![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by nomom on March 28, 2005, at 16:10:44
My daughter just got put on Concerta, 18mg today. She sees her doctor in two weeks? I've been reading that the dosage for adolescents/adults is usually around 54 to 72 mg. Is her doctor going to increase this next time she sees him? It seems like such a small dose to me. Her cousin is 6 and takes the same dosage. Is it normal to start this low?
Posted by Phillipa on March 28, 2005, at 17:27:27
In reply to Concerta Dose (in adults) Question, posted by nomom on March 28, 2005, at 16:10:44
It's always better to start low in case of side effects. I would suspect that when your doctor reevaluates your daughter he/she will adjust the dose accordingly. Fondly, Phillipa
Posted by ixus on March 29, 2005, at 1:29:57
In reply to Concerta Dose (in adults) Question, posted by nomom on March 28, 2005, at 16:10:44
Yes,
that's right. Starting dose is 18mg (first week), max 72.
/ixus> My daughter just got put on Concerta, 18mg today. She sees her doctor in two weeks? I've been reading that the dosage for adolescents/adults is usually around 54 to 72 mg. Is her doctor going to increase this next time she sees him? It seems like such a small dose to me. Her cousin is 6 and takes the same dosage. Is it normal to start this low?
Posted by henryO on March 31, 2005, at 3:01:15
In reply to Re: Concerta Dose (in adults) Question » nomom, posted by ixus on March 29, 2005, at 1:29:57
What's it for? How old is she?
The best dose is the one that achieves the desired result with tolerable side effects. The patient is ultimately the one who decides about that. Speaking as an adult with ADD and depression, 72mg is a whopper of a dose. I have taken the 36's but prefer the 18's. 10mgs of regular Ritalin will crank you right up, all be it for around two hours. Concerta is spread out over eight to ten.
Don't let miligrams fool you. Nuerontin is taken in huge sounding doses and with other drugs .5mgs is quite potent. Mgs are not equivalent med to med like horse power.
Have you ever tried Concerta? It wares off in 8 hours pretty much. I believe every doctor should be required to take their own medicines for a while. Everybody has a unique reaction to any psychoactive med, but there are reactions common to certain percentage groups. Concerta is just Ritalin SR (slow release). It is speed. It really improves concentration for me. It has good anti depressant qualities too, largely limited to the duration of the med. I've always liked Ritalin but after 60 to 90 days its efficacy begins to deteriorate for me. If I lay off it for a few months and then start again it works as before. Because of this I mostly take it on an as needed basis. This makes some people nervous but over many years I have never abused it. In fact the opposite is true I probably avoid taking it on occasions when it would be advisable.
I think we all tend to take less or even none of these drugs. Noncompliance is a far bigger problem than over use in my experience. I fought the whole med thing for years but pointless emotional pain finally made me very flexible and open to whatever works. I take my Lamictal religiously. I also take Klonipin and Ritalin judiciously but when I do they work quite well. It took years of trial and error and pain, but for the past three years or more these meds have been doing an excelent job. Hooray for drugs. I would be miserable hermit without them.
Posted by nomom on March 31, 2005, at 9:57:18
In reply to Re: Concerta Dose (in adults) Question, posted by henryO on March 31, 2005, at 3:01:15
It's for ADHD, and she's 23, 110lbs. She's been taking it for about 4 days now, no real side effects other than a slight appetite loss but that seems to be getting better. She says she doesn't notice any real difference. We're all new to this, does it take a while to work?
> What's it for? How old is she?
>
> The best dose is the one that achieves the desired result with tolerable side effects. The patient is ultimately the one who decides about that. Speaking as an adult with ADD and depression, 72mg is a whopper of a dose. I have taken the 36's but prefer the 18's. 10mgs of regular Ritalin will crank you right up, all be it for around two hours. Concerta is spread out over eight to ten.
>
> Don't let miligrams fool you. Nuerontin is taken in huge sounding doses and with other drugs .5mgs is quite potent. Mgs are not equivalent med to med like horse power.
