)… While I’m waiting for my next appt, I thought I would ask you the question from the previous entry. (doh!) I will use the term “in lieu of” in the proper context now. heh
on a side note, I remember seeing a bumper sticker that read: “My Doctor says that I have ‘Attention Deficit Disorder,’ but I don’t think the diagnosis is corr— LOOK, A BUTTERFLY!” (hahha, thnx again.. –Frank)
November 26th, 2006 at 4:33 pm
my husband was recently dx with ADHD after our son successfully was dx and treated with same. He began taking 36mg of concerta about 2 weeks ago. He said he didn’t really notice a difference , but my adult daughter and I have noticed a subtle mood stabilization, and less of a hair trigger on his anger. He did finally notice a day or two ago that he was able to reasonably deal with a situation that before treatment would have sent him into fits of anger (he has always only been verbal, never physical with anyone). we are both wondering if a higher dosage will help with his concentration/focus which he says he has not noticed any change in.
Anne
November 26th, 2006 at 4:50 pm
Anne,
Thanks for your comment.
It is possible that a higher dose would make a difference in the concentration and focus. Best to review it with the doctor to see if a higher dose of concerta would make a difference.
January 24th, 2007 at 9:35 pm
What do you consider to be a low or high dosage for Biphentin. My 5 year old is currently taking 15mg, but will be starting 20mg tomorrow. She is 41 1/2lbs. The 15mg was working, but for some reason all her old behaviours came back even while on the medication.
Thank you!
January 25th, 2007 at 12:08 am
Hi Melanie,
Biphentin dosing goes from 10 mg to 60 mg.
You can read more about Biphentin on this blog - just enter the term ‘Biphentin’ in the search box above, and you will find a very thorough article on it.
April 10th, 2007 at 10:52 pm
My 7 year old just started on Concerta. He had one week at 18mgs, one week at 27 and has now started on the 36mgs (this is the way the doctor prescribed it for a one month trial period). My son has noticeably improved in the area of his adhd symptoms however he has become quite emotional (cries easily, distraught over stuff that normally doesn’t bother him). Is this normal? Also, he almost seems too focussed now and will keep on asking even after given an answer to a question (ie yesterday wouldn’t give up on going back outside to play even though it was dinner and bed time - he just kept trying different ways to ask). Today he seems fine but I just wondered and don’t want to call the pediatrician just to ask what may be a side-effect while he gets used to the medication (I couldn’t seem to find info in their literature about this).
Thank you in advance.
April 11th, 2007 at 9:11 am
Hi Michelle,
Ultimately, the answer is to call the pediatrician and review this possible side effect.
Sometimes (though relatively rarely), Concerta can cause mood side effects - like moodiness, getting more emotional, etc.
It can also make some anxiety symptoms worse - and you would have to review with the doctor if your son’s repetitive questions are a form of anxiety - i.e. obsessively asking, or it could be that it is just a behavioral issue.
Best to talk to the doctor, and to observe how your son does over the coming days.
Thanks for reading and commenting on this blog!
Dr. Kenny
April 15th, 2007 at 10:31 pm
Dr. Handelman,
I read your article a few months ago. I took the information to heart and increased my dosage from 2 to 3 18mg capsules of Concerta a day about 2 months after starting. I felt that improved things so when I went back to see the doctor, I told him what I’d done and explained notes from my journal supporting my perceptions. I told him that I did not want to use anymore ritilin to extend my focus at the end of the day but preferred taking 2 Concerta in the AM and 1 at lunch if I knew I was going to have a long day.
He didn’t seem to like this. He prescribed a single 54mg dose. I protested. Now, 4 weeks later, I feel scattered and find myself more often than not “spinning my wheels” which simply isn’t productive.
What could I say to the doctor? Should I simply ask for the ritilin supplements again? Is there any benefit you see in taking Concerta vs Concerta supplemented with ritilin?
I should also mention when I went to see this doctor to get ADHD medicine, he asked me SEVERAL times if I’d used cocaine, cocaine containing drugs or stimulants. When I told him no, never, he didn’t seem to believe me. I told him I once tried the trucker ephedrine for finals, had felt uncomfortable doing so and noticed it seemed to make me sleepy.
As I understand it, I have been self medicating with coffee since the age of 14 and have always used a lot of sugar. People in fact would tease and ask if I was going to have any coffee with my sugar.
I’m 29 years old. Since being diagnosed with ADHD in 2006, I have started medication, bought and read numerous books and am in the process of getting an ADHD coach.
April 17th, 2007 at 8:48 am
Hi,
Thanks for sharing your experience.
Ideally, you can find a doctor who is willing to talk to you, develop a relationship of trust - and also knows a lot about ADHD.
Is this doctor a psychiatrist? Family Doctor?
When you say that you are feeling scattered - do you mean in the evening? I would expect that during the day you are probably doing well with 54 mg, but I am curious.
Most doctors will increase the Concerta and not give a twice daily dose of concerta. Then, if longer symptom control is needed, they will add regular ritalin to the concerta dose at the end of the day, if needed.
Just so you know, soon there will be a ‘triple bead’ adderall xr - meaning an adderall xr that will last for 16 hours for adults with adhd. Also, strattera can work for 24 hours for people who take it.
All the best,
Dr. Kenny
May 2nd, 2007 at 12:48 am
Dr. Handleman,
I am in the beginning stages of meds for ADHD (mostly inattentive) and would like basic feedback on how to know a dosage issue from a problem with a particular med.
I have only taken Concerta so far - took 18mg for a month, feeling slightly less foggy and not snacking as much - went 10 days without it before follow-up appt - have been on 27mg for a week or so and am clearer, but am suffering from serious misdirected focus, meaning I cannot seem to sit down and do my work, but I have accomplished many other tasks.
There are some OCPD/OCD issues mixed in and I am definitely feeling the effects of anxiety, which began to present itself more physically than ever in the few months before the ADHD diagnosis, it also occurred during the 10 days off Concerta. While I appreciate my ADHD doctor’s caution, is there any point in continuing the 27mg for another 3 weeks? Should I know by now if I need a higher dose or if this just isn’t the right med for me?
I have consulted with multiple professionals as a way to have some checks and balances, and Effexor has been mentioned. Should Effexor be brought into play before/instead of changing doses? I have read enough to be concerned about Effexor and the rough discontinuation. Do you consider it a reasonable compliment to Concerta if properly prescribed?
You can tell I’m analyzing to death — any comments would be appreciated!
May 6th, 2007 at 1:21 am
Hi Jenny,
Thanks for your thoughts.
Firstly - I cannot tell you how to change doses of your medication!
You need to talk to your doctor.
When it comes to the doses of Concerta for adult ADHD, I will refer to the
Canadian ADHD Resource Alliance Practice Guidelines - found
at http://www.CADDRA.ca
These guidelines document a maximum dose of Concerta for adults of 108 mg.
Generally, the PDR lists 54 mg for kids, and 72 mg for teens. I am not sure if Concerta is indicated in adult ADHD in the US, it isn’t in Canada. It is still often used, but there aren’t any ‘official’ rules for it.
When it comes to anxiety and ADHD, if Concerta is helping to relieve the anxiety somewhat when your focus improves, then stick with it before adding another medicine.
If it doesn’t help with the anxiety, consider trying Strattera, because it is often very good at helping ADHD and anxiety symptoms at the same time, and may prevent the need for two medicines - i.e. a stimulant and an antidepressant for anxiety.
