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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 Lynne on March 14, 2006, at 23:03:05
Can anyone compare these two meds for me. I want to switch from Dexedrine to one of these. I had previously tried Ritalin LA and didn't like it. It put me to sleep. I tried Concerta a few years ago and I liked it. Can't remeber why I switched to Dex. Just curious about the Focalin XR.
Thanks,
Lynne
Posted by alohashirt on March 15, 2006, at 0:35:28
In reply to Focalin XR vs Concerta, posted by Lynne on March 14, 2006, at 23:03:05
I switched from Concerta to Focalin XR. Focalin XR is a litle shorter acting more "front loaded than Concerta. Feels "sharper", more similar to dexedrine effects even though its the active isomer of methylphenidate.Focalin XR has less of the "train tunnel thnking" and a smaller dose is needed. Focalin XR is a tier 3 med with Oxford
> Can anyone compare these two meds for me. I want to switch from Dexedrine to one of these. I had previously tried Ritalin LA and didn't like it. It put me to sleep. I tried Concerta a few years ago and I liked it. Can't remeber why I switched to Dex. Just curious about the Focalin XR.
>
> Thanks,
> Lynne
Posted by theo on March 15, 2006, at 7:48:37
In reply to Re: Focalin XR vs Concerta, posted by alohashirt on March 15, 2006, at 0:35:28
Focalin XR is a tier 3 med with Oxford
What does this mean?
Posted by Lynne on March 15, 2006, at 13:10:45
In reply to Re: Focalin XR vs Concerta, posted by alohashirt on March 15, 2006, at 0:35:28
Thanks Alohashirt. So it sounds like Focalin XR is more like DEX Spansules. The reason I don't like Dex is because it only lasts about five hours for me and then I want to sleep. Taking another dose keeps me awake at night.I want something smoother and able to last through the day.
Lynne
Posted by alohashirt on March 15, 2006, at 22:52:58
In reply to Re: Focalin XR vs Concerta » alohashirt, posted by theo on March 15, 2006, at 7:48:37
> Focalin XR is a tier 3 med with Oxford
>
> What does this mean?Insurers divide drugs into categories and pay copays accordingly
Tier 1 is generic or preferred, tier 2 expensive drugs, tier 3 expensive with a cheaper alternative.For me it means $35 copay cf $7, or $15 for tier one or tier 2 meds but each employer negotiates a different plan with different copays
Posted by alohashirt on March 15, 2006, at 22:58:39
In reply to Re: Focalin XR vs Concerta, posted by Lynne on March 15, 2006, at 13:10:45
Lynne,
Definitely similar to Spansules. Focalin XR is better for me because whilst the ADD symptoms are reduced for maybe an extra hour, the Focalin doesn't affect my sleep the same way
that dexedrine does. It also is more consistent in its effects
and doesn't raise my blood pressure.> Thanks Alohashirt. So it sounds like Focalin XR is more like DEX Spansules. The reason I don't like Dex is because it only lasts about five hours for me and then I want to sleep. Taking another dose keeps me awake at night.I want something smoother and able to last through the day.
>
> Lynne
Posted by Smeegle on March 19, 2006, at 0:16:01
In reply to Lynne: (Re: Focalin XR vs Concerta, posted by alohashirt on March 15, 2006, at 22:58:39
Unlike any other ADD med I have been on, Focalin got me through work and night school with just a single dose. Yep, a full 10-12 hour day. It usually wore off around 8pm. Didn't mess with my appetite or sleep and no jitters. I was pleased with Focalin. I have been on Adderall (SR and Reg), Ritalin, Concerta and Provigil.
Smeegs
Posted by Lynne on March 19, 2006, at 9:54:01
In reply to Re: Lynne: (Re: Focalin XR vs Concerta, posted by Smeegle on March 19, 2006, at 0:16:01
Thanks Smeegs, What dosage of Focalin Xr do you take? I have tried all the others just like you have. I have taken Focalin XR 10mg for two days now and I think I really like it. I just might need the dosage upped to 20 mg. I also need to add a AD to it and have hated everyone I've tried so far!
Thanks again,Lynne
Posted by alohashirt on March 22, 2006, at 23:13:01
In reply to Re: Lynne: (Re: Focalin XR vs Concerta, posted by Lynne on March 19, 2006, at 9:54:01
Lynne,I take 40mg at 7.00am and 10-20mg at 12.00 noon.
> Thanks Smeegs, What dosage of Focalin Xr do you take? I have tried all the others just like you have. I have taken Focalin XR 10mg for two days now and I think I really like it. I just might need the dosage upped to 20 mg. I also need to add a AD to it and have hated everyone I've tried so far!
>
> Thanks again,Lynne
Posted by motherof2plustwins on April 9, 2006, at 2:03:50
In reply to Re: Lynne: (Re: Focalin XR vs Concerta, posted by Lynne on March 19, 2006, at 9:54:01
I was curious about your choice of meds. I have a nine year old daughter that takes 57mgs of Concerta a day. Some days we have to supplement 10 mg of Ritalin for afterschool...homework and drum lessons. It helps her go to school and function quite well. Her affect is rather flat most days, though. It is hard to watch the change. I had thought about taking her out of school before we started meds, because she was so far behind and was extremely anxious about school. So...She has been on Concerta now for 3 years and every time she gains a little weight the medicine quits working. Her doctor told me that most kids don't respond like that, but a few do and she is one of them. So we have raised her meds to the highest Concerta has...as a matter of fact they didn't have the 57 mg when she first started taking it.