>
> Have you ever tried Concerta? It wares off in 8 hours pretty much. I believe every doctor should be required to take their own medicines for a while. Everybody has a unique reaction to any psychoactive med, but there are reactions common to certain percentage groups. Concerta is just Ritalin SR (slow release). It is speed. It really improves concentration for me. It has good anti depressant qualities too, largely limited to the duration of the med. I've always liked Ritalin but after 60 to 90 days its efficacy begins to deteriorate for me. If I lay off it for a few months and then start again it works as before. Because of this I mostly take it on an as needed basis. This makes some people nervous but over many years I have never abused it. In fact the opposite is true I probably avoid taking it on occasions when it would be advisable.
>
> I think we all tend to take less or even none of these drugs. Noncompliance is a far bigger problem than over use in my experience. I fought the whole med thing for years but pointless emotional pain finally made me very flexible and open to whatever works. I take my Lamictal religiously. I also take Klonipin and Ritalin judiciously but when I do they work quite well. It took years of trial and error and pain, but for the past three years or more these meds have been doing an excelent job. Hooray for drugs. I would be miserable hermit without them.
Posted by CareBear04 on March 31, 2005, at 13:09:44
In reply to Concerta Dose (in adults) Question, posted by nomom on March 28, 2005, at 16:10:44
hi-- i'm pretty similar to your daughter-- 22 and about 105 pounds. when i first took concerta, it was a switch from adderall, which i'd been on for awhile. maybe because my dr wasn't familiar with the weird dosing, i ended up on a really big dose-- 3 x 27mg = 81mg in the morning. then, i would take a dose of immediate release adderall later in the day. at the dose your daughter is on, i don't think i would feel a thing. it's not always true that small people need small doses; even when i was much skinnier, the pharmacist has asked me how i'm even awake on high doses of so many meds that would knock most people out. in your daughter's case, the pdoc is probably just starting out conservative, especially if this is her first stimulant. since they're addictive, there's no reason in giving someone more than they need. also, since they have street value, a person could always put aside the amount beyond what they need and sell it. or so think the cynical doctors. i would guess that your daughter will probably need more than the dose she's on. has it helped her at all?
Posted by theo on March 31, 2005, at 15:03:07
In reply to Re: Concerta Dose (in adults) Question » nomom, posted by CareBear04 on March 31, 2005, at 13:09:44
Need your input! I go to the doc tomorrow to discuss either an activating SSRI or a stimulant.
Why did you switch from Adderall to Concerta? My doc will probably suggest one of the two, Adderall or Concerta. Which one is smoother?
Posted by CareBear04 on March 31, 2005, at 16:22:02
In reply to Re: Concerta Dose (in adults) Question » CareBear04, posted by theo on March 31, 2005, at 15:03:07
hey theo,
i've had good experiences with both. i've been on all but one of the SSRIs, and my most recent is prozac, which is the most activating. i like it a lot, and it (or something coinciding with the timing of prozac) has taken me from what i thought was normal mood to what i now recognize as normal me. it's been a huge boost, and i wish i'd tried prozac earlier.i like both adderall xr and concerta. both are quite smooth since they're long-acting forms that come on and wear off slowly. for me, concerta is slightly smoother and lasts for a little longer. but i need a giant dose to get similar effects to considerably less adderall. adderall xr (not generic immediate release) packs a powerful punch for me, especially if i take it on an empty stomach and wait an hour before eating. studies say that concerta absorption is not dependent on food, whereas adderall absorption is slowed down. adderall also has stronger appetite-suppressing properties, though concerta has some, too.
overall, i prefer adderall to concerta, but i like to switch to concerta every month or two to let my tolerance recover. i usually take 40-50 mg a day of adderall. my current prescription is for a 20mg xr capsule twice a day. i take the second dose around noon or 1. before, i took a 30mg xr and then two doses of 10mg immediate release later. i like the current dosing better. on concerta, i took 81mg in the morning, then a later dose of regular adderall. adderall plus prozac is working great for me.
Posted by paulbwell on March 31, 2005, at 17:39:21
In reply to Re: Concerta Dose (in adults) Question » theo, posted by CareBear04 on March 31, 2005, at 16:22:02
Hi Care,
Do you remember I mentioned Magnesium ASPARTATE to you? and it's studies showing similar mood stability effects to Lithium.