I am considering creating educational materials on ADHD Medication. If you want to be sure to hear about it - please enter your name and email address in the box at the top of this blog, or join my newsletter at:
http://www.THeADHDDoctor.com
May 22nd, 2007 at 5:44 pm
My daughter as ADD and has finished high school, with honors. She has worked really hard and has been on medication for 4 years. She cannot take dexedrine (or adderall) as they cause too much anxiety for her. She eventually was taking 108 mg of Concerta along with 70 mg of ritalin first thing in the morning. For some reason the initial dose from the Concerta doesn’t seem to work on her. I realize that this is a fairly high dose but we worked closely with her pediatrician fine tuning the dose. My daugher was one of 3 patients she had that seemed to metabolize her meds quickly and have difficulty absorbing/using teh initial dose of Concerta. She specializes in ADD/ADHD and was very knowledgable. Unfortunatley my daugehr is now almost 19 and so can no longer see her pediatrician. She had told us about Biphentin and that it was coming out and that maybe it would work for her as the delivery mechanism was different.
Do you have any idea on this and if so what is the conversion on doses from Concerta to Biphentin? We are going to go see our family doctor but I always like to have done my homework before we go in. She has taken some time off and will be going to university in the fall so she wants to do some experimenting with her meds to make sure that they are working before she heads off to school. She isn’t interested in Straterra because she doesn’t want to take meds every day and wants the option of when she takes them.
May 22nd, 2007 at 7:58 pm
Hi there — Can you think of any reason that two 18-mg Concerta taken together would behave differently than one 36 mg Concerta?
My son did great going from 18 mg to two 18-mg pills so we thought surely 36 mg was the right dose. Unfortunately, the 36 mg. pills seem to be more abrupt in onset and withdrawal, giving him some mood swings he didn’t have on the double 18 dose.
I am currently awaiting a call from his doctor onthis, but wondered if you had any ideas about why the delivery of the medicine might be different in those cases?
Thanks,
Sheila
May 22nd, 2007 at 11:47 pm
Hi Vivian,
The trick here is to convert back to equivalent ritalin doses, and then convert it to Biphentin after.
By my calculation - 108 Concerta in the morning is equal to: 24 mg ritalin 3 x per day (multiply 108 by 22%). She is also taking 70 mg of ritalin first thing in the morning.
So, her morning dose of the medicine is about 94 mg.
This is a very high dose, and is unusual. That said, with close monitoring, some patients can go to a higher dose if needed.
If it you are going to use all biphentin - to get 40% of the dose as an initial release - that would yield a staggering 235 mg of Biphentin in the morning!
If you use the similar regimen of 70 mg of ritalin in the morning with the biphentin, then you would want a dose of 60 mg.
Of course - speak to your doctor and get close monitoring for side effects when using high dose stimulants. And don’t take these comments as medical advice!
Also, there is a chance that your daughter may respond differently to the biphentin (compared to Concerta), and then she may need less of the ritalin or medicine altogether.
Please let us know how this works out.
Thanks,
Dr. Kenny
May 22nd, 2007 at 11:56 pm
Hi Sheila,
I hear what you are saying here with the Concerta dose of two 18 mg pills vs. one 36 mg pill.
The short answer is that I don’t know what the difference is.
The longer answer is that I have seen this before.
Some people are very sensitive to the delivery of the medicine, and if the Concerta dose of 36 mg is different if it is two 18 mg tablets, vs. one 36 mg tablet - well just go with the one that works.
Hopefully cost won’t be an issue - because generally two 18 mg pills will cost more than one 36 mg pill.
All the best,
Dr. Kenny
July 11th, 2007 at 1:31 am
My son is 9 years old and has been on meds since age 3. He is currently taking Adderral 20 mg, risperadal 1 mg (at night), remeron 15 mg (at night). Prior to this he took a higher does of Adderral along with 60 mg of Straterra, but the Straterra caused extreme moodiness and crying fits. In the past the risperadal did wonders with the anger and agression, but as he gets older we have noticed some of the same problems coming back. The higher dose of Adderral (60 mg) caused a tick. We are just getting ready to try Concerta 27 mg to begin with and I wanted to know what the equivalent dose of Concerta is to 20 mg of Adderall XL?
My son really likes his night time medicine and tells me it helps him sleep and helps him not have as many nightmares.
We just need to find something that works best for day time. Particularly with impulsiveness, attention, etc. The Adderral helps and you certainly can tell if he does not take it, but it is only 50-75% effective.
Thanks.
July 21st, 2007 at 8:26 pm
Hi,
To convert the dose of 20 mg Adderall XR to concerta - I like to go back to the equivalent dose of ritalin.
Adderall XR is like 10 mg adderall morning and noon.
This is like 20 mg of ritalin morning and noon.
To get 20 mg of ritalin twice daily in Concerta - you should likely start in the 54 mg to 72 mg daily.
Of course, you need to review this with your son’s doctor - and see what is best for your son - as he is on several medicines.
Likely - if you start at 27 mg of Concerta - this is too low of a dose, and it may result in a significant number of symptoms.
Good luck - and I hope this helps in your discussions with your doctor.
Dr. Kenny
July 24th, 2007 at 3:31 pm
I am 45 and just diagnosed with ADD. I was started on COncerta 18 mg about 2 weeks ago. After seeing my therapist today, he suggested I increase to 36mg. I will be going to my internal med physician on Friday to get a new prescription for 36mg…but could I start with 2 of teh 18mg until then?
Thank you.
July 24th, 2007 at 4:09 pm
Hi Karen,
I cannot diagnose or recommend treatment online.
What I can tell you is that 2 x 18 mg Concerta is pretty equivalent to a 36 mg tablet.
In my clinical experience, a very small percentage of people react differently to the preparations - but I have no explanation for that.
All the best,
Dr. Kenny
July 24th, 2007 at 9:36 pm
Dr. Kenny,
Thank you for the response. One more question. Any thoughts on taking Concerta with Wellbutrin or Cymbalta?
July 25th, 2007 at 12:15 am
Karen,
This is a question for your doctor to answer.
In general, taking Concerta with Cymbalta or Wellbutrin should be a concern (though you have to talk to your doctor about your specific situation).
The only concern may be additive side effects - like getting ‘jittery’ or agitated.
All the best,
Dr. Kenny
July 27th, 2007 at 7:23 pm
Dr. Handelman:
I’ve been on Conerta for a month now (two weeks at 18; two at 36; and now just starting 54). I’m a very high-functioning 39 year old in good health (at least an hour of cardio per day). They’ve started me so slowly because I was on Adderall for 2.5 months and - while it improved impulsivity control - it shot my BP through the roof (150/110 instead of 120/80).
My question is about mood changes as a side effect. Today is my first day at 54mg. Is it even possible that the extremely bad mood I’ve had all day (anxious and cranky and impatient) could have been brought on by such a small dosage change on the first day? I have a lot of other external factors that could have contributed to such a mood, in a “normal” person, but they’re not much different from any other day in my AAA life. That’s why I’m wondering if it could be the drug (or am I, as an imperfect being, just having a bad day)?
Thoughts?
July 27th, 2007 at 10:02 pm
Hi Todd,
Thanks for your comments about your experience with Concerta.
The short answer is - wait until tomorrow or the next day…
Yes, mood side effects are possible.
Yes, the medicine works quickly - i.e. within 1 hour after taking it, it is fully therapeutic on the first day.
So, it is possible that the Concerta has made you agitated, or it is possible that you, as an ‘imperfect being’ are just having a bad day.
That’s why I say - wait a few days - and that way you’ll see if it is the Concerta or just a situation.
