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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by jakeo29 on December 14, 2008, at 13:50:11
Frustrated that Concerta 54 mg is still showing little response to improve wakefulness effectively, only once here (because I usually pretty strict that I take my medications as prescribed). I took two, which would be 108 mg. Now I feel the wakeful effects, not overly awake, wigged out, manic or speedy. Just feel how I should feel on Concerta. Awake, Normal, like a typical day should be. Should I report that to the doctor or is that way too much for Ritalin. I have no tolerance to it. We are talking about a situation here where at 108 mg extended release just to get it to work, rather than that taking that much because it wears off or anything. Is it unusual that it takes higher level doses just to get the medication to work. Because like with with Provigil, it does not even do much unless I take higher doses (even without tolerance) Again I do not want to seem like a junkie because I do not feel "high" just "Normal". Adderall is different, much lower doses do work, however that medication wears out very fast causing me the need to take more to get the therapeutic effect to last all day. I just had to see, again I really do usually stick to my meds as prescribed, but like with any other meds, they raise the dose until you feel a therapeutic effect. And of course I will talk to my doctor before I actually take more. So I will stick at 54 mg as prescribed. But the "d*mn" excessive day time sleepiness is so frustrating. I think my changes in mood and motivation at this moment are directly related to my level of wakefulness. I am also now taking my multi-vitamin and Omega-3's and my body seems more "regular" Am I way out of bounce on that Concerta dose if I ask my sleep doctor and psychiatrist? The concerta seems to only really be effective at this extended release dose, and I do not want to switch to amphetamines because they are more screwy to work with and give you unnecessary ups-and downs. Thanks-Jake.
Posted by jakeo29 on December 14, 2008, at 14:10:02
In reply to Concerta Dose, posted by jakeo29 on December 14, 2008, at 13:50:11
Found this online explaining why 54/mg /day of concerta is not really 54 mg of Ritalin, therefore since it seems to take a bit more Ritalin to even get a therapeutic response it would make sense that I am noticing a more even-keel response with trying 108 mg. And maybe I may not even need quite that much. Perhaps the doctor may go into the 90 /mg range. Any other experiences would be appreciated :) Thanks -Jake
""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 mgThe 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 dayHere is an example of how some people get into trouble:
Lets 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 wasnt 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 dayTo 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 tabletsWhats the bottom line ?
If you or your loved one was switched from another form of methylphenidate to Concerta, and it seemed that Concerta didnt 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 doctors appointment.
Concerta is a great preparation of methylphenidate, and can work very well.
Dont give up on it unless you are sure you have had the right dose.""
This is the end of the thread.
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