Have you managed to get some?
tried it? 500-1000mg a day maybe up to 2000mgs.Remember ASPARTATE- form is the only form worth taking, and is very safe to take, it even helps Benzos work better too! and is a natural laxative! which may help with, (is it Percoset? you take) SE's
I hope it works for you, allowing you to lessen your medicine intake, allowing you to feel healther.
Let me know.
Posted by paulbwell on March 31, 2005, at 17:41:35
In reply to Re: Concerta Dose (in adults) Question, posted by paulbwell on March 31, 2005, at 17:39:21
Posted by CareBear04 on March 31, 2005, at 20:36:23
In reply to Re: Concerta Dose (in adults) Question, posted by paulbwell on March 31, 2005, at 17:39:21
thanks paul! no i haven't tried magnesium asparate yet, but i'll look for it the next time i got to a GNC or other health store. it would be nice to have those good effects and natural augmentation of other drugs. what exactly does magnesium do in the body? thanks again!
Posted by paulbwell on March 31, 2005, at 21:13:23
In reply to Re: Concerta Dose (in adults) Question » paulbwell, posted by CareBear04 on March 31, 2005, at 20:36:23
I'm no chemist, but type
"cold cure + magnesium" into google and you will see a great site. non commercial tooIt does potentiate my Valium and Other Benzos.
Anti-manic qualitiesCheers
Posted by theo on April 1, 2005, at 11:55:00
In reply to Re: Concerta Dose (in adults) Question, posted by henryO on March 31, 2005, at 3:01:15
My doc decided it's time for me to try a stimulant and started me with Concerta 18mg. If it doesn't work, he said then we would try Adderall XR.
I'm currently on no other meds, so this will be a true test. I'm a little nervous simply because I don't know what to expect. When should I take it, around 7:00am? Does it have any AD or mood lifting qualities?
My doc said he preferred Concerta, if it works for me, because it seems to not poop out at easy as Adderall in the long haul. Is this true?
Any input to reduce my nervousness in taking the first dose would be appreciated.
Posted by Ritch on April 1, 2005, at 13:11:51
In reply to Got Concerta prescribed today, 1st Stim trial, posted by theo on April 1, 2005, at 11:55:00
> My doc decided it's time for me to try a stimulant and started me with Concerta 18mg. If it doesn't work, he said then we would try Adderall XR.
>
> I'm currently on no other meds, so this will be a true test. I'm a little nervous simply because I don't know what to expect. When should I take it, around 7:00am? Does it have any AD or mood lifting qualities?
>
> My doc said he preferred Concerta, if it works for me, because it seems to not poop out at easy as Adderall in the long haul. Is this true?
>
> Any input to reduce my nervousness in taking the first dose would be appreciated.
Concerta definitely would be the smoothest route to taking methylphenidate. I've never read anything about relative merits of anti-poopout of mph vs. amps. I wouldn't worry too much about taking it-just see how you feel on the stuff.. is it making you too uptight? are you getting any tics from it? The immediate reactions are more important now.. stims don't have "start up" sidefx that fade away.. they just tend to stop working. As far as when to take it goes, I would just try it first thing in the AM when you get up.. then see if you crash too soon in the evenings from it. If so, then you can maybe take it a little later in the mornings. Hope this helps.
Posted by CareBear04 on April 1, 2005, at 14:25:30
In reply to Got Concerta prescribed today, 1st Stim trial, posted by theo on April 1, 2005, at 11:55:00
good luck, theo. everyone is different, so i can't say how you'll react. i don't take stims for mood, but i do feel brighter on them. concerta and adderall both poop out if you take them long enough. i would take it first thing in the morning, even before you get out of bed. the extended release stims take close to an hour to start working.
Posted by theo on April 2, 2005, at 8:06:22
In reply to Got Concerta prescribed today, 1st Stim trial, posted by theo on April 1, 2005, at 11:55:00
I went to pick up my fill from Walgreens and Blue Cross kicked it back saying they have to get reasons for me needing it, etc. from my doctor, could be up to 72 hours!!!
When I call my insurance company (Blue Cross/Blue Sheild) to expedite this, do I say I'm trying this to see if I'm ADD? What should I say to get them to approve it??