I tend to recommend that people stick with a dose for at least 1 week to test it out - so they can see how they feel on a good day, a bad day, an irritable day, a day when they haven’t slept as well, etc.
Of course, you need to speak with your doctor before making any treatment decisions or changes.
All the best,
Dr. Kenny
September 18th, 2007 at 12:57 pm
Hello everyone,
I have a question pertaining to Concerta. When our 14 year old son takes his meds in the morning he does pretty good. He is one of the people that metabolize his meds very quickly. He takes a 54 mg Concerta at 0700 and by 1500 (3 p.m.) it has worn off. So the doctor has added an 18 mg Concerta in the afternoon but it has very little effect on him. Our son also takes Clonidine 3 times a day to help keep his anger under control.
My question is this: Can he take 2 doses of 54 mg/day? I mean, yesterday he was a total terror, admitted to not taking his meds in the morning and took his 54 mg in the afternoon. He didn’t have any problems going to sleep and the house was a lot more peaceful. He can be very dangerous at times and it is imperative that he is brought under control. We have 4 other kids in the house that he torments and treats horribly (because he’s bigger than they are) and short of having him removed from the house we don’t know what to do.
HELP!
September 18th, 2007 at 1:04 pm
Hi,
This is a great question.
It is one that you will have to follow up with your doctor about.
There are some treatment guidelines that talk about using 108 mg of Concerta daily for adult ADHD. In teens, there is recognition that 72 mg can work well as well.
The issue is that the higher the dose goes, the bigger the risk of increased heart rate and blood pressure.
Talk to your doctor about it and see if he can help you out.
Dr. Kenny
September 18th, 2007 at 1:27 pm
Thanks for your quick reply.
One of my problems I think will be that this doctor (psychiatrist) has told us that 72mg is the highest he can go, however, the previous psychiatrist was the one that told us that it could go as high as 108 and we had been considering it before my husband’s job (Army) transferred us to a new state. We feel like we don’t have any hope. I mean, we’ve had the police out to our house twice in two weeks because he was threatening bodily injury and threatening vandalism by keying our cars. He even said if we put him in juvy that he would think of ways to kill us. If we don’t get this under control soon we may have to go a different route than we would rather take.
September 22nd, 2007 at 1:40 pm
Dr. Handelman,
Our six year old son has been taking 18mg Concerta for the past 2 months. He was diagnosed with ADHD without Hyperactivity. He has been doing quite well. We are now considering raising the dose to 27mg, but are concerned because he has difficulty falling asleep at night. Will raising the dose to 27mg make this problem worse? It takes him an hour to get to sleep at night, although he doesn’t seem to be exhausted the next day - still gets 9-10 hrs of sleep each night. We have heard about Melatonin to help him get to sleep, but haven’t tried it. What are your thoughts about this?
Anne
September 23rd, 2007 at 12:49 am
Anne,
Of course, talk to your doctor about any treatment decisions.
1) Yes, increasing the dose may worsen the side effect of insomnia. The only way to find out how much, is to try it out!
2) Yes, melatonin can be good for sleep, and there is no problem with drug interactions there. It is natural and may help. You could go to the pharmacy or natural health store and get some melatonin and see if it works for your son.
Dr. Kenny
September 25th, 2007 at 10:05 pm
Dear Dr. Handelman
I am a 40 year old female recently diagnosed with ADHD and just started medication. I began with a low dose, taking 5mg of Ritalin and noticed a big improvement immediately in my focus, motivation and follow through but I got terrible headaches as the dose wore off. My doctor switched me to 18mg Concerta to make it last longer and avoid the headaches. My question is: I realize these are the same dose of the same ingredient and now on the Concerta I feel spaced out like in a fog and my memory is worse than before but my focus, motivation and follow thorugh are still much better. The first few days I felt it lasted 12 hours, now I feel it wear off after 8 hours. While on the Ritalin, aside from the headaches, I felt fine. Does spacieness and the memory issue result from too low a dose or could regular Ritalin just be a better fit for me?
Thanks,
Pam
September 26th, 2007 at 5:09 pm
Hi Pam,
Those are great questions.
I don’t really know the answer - that is one you will have to work out with your doctor.
In my experience, in general, only a small percentage of people are so sensitive that there is a real difference in how one form of methylphenidate responds compared to the other (i.e. regular ritalin vs. concerta). You seem to be in that group.
Talk to your doctor about how you are feeling, and see if you can find an adjustment that may work (maybe even trying metadate CD or ritalin LA).
Dr. Kenny
September 27th, 2007 at 7:02 pm
Thanks for your quick reply.
Are both of those formulations available in Canada?
Another question if I may: Is there a link between ADHD and sleep?
I have experienced excessive daytime sleepiness since my teens which all medical tests indicate is not related to any health issue. I was then diagnosed with sleep apnea syndrome and put on cpap which helped somewhat. Since taking the ritalin I have slept better and deeper, awaken feeling more refreshed and have less daytime sleepiness and more energy without using the cpap and my ADHD symptoms are under control.
October 10th, 2007 at 5:57 pm
I am 25yrs old and I recently was diagnosed with ADHD. Doctor started me on 18mg of Concerta. It was kinda working but wasnt lasting 12hrs more like 4hrs. So he changed the mg to 36. I have now been takin the 36 for 2 days and I feel more anxious than ever. I feel like l’m speeding up not down. I hate it, it does far from slowing me down! I’m afraid 36 is too high for me? Any Answers
October 28th, 2007 at 9:33 pm
Greetings,
My son was dx with ADHD w/hyperactiviey and ODDabout 6 months ago. we have tried adderall, straterra. the straterra is great so far.
We have recently increased his dose to 36mg a day for straterra from 25mg. when he was on the 25mg, he was pretty normal for a child with his level of energy and degree of ODD. when we increased his dose, he started to be a bit more fidgety and restless and alot more talkative (not in a good way…he hasn’t stopped in 2 days) .
Is it possible that increasing his dose by just a little could cause him to have a stimulant effect instead of curbing his outbursts and controlling his hyperactivity?
I would appreciate any thoughts.
November 17th, 2007 at 12:59 pm
I have had ADHD my whole life, but just started Concerta 18 mg a couple of weeks ago. I am a 32-year-old female, and I smoke. The first week everything was fantastic. I felt so good, I decided to quit smoking. As soon as I started using the patch with my Concerta, I started having heart palpitations, chest pains, and headaches. I have had similar symptoms from excessive caffeine and ephedrine in the past. I stopped using the patch and started smoking again, and everything was great again for about five days. Then two days ago the symptoms came back. I am very frustrated because I don’t want to discontinue the Concerta. It has really improved my life. The symptoms seem to start around six to seven hours after I take my medication. I looked it up and this is when the concentration of methylphenidate peaks in the blood, although I woke up with the symptoms today. So, here are my questions. Do you think a different medication would be better? All other forms of methylphenidate, including Daytrana, have higher peak blood concentrations than Concerta, so I don’t think any of those would make a difference. According to the internet, Focalin and Strattera don’t work as well. Maybe Adderall wouldn’t cause the symptoms, but the internet seems to warn about cardiac symptoms more for Adderall than Concerta, so I’m not sure. Perhaps there is another medication I could take along with the Concerta to help reduce the symptoms. My sister thinks the symptoms are from anxiety, but I am going to monitor my blood pressure and have an echocardiogram to be sure. Please help if you can.
November 17th, 2007 at 7:45 pm
Hi Lacey,
This is really one to go through with your doctor in detail.
It may be a direct side effect of the methylphenidate, causing you the palpitations. In that case, a different methylphenidate (i.e. other than concerta) - in the form of ritalin LA, or metadate CD, or other types may in fact be the same. However, trying Adderall or Strattera may be different. As Adderall is also a stimulant, it is more likely to cause this side effect than strattera.
But as I say, you will need to work this out with your doctor.
All the best,
Dr. Kenny
p.s. to learn more about medication for ADHD, get a copy of my free special report here: http://www.medicationmastery.com
November 21st, 2007 at 1:35 am
Can concerta cause seizures? My son as taken concerta for about 5 years, this past April he had his first seizure, a Grand Mal and has had two since then. I have had a number of people tell me its the medicine but my doctor says it isn’t. What should I think?
November 22nd, 2007 at 12:55 am
The short answer is: talk to your doctor about it (especially the neurologist who is lookiing after the seizures).
The second short answer is: yes and no.
For some people, methlyphenidate can increase the risk of seizures.
For others, it won’t.
Talk to your doctor.
Dr. Kenny
p.s. Here is the summary of one study:
http://www.addadhdblog.com/adhd-concerta-and-seizures/
December 3rd, 2007 at 9:10 pm
Can Concerta and Bipentin dosage be compared? Are they about equal?
I know they have different relears emechanisms.
December 4th, 2007 at 1:00 am
Hi,
The main difference is that Biphentin is 40% immediate release (vs. the 22% that concerta is) and that it only lasts about 8-10 hours.
To convert the biphentin back to a ‘regular ritalin’ equivalent, you would multiply the biphentin dose by 0.4 and then consider that dose in the morning and noon and then relate that to the concerta.
For more info on biphentin, visit here:
http://www.addadhdblog.com/biphentin-the-newest-addadhd-medication-in-canada/
Dr. Kenny
December 12th, 2007 at 7:13 pm
My daughter is 7 years old and was on Focalin (20mg) which seemed to be losing its affect. Her pyschiatrist just placed her on Concerta (27mg) and Zoloft (50mg) as well as 20mg of Ritalin in the morning. The only current negative side affect has been a loss of appetite (although she makes up for it in the evening). However, I am concerned that this is too much medication for a 7 year old. She has been diagnosed with ADD and seems to have some learning disabilty issues (she has a hard time grasping out of the box concepts). However, she has never been depressed although I adopted her at 3 years old from an orphanage. The doctor put her on Zoloft because she felt that she maybe anxious and has some rigidity (she tends to be stubborn, and has a bad habit of breaking things).
Should I be concerned?
December 29th, 2007 at 12:03 am
Hi
9 months ago I went to a psychologist and had some pretty extensive testing done. He said I seemed to meet the criteria for ADD not the hyperactive type, which he said was why I was probably never identified. Part of the reason came out in my IQ testing. He said I probably compensated pretty well. I don’t know about that, but he also I had some minor anxiety issues and also labeled me major depressive disorder. I had found my way to Wellbutrin as an antidepressant a few years before after finding that SSRIs just made me pretty disinterested sexually. So I got off Wellbutrin and on Concerta and for a few weeks I was quite noticeably more engaged in life. After that, not as much but no significant depression until the 36 SR wore off about 5:00 at night, so I started taking 18 mg at noon and that seemed to help with the depressive thoughts. But now I seem to be having some sad or hopeless thoughts even in the midst of the Concertal dopamine feel good. So I am wondering if perhaps I should drop the Concerta and I just go back to Wellbutrin or perhaps look into an antidepressant to take as well as the Concerta. Can you give me your opinion? Doesn’t Concerta affect my depression very similarly to Wellbutrin? I’m sorry to ask this of you, but I haven’t been going to a psychiatrist because where I live there is such a very long waiting period. So my local physician has been reluctantly walking through this with me. I thought perhaps my depression was just the result of the ADHD but I am thinking now they may just be two comorbid problems. Any thoughts you have on this would be very much appreciated. Perhaps I should just increase the Concerta, but I know that can raise blood pressure and heart rate. Thank you for your consideration of this situation.
M
December 29th, 2007 at 12:13 am
Hi
I am 53 years old and 9 months ago I went to a psychologist and had some pretty extensive testing done. He said I seemed to meet the criteria for ADD not the hyperactive type. He also said I had major Depressive Disorder. I was on Wellbutrin 300 a day at the time and functioning fairly well, but wanted to address the ADD, so I stopped the Wellbutrin and went on Concerta 36 SR then added 18 mg at noon because I had some depressive thoughts at night after the morning dose wore off. I am still having some depressive thoughts and lack energy. Do you think I should consider going back on the Wellbutrin or adding another antidepressant instead, or perhaps increase the Concerta? SSRIs were not helpful for me but I don’t understand how these medications work. I guess I thought the depression might have resulted from the ADD but now I’m not sure.
Thanks, Michael
December 29th, 2007 at 10:14 pm
I thought that was an odd use of the word “moderation”. Perhaps a few of these could be left out??? This is giving me a mildly depressive thought.
January 6th, 2008 at 10:18 pm
Hi Dr. Handelman, thanks for all the helpful information. Just a quick question since it’s the holidays and my Doc is out of town: is there any reason (beside the financial difference) that one shouldn’t take 3 18mg Concerta instead of 1 54mg? The reason I ask is that I recently lost my 54mg pills on a cross-country trip but I still have some 18mg pills left over from when I first started the medication about a year ago. Thank you.
January 16th, 2008 at 2:20 am
My 11-year-old son has been diagnosed with add in November, 2006 He begin taking ritalin 5 y10 milligrams. The psychiatric change the medicine for concerta. He is taking 27 miligrams but his behavior is the same. The teacher said to me that they know that he tried very bad but he don’t pay attention in class like always ; his grades are very bad. I would like to know how long take to the body adjusts to the medicine and how long the doses lasts.
January 18th, 2008 at 4:30 am
Hi Dr. Handelman,
I’m glad I found this site. I just came back from asking my pharmacist some questions. I am 27 and discovered about 10 months ago that I may have ADHD (inattentive type) and finally managed to get in to see a psychiatrist. I have read a lot of books and am fairly convinced personally that I do have ADD. I tried Dexedrin for about a month and thought it was helping a bit with clarity of thought and maybe mood stabilizing but it wasn’t as significant as i was hoping it would be. I have now switched to Concerta. I started with an 18 mg dose for a month. I think the biggest effect I seemed to notice was related to stabilizing my moods as prior to this I would find myself on a rollercoaster emotionally and struggling not to cry at work for no good reason etc. I think it has also helped me to think more clearly and be more organized and efficient in general. I went back to my psychiatrist about 2 weeks ago for follow up and a refill. I was cautious about claiming that Concerta had made a dramatic effect, in part because I was wondering if some of it was situational as I have a job that is very variable in stress and workload and also my exercise routines were not necessarily very consistent so i was wondering how much ie increasing my exercise regime may have affected my concentration adn moods etc. My psychiatrist suggested maybe it was just the placebo affect and felt that if the main difference was mood stabilization that it might not be worth taking and questioned if I have ADD in that case. He agreed to increase my dose to 36 mg to trial for a month. I have been on the higher dose for about 2 weeks and relate to one of hte comments above about feeling almost like it’s sped me up in a negative sense. I feel more distractable and less able to focus, poorer memory and follow through and overall I really don’t like how I feel and don’t find I am being very productive. It struck me as strange that a higher dose could make me feel this way as I thought it would, if anything ,cause a more noticeable positive effect regarding executive functions. I know i need to see my psychiatrist as far as dosing etc, but was curious about this effect the higher dose seems to have had on me….?? Would love any feedback. Unfortunately, I can’t cut back my current dose cause i’m taking one pill that’s 36mg.
sorry this is so long….