Posted by Ritch on April 2, 2005, at 10:44:51
In reply to Concerta insurance delay!!!, posted by theo on April 2, 2005, at 8:06:22
> I went to pick up my fill from Walgreens and Blue Cross kicked it back saying they have to get reasons for me needing it, etc. from my doctor, could be up to 72 hours!!!
>
> When I call my insurance company (Blue Cross/Blue Sheild) to expedite this, do I say I'm trying this to see if I'm ADD? What should I say to get them to approve it??
I would go ahead and pay out of pocket and let your doctor talk to them. If you call them and tell them you are trying to *see* if you are ADD or not, they probably won't buy that---they would want your doctor to formally diagnose you as ADD and then write the Rx. They may have to formally communicate with your pdoc to approve it-just procedures. When I tried Focalin--my pdoc wrote directly on the Rx the ADD diagnosis. I don't know if that was simply a C-II requirement, or whether it helped with the insurance or not, but they did pay. My current insurance, however, will *not* pay for it though. They will only cover generic methylphenidate. Your pdoc probably knows what to do, just hope that you can get Concerta covered, and you don't get stuck with immediate release methylphenidate.
Posted by theo on April 2, 2005, at 10:53:32
In reply to Re: Concerta insurance delay!!! » theo, posted by Ritch on April 2, 2005, at 10:44:51
I went ahead and paid out of pocket for 15 pills. I figured I'll know within a few days if this med is right for me, aren't the effects known quickly?
If it works, I'll just go get another slip from my doc. I am wondering though, do insurance companies only cover stims if the Rx is coming from a pdoc versus a regular doc? My regular doc is the one who prescribed it simply because my pdoc charges me $125.00 appointment just to come pick up a prescription and I can pay a $10.00 copay at my regular doctor.
Posted by CareBear04 on April 2, 2005, at 13:30:28
In reply to Re: Concerta insurance delay!!! » Ritch, posted by theo on April 2, 2005, at 10:53:32
eek! i had no idea things could be so complicated. i've had many many C-II controlled substances, and my doctors have never so much as had to make a diagnosis to justify the prescription. my health plan for the last two years has been an preferred providor organization, so insurance covers most providers and most needs. before that, i was part of an HMO, and i don't know if they're more strict about getting doctors to justify the need for drugs. i'd be interested to hear of peoples' experiences. the two insurance companies i've been with recently that i think are national are aetna and beechstreet. i haven't had problems getting drugs with either.
Posted by Ritch on April 2, 2005, at 21:57:48
In reply to Re: Concerta insurance delay!!! » Ritch, posted by theo on April 2, 2005, at 10:53:32
> I went ahead and paid out of pocket for 15 pills. I figured I'll know within a few days if this med is right for me, aren't the effects known quickly?
>
> If it works, I'll just go get another slip from my doc. I am wondering though, do insurance companies only cover stims if the Rx is coming from a pdoc versus a regular doc? My regular doc is the one who prescribed it simply because my pdoc charges me $125.00 appointment just to come pick up a prescription and I can pay a $10.00 copay at my regular doctor.I *think* ANY *covered* doctor who writes for the stimulant with a diagnosis of ADD would be covered by the insurance co. on the prescription... but you are *still* going to be at the mercy of your particular insurance company's formulary. If they don't cover fancy expensive stims like Concerta and Adderall XR (i.e.), and will only pay for generic dextroamphetamine or methylphenidate than you are stuck I'm afraid...
Posted by alohashirt on April 2, 2005, at 22:09:50
In reply to Re: Concerta insurance delay!!! » theo, posted by Ritch on April 2, 2005, at 21:57:48
It sucks.
Its taken two years working with my pdoc to titrate the ADHD
meds so they work as well as they do. Each change / tryout
of a new med, especially the extended release non-generic
(read expensive) meant that Oxford barfed and I had to either
pay our of pocket and claim back or get my doctor to FAX a
"prior authorization" to Oxford/Medco. This happened at least
six times. I've stopped taking it personally.1) Strattera
2) STrattera+ritalin (Oxford said Strattera shouldn't be combined)
3) Metadate CD
4) Concerta
5) bigger dose of Concerta
5) Adderall
6) Concerta + dexedrine
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.