January 22nd, 2008 at 12:16 pm
Sorry this is so long. I hope to hear back from you….thanks for your time.
January 24th, 2008 at 5:06 pm
Hi there
My son, who is 11 years old and extremely skinny (65lbs) currently takes the 54mg of Concerta. He was taking .5mg of Risperdal 2x per day up until the middle of December when we stopped those (he had been taking those since he was 6 years old). He has been having problems at school and the psychiatrist would like to bump him up to 72mg. I have some 36mg Concertas left from when he was taking those before the 54mg. So, I am going to give him 2 x 36mg now instead. My question is: Does 72mg seem too high of a dose for an 11 year old who weighs only 65lbs? Or does weight not have anything to do with it?
I really appreciate your comments.
January 25th, 2008 at 11:01 pm
Hi. I’m worried sick about my 18 year old son. He was officially diagnosied with ADHD (inattentive) this past summer. He was tested because he was finding his lack of ability to concentrate debilitating. He was initally prescribed Concerta but because he felt extreme agitation and mood swings, our doctor then prescribed Ritalin. He loved the Ritalin and one day described it as being “addictive”. I immediately took it away and we went to our doctor again. Since he also exhibits symptoms of depression our GP presribed 300 mg of Wellbutrin XL with no noticeable benefits. I’m wondering about the effect of the Ritalin. Since it made him feel “high”, does that mean he doesn’t really have ADHD - because that’s what I’ve read? He has a very addictive personality so I’m very worried.
January 30th, 2008 at 5:31 am
hi
i used concerta 36mg and i cannot sleep till 1 or 2am, even with a lower dose its not effective but keeps me up all night. i also get a bit sleepy during the day with this medication. i have tried adaphen 10mg it works well but its short lasting, any suggestions?
January 31st, 2008 at 7:09 pm
I have an 11 yr old daughter who has been on 108 mg (taking both pills first thing in the morning) of Concerta for over a yr. During this time she has been in and out of the hospital due to the following:
* Stomach pain
* Extreme Fatigue (24 hr of not moving from her bed at all… This would occur one or two times a month, sometimes more sometimes less
* No appetite (zero, she would take one bite of food and claim that she was full and her stomach hurt)
* Weakness
* Glassy Eyes
* At times over active and was disrespectful, spoke back (argued) to her dad & I very often
* Weight loss in the beginning, now maintains
* Did not grow in height for 2 yrs.
Every time I spoke to her Pediatrician, and asked if the medication could be causing all of the issues, he said no… He claimed that it was all due to depression and had nothing to do with the medication… Last summer (June) he thought it be in her best interest to add 40 mg of Strattera in with the 108 mg each day… I refused to add the extra medication considering all of the medical problems she was already having…
After much research I found, (what I 100% believe) that the reason for all of her medical problems was due to being over medicated… She has now been off of the medication for almost 3 wks and has gained @10 lbs She is showing many signs of improvement with each day… She is very well behaved and actually much calmer and more relaxed off of the medication… She is now being home schooled and doing very well…
I only wish I had obtained this knowledge long ago, to prevent all of her hospital test and sickness.
March 1st, 2008 at 11:07 am
How do you know if you need more Concert (36mg to 54mg daily) for a teenager that doesn’t really “get it”. She claims she sees no difference, but her family and I do see a difference, a very positive difference. I am just not sure. If I go to the doctor, they may base it on my child’s “no difference” opinion and give too much. Is there a way to just try the 54mg after talking to the doctor and seeing how it effects her for 2-3 weeks? She has “masked” the feelings of being different for almost 15 years now and gets her answers by watching others… This is a time where we are depending on her for the answers and it is a hard one….
March 1st, 2008 at 11:50 am
Connie,
It is relatively common for teens with ADHD to lack the ability to reflect on themselves. A doctor will ideally be aware of this, and take into account parent, teacher, and family feedback, as well as the teen’s feedback.
In so far as dose, generally, if there is room for further improvement, and there are few or no side effects, it is worth trying a higher dose, in my opinion.
Speak to your doctor about it.
Dr. Kenny
http://www.MedicationMastery.com
April 16th, 2008 at 1:33 am
Hi Dr. Handelman,
What antidepressant (for depression and anxiety) works best and is safe to use with Concerta (36 mg)? My doctor recommends Lexapro 20 mg but I have horrible headache if I use Lexapro over 10 mg.
Regards,
Rick
April 25th, 2008 at 4:33 pm
Hi Rick,
Talk to you doctor - but generally there is no drug interaction between the ADHD medicines and the newer antidepressants.
Dr. Kenny
April 30th, 2008 at 1:05 am
Hello Dr, Handelman,
My son is 7 years old and was just prescribed to take 2 Concerta tablets of 54mg in the morning. He was previously taking one 54 mg Concerta along with 10 mg of Ritalin 3x/day. My concern is that taking 108mg of Concerta is too much for him and I am hesitant on starting him on this regime. I expressed my concern to his DR. and was told that it was perfectly fine but all of the literature that I have read including what is on the Concerta website, and what I have read on this thread says that the maximum dosage of Concerta for an ADULT is 108 mg per day. My son is 7 years old, 4ft. 6″ and weighs 105lbs. So he is a big boy but does that mean its ok for him to take 108 mg of Concerta? Thanks you in advance for your response.
Connie G.
May 8th, 2008 at 4:35 pm
Thank you for Concerta dosing information, especially the CADDRA guidelines. I am an adult and a big guy (>100kg). My current RX is 72 mg/day with a limited RX (not enough for daily use between visits) of Ritalin 10 mg to be used PRN (max 3/day).
I found I needed at least 3/day with Concerta to do well at least on working days but was beginning to feel like an “abuser” since I wanted to take them every day but had limited supply and believed I was exceeding the dose range.
Is there any literature supporting up to 108 mg other than CADDRA documents - I did a quick search of PUBMED and didn’t see anything.
Thanks,
GG
May 8th, 2008 at 7:28 pm
Hi Gary,
I’m sorry to say that I am not aware of other treatment guidelines or research which speaks to this high dose/off label usage of Concerta.
Most experts in ADD/ADHD are comfortable in certain circumstances to try higher dose medicine - see if you can get a consultation with an expert - even if it means driving to a nearby university. (find the nearest university with a medical school, contact the department of Psychiatry, and ask who is working on adult ADHD. You will likely find someone…)
All the best,
Dr. Kenny
May 15th, 2008 at 6:28 pm
Hi,
I am an 18 year old currently taking 50mg of Ritalin morning, lunch and evening. For a total of 150mg per day. I was just wondering what the concerta equivalent would be.
Thank you..
May 17th, 2008 at 1:19 pm
i have a 11 yr old newly diagniosed with adhd i am concerned re the concerta he started off on 18mg it was ok but he still lacked focus according to the child the teachers and parents, he was increased to 27 mg he seems more nasty?? he had odd? before he was medicated and now wondering if this is the right meds for himshould he take ritalin
May 24th, 2008 at 11:54 am
My daughter, who is now 15 y.o., has been taking ritalin since the 3rd grade, for ADD. She is presently taking 54mg. daily of Concerta. She takes it only on school days. Goes off the medication completely on week-ends and over the summer. She takes Concerta mainly to better focus in the classroom. She has grown each year and has not lost any weight. But she does seem to talk of being depressed more often lately, which I realize could also be some what normal at times for a teenager. She does not want to be off the medication, because she says it helps her day, so we continue to give it to her. My concern is long term effects and what types of blind studies have been conducted that are NOT sponsored in some way by the pharmaceutical industry. Is in good or bad for her to be off the meds for week-ends etc?
Thank you.
May 24th, 2008 at 12:25 pm
Laura,
1) Regarding stopping the medication on the weekends and holidays - most doctors recommended doing this until about 10-15 years ago. Now we recognize that ADD/ADHD can impact outside of school - i.e. socially, emotionally, etc. So, unless there is a problem/side effect, then continuing it makes sense. Talk to your doctor about the specifics in your daughter’s case.
2) Regarding the beginning symptoms of depression: a relatively high percentage of teens with ADD can develop depression. Best to get your daughter assessed by your doctor.
3) Regarding long term studies- there are pretty good studies showing long term safety. There are also studies showing the long term impact of NOT treating ADHD effectively. It ultimately comes down to balancing risks and benefits. I hate to sound like a broken record - but best to talk to your doctor about it.
Thanks for contributing to this blog.
Dr. Kenny
May 25th, 2008 at 12:55 pm
Thank you for your advice. I will speak to my doctor about these issues. I also would like to know how many people write to you with comments of depression from teens on Concerta? My daughter has cut her self a couple times, partially in cry for help, I believe, as it was a superficial cut to the wrist horizontally. Do other teens on Concerta act this way also? My daughter has seen a psychiatrist twice in the past, but i could not convince her to continue. Also are you in anyway affiliated or compensated by any pharmaceutical company? I am sorry this needs to be asked, but the fingers of this industry reach so many more places than people realize.
Thank you.
May 26th, 2008 at 11:40 pm
Hi Laura,
1) Depression in teens on Concerta - the issue here is the rate of depression in ADD/ADHD irrespective of treatment. In other words, there is a high rate of depression developing in ADD/ADHD (upwards of 20-30% in teens). That rate may drop somewhat if the ADHD is effectively treated. Can concerta cause depression directly as a side effect - I have seen it, though it is usually pretty dramatic (i.e. tearfulness and a dramatic sadness starting within days of starting Concerta), and not a gradual chronic thing.
2) Regarding funding from the pharmaceutical companies: I receive no funding from pharma on this blog. This blog started as a hobby/interest. I have some ads for projects that I work on, and at the time I’m writing this, I have some amazon.com links (i.e. to support this blog - buy books at: http://www.theadhdbookstore.com!) I may soon try other advertising programs (like google ads).
Thanks for your questions and comments.
Dr. Kenny
May 27th, 2008 at 12:57 pm
I started on 11mg of Concerta (my first time on any ADD drug as I was just diagnosed). I’m 30, a little overweight (5′4 and 160 lbs) and also taking lamotrigine for bipolar disorder 2.
The 11mg dose made me lose my appetite and feel full of energy. I was able to focus better and get things done. I still felt the does began to wear off around 5pm and asked if i could go up to 36mg.
Since being at 36 I am tired ALL THE TIME. As in, I’m yawning, have those dry/cloudy eyes you get when you first wake up (but all day) and the focus/energy is totally gone. Also, my appetite came back.
I don’t understand…I guess I should go back to the lower dosage? Or maybe I don’t have ADD after all?
June 4th, 2008 at 1:00 pm
Dear Dr. Handelman
I am a 50 year old male attorney in excellent health. I have been taking ritalin, adderall, and dexedrine, in various, usually high doses for approximately 15 years. Several doctors have concluded that I metabolize stimulants extremely quickly as only high doses seem to work for me. I’ve been told this is unusual but not unprecedented.
For the last two to three years, I’ve been taking 4 or 5, 36 mg Concerta capsules every morning. About 2 months ago, that dosage stopped working. Over the last two weeks, I tried increasing the dosage to 8, 36 mg Concerta capsules daily and found it is working again. At this dosage, my appetite is fine, my mood is pleasant, I fall to sleep immediately at my normal bedtime and I am back to being productive rather than “spaced outâ€. My heart rate and blood preasure are both normal.
I am scheduled to see my Doctor this week about the possibility of increasing the dosage from 5 to 8 36mg Concerta/day. I recognize that this dosage is very high relative to what is officially recommended and I was wondering if anyone has had experience with such a high dosage? For example, several years ago I read about someone suffering from narcolepsy who was taking 1,500 mg of ritalin daily apparently without ill effect. Any information concerning other known cases requiring such high doses would be appreciated.
June 6th, 2008 at 8:37 am
We live in England. Our 22 year old daughter and takes a total 120 mg of Ritalin per day (30 mg every 3.5 hrs - 4 times a day) which covers 14 hours. So this means she would be taking 103mg Ritalin to cover 12 hours.
We are hoping to transfer to Concerta XL and would like to know the equivalent dose. We used the information on this website to take to the consultant who passed it on to the pharmacist to investigate, but she said that in the UK Concerta XL is different to the Concerta in Canada.
They seem very unsure what to prescribe and we keep getting conflicting information. We are concerned that if she drops the dose it will have a huge impact on her life. Sammy also has Learning Disabilities.
Can you throw any light on this for us please as yours is the only information we can find that is clear and concise?
Many thanks
Glynis
June 6th, 2008 at 4:29 pm
Hi Glynis,
Thanks for the question (and the compliment - it’s appreciated :-).
I have searched online - and it appears that concerta XL in the UK is in fact the same as concerta in Canada.
If you refer to this webpage (scroll to 1/3 of the way down):
http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=8382
You’ll see a ‘dosage conversion’ table. The conversion is pretty much what I have here.
Although I couldn’t find the exact 22% immediate release on any of the websites, I believe that Concerta XL is the same as Concerta.
I have attempted to contact Janssen Cilag in the UK to see if they can clarify the issue for me.
I’ll let you know what I hear back.
All the best,
Dr. Kenny
June 11th, 2008 at 6:38 pm
Hi! I am 24 yrs. old was recently diagnosed with ADHD. My PDr. started me on Concerta 27mg and it worked ok for a couple days but I noticed that the medicaton was giving me headaches and I wasn’t really motivated to do much. It was also wearing off quickly(2-3 hours) and making me tired by 5pm. I explained all of this to my Dr.. He decided I need a higher dose so he moved me up to concerta 54mg. I have only been taking it for 2 days but I already find myself even more unmotived and tired than before. My question is, do you know why concerta is causing this effect? Is this normal? Before the medication I could not concentrate, was unorganized, and had a horrible time memorizing anything, but at least I had enough motivation/energy to get stuff done.
I just don’t know what to do! I think I would like try another medication but I think my Dr. believes that its just a dosing problem not the medication.
Thanks,
Ashley
June 16th, 2008 at 5:07 pm
Glynis,
I’ve just received a response from Janssen-Cilag in the UK who shared a letter with me that Concerta XL is in fact that exact same preparation as Concerta in Canada - i.e. it is a 22% immediate release medicine, and the dosing in Canada, the US and the UK would all be the same.
All the best,
Dr. Kenny
June 16th, 2008 at 6:03 pm
Thank you so much for all your efforts with this! I have forwarded it on to the hospital pharmacist for her information - unfortunately the consultant dealing with Sammy’s case has left rather suddenly and so we await a replacement.
Hopefully it won’t be to long before we can get things sorted.
Thank you once again.
Glynis
June 19th, 2008 at 5:38 pm
Ashley-
I have a similar problem, but I have not had my dosage increased yet. I am 25 and was just diagnosed with adhd. My Dr started me on concerta 18mg. I have horrible headaches and feel somewhat groggy. I am wondering if it will actually help to increase the dose, or should I switch to vyvanse? Have you resolved your problem?
June 20th, 2008 at 7:42 pm
Hi Mackenzie!
I tried to up my dose on Concerta to see if the side effects would go away but it just made things worse. I would at least try it once to see what it will do before switching because everyone is different.
My Dr. actually switched me to Metadate CD, 20mg. He said I can go up or down with the dose depending on what is right for me.
The first few days I experienced the same symptoms I had on Concerta(headaches, unmotivated, irritable). But after a week of taking Metadate CD the symtoms went away and now I feel great. I take 30mg in the morning and 10mg in the afternoon. It works out perfect. I can now focus, multi-task, and drive safely!lol! What I like most about Metadate is the fact that you have control of the medicine, not the other way around like Concerta. It comes in a capsule that you can undo so you can take some of the medicine out if the entire dose is too much. I know that some parents love it because they can pour the medicine(tiny beads) on a spoonful of applesauce and have the child take it that way if they can’t swallow pills.
Anyway, I have not tried vyvanse yet, but if for some reason the Dr. wants to switch my med. then I will ask to try that one. There is a coupon on Vyvanse’s website to try it Free for a month.
Let me know what you decide to do.
Good Luck!
Ashley
June 21st, 2008 at 1:07 pm
Ashley-
yeah…I might have to try vyvanse too. I have lost my headaches, and I can focus a little better…but it still doesn’t do much. I might try and take two 18mg pills to see if that makes it better. Did your heart rate noticeably increase? My heart rate is definitely faster since I started taking it. I guess that’s normal, as it is a stimulant. I’ve never heard of metadate. Maybe I will try that. Thanks for your help! It’s nice to know someone else is going through the same thing.
June 23rd, 2008 at 3:49 pm
Hi,
I’m just trying Concerta for the first time after about four years of adderall and then dexedrine (most recently two spansules of 15 mg spaced out). I always felt that ritalin worked better for me than dexedrine but that I seemed to metabolize it very quickly and the run off was very ugly (worse than without any medication). This time I’m trying twice the dosage of concerta that did last time and after reading your discussion about dosing that seems about right. Last time it just didn’t cut it. That and not being on a plan to cover it meant I didn’t try it again till now. I have high hopes for it as the only alternative I can see on the ritalin horizon is the Daytrana patch which I’m told won’t be in Canada for a while.
Thanks,
Mike Craig
June 25th, 2008 at 8:21 am
hi i was wondering do you know what convertion of 60mg of adderall to strattera would be please email me if you do
June 25th, 2008 at 11:14 pm
Mackenzie,
My heart did speed up a little bit but not bad enough to make me worry. I think the biggest things to look out for are chest pains, shortness of breath, and high blood pressure. If the increased heart rate make you worry, you might want to call your Doc’s nurse or call your pharmasist. I always call the nurse if I worry about a side affect. My problem now is that the Metadate CD is not as affective as it was the 1st 8-10 days. I have tried higher doses and taking it at different times but nothing seem to work. I’m starting to think that it’s just the type of stimulant my Dr. Keeps prescribing and I need to try something different. How’s everything going for you now? Are you still thinking of switching?
-ashley
June 26th, 2008 at 11:34 pm
Dr. Kenny Handelman
I a a teenager who has had very…well depressing thoughts for at least the last three years. This may be due to certain circmstances three years ago, as that was around the time when my father killed himself (please don’t feel sorry for me…I have coped with it well and now I feel like he’s always with me ^.^). But I don’t think this is the case as I only realized this depression several months afterwards… I’m a teenager and I’ve looked over the internet to see the possible side effects of the Concerta that I take now and have taken for about 8 years. I know that this may just be because of the fact I’m a teenager and that many teenagers feel this way, but I’m concerned it may have something to do with my 54mg of Concerta that I have taken for half of my life thus far. I’m an honor student and I’m in an advanced program that will allow me to skip at least 1 year of college, so I like the Concerta for that…but I used to not take it when I was with him (my parents are divoricees since I was 4), and I never felt any side effects of this. Now I find that when I skip one day of my meds that I’m overly hyper in school, but after 2 days of not taking (without my mom knowing I was doing this as she thinks I absolutely must have it) I’m calm and it is as if I had taken the pill. I’ve talked to my doctor about going off it, but my mom refuses to discuss it…but I’m more worried about the fact this medicine I take for my ADHD may be causing my almost constant feeling of paranoa, depression, thoughts of all the different ways I or others could die, my almost constant mood changes, my talkativeness, my involuntary speech (causing me much embarassment in school), my suicidal thoughts, my delusions, and my head randomly jerking to the side.I’m concerned about all of this and I plan to talk with my doctor over the phone tomorrow (without my mom at my side) about how I’ve been feeling because I thought I was crazy for the longest time and it only occured to me today that my medicine could be what is causing me to feel like this. I even went close to attempting suicide…but as I still have people who care for me, I don’t want to hurt them, so I keep living, to see them smile. I know that Concerta, as it has methylphenidate as a main ingredient, can be used as an anti-depressant and that as a teenager I’m a person who can react adversely to anti-depressants. I’m just really concerned that my dark thoughts are becoming more and more dark and that they are causing me to brood more and more and to say and write more and more dark things. I’ve also been feeling more and more agressive to the people in my class as I spend most of my day with these same 16 others, and frankly they enjoy making fun of the things I say and they enjoy making fun of me in general. Only a few of my classmates know I’m ADHD, and I don’t like taking about it because it makes people feel sorry for me…and that, to me, is unacceptable. Please help me to understand better…and sorry I talked so much, I’ve just have kept most of this stuff from everyone I have ever known.
A very worried teen named,
Dannielle
June 28th, 2008 at 9:18 am
Danielle,
You are a very brave person… Keep up the great work!
I will make a couple of comments, but the best thing to do is to talk to your doctor in detail about your circumstances.
1) It sounds like you are developing motor and vocal tics (similar to Tourette’s). These can be worsened by Concerta (or any stimulant). If this is the case - talk to your doctor about adapting your medicine, or taking another medicine that helps to lower the tics.
2) Regarding depression, it is possible that a) you’ve developed a depression - which is common for people with ADHD - and it needs treatment - i.e. therapy or medicine, or b) that the concerta is contributing to your depression. You’ll have to review that in detail with your doctor.
3) If you can do well without the medicine - it may be worthwhile to try a time without it (again - talk to your doctor about this).
Good luck, keep strong, and ask your doctor for help in getting your mother to see your perspective.
All the best,
Dr. Kenny
June 30th, 2008 at 11:49 pm
hi, I’ve been taking concerta for my adult ADHD just a few weeks ago.
I started off with 18mg, and having no effect, I’m on my second week of 27mgs. I’m not sure if this is working well for me, but I do feel more focused, but the only problem with my focus is that it is misdirected. I cannot focus on my work but rather “day-dream”
My anxiety has gone down.. but I don’t think this is the right dose for me . I test tried tow 27mg concertas one day, and I was so focused.. well exceedingly focused.. not to mention I couldn’t fall asleep ~!!
I told my physician, and he said I should stick on 27 for now, but I think I need a higher dosage.
Another strange side effect is that I used to suffer from insomnia, but now that I am on concerta, I can fall asleep at night .
This is great, but I also have a sleep attack 2-3 hours after I’ve taken my medication, and it forces me to sleep for about 1 hour. I feel so unbearably tired.. I usually take the medication just before lunch, so it can last till midnight, so i am very focused when the 6-8 hour peak hits at about 6-7 . I don’t take it on weekends.
I cannot figure why I am falling asleep right after taking concerta. I s there something in my metabolism that can’t withstand the initial onset, or is this dosage not right? Is the meds not working? 2 tabs of 27mg did do the trick, but I was feeling a little too jittery. I can’t seem to find the reason for my tiredness and noon sleep attacks.
Thanks~
“please take away my sleep after concerta” Cathy
July 2nd, 2008 at 11:03 am
Hi Dr. Handelman.
I was reading most of the questions and couldn’t find something that answered my problem.
I was diagnosed with ADHD a couple of weeks ago. The psychiatrist prescribed the following:
27.5 mg ritalin X 2 a day
80mg Ritalin LA
90mg Concerta
Now 90mg concerta as mentioned in your blog is the equivilant of 20mg ritalin 3 times a day (or, the equivilant of 20mg ritalin PER dose). My single dose was 27.5 (given twice). How come she only gave me 90mg then? Shouldn’t it be higher than 108mg? I know Ritalin works for 4 hours give or take, and 2 doses or 3 doses will only make it longer. Increasing the dose changes the effects but not the effect period … Was she mistaken?
And another thing - Ritalin LA 80mg?? meaning I get 40mg Ritalin per dose? (2 releases, one imidiately the other after 4 hours). Its almost 1.7 x 27.5 ! Was she mistaken again?
TOVA had a score of +4.3 with Ritalin 27.5mg. I felt a great change! But it had dire concequances and nasty rebound effect. Ritalin LA I believe works well but makes me feel as if I get butterflies in my stomech (as if I’m thrilled about a special occasion that doesn’t really exist). I prefer Ritalin LA for Ritalin but the dosage frightens me!
And concerta? I had very high hopes for Concerta. 36mg, 54mg, 72mg, 90mg and even self prescribed (I know, I’m a bad boy) 108mg didn’t do ANYTHING regarding my concentration! I dont get it :/ It helps with the impulsiveness and hyperactivity - but I still can’t read or study properly (well, not atleast like I can do with Ritalin and Ritalin LA).
I’d really like to hear your thoughts about the prescription “flaws” and inconsistancies. I’d also like to hear what you think about Concerta. Could my body be immune to concerta? Do I have any other long-lasting choice other than concerta? LA works best for 6-7 hours, and thats not enough. I dont wanna overdose methylphenidate with extra pill taken afternoon. I live in Israel, and Israel hasn’t got ANYTHING else for adhd other than the 3 mentioned drugs (no adderall, no straterra, no dex).
Thanks.
July 15th, 2008 at 12:22 pm
Hello Dr. Handelman,
I am somebody who was diagonised with ADHD when I was four years old and that is when I started taking Riddlen. I took that for 8 years and I had the usually side effects loss of appitiete, sleeplessness, stomach craps which didn’t bother me too much. I then switched to Addrell which worked a lot better for two years. At 14 I stopped taking any medication all together because I felt different and got very fustrated that I couldn’t be all I could without aid for an outside source. That is when I hit puberity so I had the normal inscurities of a young teenager. Not a good combination.
When I stopped I felt fine physically I didn’t gain a little bit of weight but that’s normal. Though I noticed I was always in a slump, you know I couldn’t achieve my potenial no matter how hard I tried and that was even more fustrating. I can make close to straight A’s but I was very close to a C average. Not good at all.
One month after my 17th brithday I went to a doctor and asked to go back on Adderal it has worked great. I will be 18 in one month to come. My grades are great my weight went down so I feel good about myself. I got in to National Honors Society best of all if I want to do something I know have to drive to do it.
Going on medication can be hard and even when your on it. I ask myself all the time am I the medicatied me or the unmedicatied me. It’s tough to watch other people do things so easily and think, ” It’s hard enough to do on meds but off it be close to impossible.” On the flip side though never let your ADD/ ADHD get in the way off doing what you want to. And never let it be an excuse for not doing something. It may make life harder and emtional upsetting but it’s an out. You just feel ten times better when you do achieve something that is difficult to you.
So aside for that little tid bit for those who are unsure. Dr. Handelman I do have a question for you. When they say the meds go quickly in the body as they do out of the body. How long do they normally mean. I know from taking Adderall the effects of the medication are almost immediate and I can tell when it wears off but how long does it linger in your blood stream? Days, weeks, months?
Thank you for your time,
Heather
July 15th, 2008 at 12:49 pm
Hello Dr. Handelman,
I am somebody who was diagonised with ADHD when I was four years old and that is when I started taking Riddlen. I took that for 8 years and I had the usually side effects loss of appitiete, sleeplessness, stomach craps which didn’t bother me too much. I then switched to Addrell which worked a lot better for two years. At 14 I stopped taking any medication all together because I felt different and got very fustrated that I couldn’t be all I could without aid for an outside source. That is when I hit puberity so I had the normal inscurities of a young teenager. Not a good combination.
When I stopped I felt fine physically I did gain a little bit of weight but that’s normal. Though I noticed I was always in a slump, you know I couldn’t achieve my potenial no matter how hard I tried and that was even more fustrating. I can make close to straight A’s but I was very close to a C average. Not good at all.
One month after my 17th brithday I went to a doctor and asked to go back on Adderal it has worked great. I will be 18 in one month to come. My grades are great my weight went down so I feel good about myself. I got in to National Honors Society best of all if I want to do something I know have to drive to do it.
Going on medication can be hard and even when your on it. I ask myself all the time am I the medicatied me or the unmedicatied me. It’s tough to watch other people do things so easily and think, ” It’s hard enough to do on meds but off it be close to impossible.” On the flip side though never let your ADD/ ADHD get in the way off doing what you want to. And never let it be an excuse for not doing something. It may make life harder and emtional upsetting but it’s an out. You just feel ten times better when you do achieve something that is difficult to you.
So aside for that little tid bit for those who are unsure. Dr. Handelman I do have a question for you. When they say the meds go quickly in the body as they do out of the body. How long do they normally mean. I know from taking Adderall the effects of the medication are almost immediate and I can tell when it wears off but how long does it linger in your blood stream? Days, weeks, months?
Thank you for your time,
Heather
August 7th, 2008 at 11:59 pm
Hello Dr. Handelman,
I had a question regarding dosage. I am currently taking 40mg of Ritalin in the morning, and then I take 20 mg when it is needed. I am prescribed to take two 20mg tablets in the morning and then take one 20mg tablet when needed later on in the day. Currently, I take about another 2 or 3 tablets ( 20mg at a time, and at different times) after and morning two 20mg tablets because I feel they are needed. I am a university student and am in the process of studying for final exams, which has been the reason for the increase in dosage because I feel it is needed. I feel the Ritalin wear off after 3 to 4 hours, so I take another one to help me continue to study. I have been taking Ritalin for a couple years now and I usually only take it during classes and studying. My doctor seems to think this is fine.
I was wondering if this is OK Would you suggest taking two 54 mg CONCERTA tablets.
Do you have any suggestions on what dosage I should take? Is what I am taking too much.
Thanks
August 11th, 2008 at 3:56 am
Dr. Handelman,
I am 32 year old male, started 18mg Concerta last month, and moved up to 36mg last week.. Fortunately inatte