My question on here is whether or not Focalin has affected anyone the same as what I described above. Flat affect. She is active, but shows hardly any emotion about her daily life or surprises. I ran out of her concerta last week and used a Focalin from a friend (never have done that before, but they are testing here and was worried about my daughter's anxiety levels...I don't care about the test). Madelaine, my daughter, came to me later that night really happy and excited. She told me that whatever medicine I had given her was awesome. She said that she was happy and could concentrate at the same time. I asked her to give me a little more information and she said that she had been happy, a little more active and had been a little goofy, but it was okay because she could still concentrate. I think it is sad that she found it so strange to be able to be happy and focus at the same time.
I have talked with her doctor about her meds, because I was scared that when this Concerta completely quits working, we won't have an option. Now I feel better, but haven't found too much positive information about Focalin.
She has overcome the upset stomachs and never being hungry...completely outgrew them---will that start all over again?
I am sorry....I hope someone will take the time to read this entire message and respond. I have so many questions.
Char
Posted by SLS on April 9, 2006, at 7:13:34
In reply to Re: Lynne: (Re: Focalin XR vs Concerta » Lynne, posted by motherof2plustwins on April 9, 2006, at 2:03:50
Hi Char.
I don't have any personal experiences to share, but I thought you might want to know (if you don't already) that Concerta and Focalin are related drugs. Concerta is methylphenadate, the same ingredient that is contained in Ritalin. It differs from Ritalin in how the pill is absorbed into the blood stream once it is swallowed. It is formulated in such a way as to be absorbed more gradually - it is an extended-release version of Ritalin. The methylphenadate molecule comes in two forms. Ritalin and Concerta contain both. Focalin, on the other hand, contains only one form of the molecule - the one that does the good work. It leaves out the form that might be producing the flat affect for your child. I really don't know for sure if this is the cause and effect that you are seeing, but that would be my first guess.
Hopefully, someone with more knowledge and experience will comment further.
- Scott
Posted by ADHDdoc on April 10, 2006, at 19:13:49
In reply to Re: Lynne: (Re: Focalin XR vs Concerta » Lynne, posted by motherof2plustwins on April 9, 2006, at 2:03:50
I am a physician; I treat only children with ADHD, and know a fair amount about all the medications that you and others have discussed. Let me add just a few thoughts to what has been said already:
1. ADHD is a CHRONIC condition. Your daughter may have to take some sort of medication to treat her ADHD for at least the duration of her schooling, and she may choose to continue to take medication throughout her adult life, since the impairment from ADHD may be lifelong. Therefore, I think you SHOULDN'T settle for treatment with a medication that causes anything more than mildly inconvenient side-effects! Flattening of the personality on stimulants is not uncommon, but I think it is an unacceptable side-effect for most (kids sometimes describe this as "not feeling like myself," or noticing that they're "not as funny" as they used to be). Marked personality flattening is a GOOD reason, I think, to pursue a clinical trial of another medication (and more than one, if needed) - until you find one that doesn't change your daughter's personality.
2. It's fine to compare notes with others about which medications and doses they take. However, you should be aware that what works for them will give you very little help in predicting what will work for you (especially if you're not genetically-related to one another)! Here are only four of the many reasons why this may be true:
a. It turns out that about a third of ADHD patients do much better on a methylphenidate-based medication (e. g., Concerta, Focalin-XR, Ritalin-LA, etc.), while another one-third do much better on an amphetamine-based medication (e. g., Adderall-XR). And, the final third seem to do EQUALLY well on EITHER amphetamine or methylphenidate! The same variability is true about dosage. I have some patients who do well on 36 mg. of Concerta each morning, and others of the same age and size who require 72 or 108 mg. of the same medication to get an optimal effect. There are small genetic differences in how people metabolize these medication, and these can make your response to a treatment quite different from someone else's. So, please feel comfortable doing what works best for you/your daughter, even if someone else reports that they had a horrible reaction to the exact same treatment. That just isn't going to tell you much about what will work for you.
b. About 70 % of children with ADHD also have one or more additional neurodevelopmental or psychiatric problem (such as an anxiety or mood disorder, or Tourette's Disorder, for example). These additional conditions, sometimes called "comorbidity," also may affect how well certain medications are tolerated or what side-effects are experienced. Someone who tells you that their child also has ADHD may not mention that she has an anxiety disorder, also.
c. You can't know whether someone else's doctor is up-to-date on the best treatments for ADHD. So, even if someone else's medication or dosage is different from yours, it doesn't mean that what you take isn't right for you (maybe what THEY'RE taking isn't so great). Just make sure that the physician that YOU are consulting knows about the latest treatments and how to use them optimally.
d. Most lay people can tell you what has worked best for themselves (or their loved ones), but you need to have experience with dozens, or hundreds (you know, A LOT) of patients with ADHD before you can get much perspective on how well certain treatments really work. You may know two people who didn't do well on a certain medication, but that doesn't tell you much about how well it will work for a third person. So don't pay attention to generalizations based on one or a handful of experiences.3. Always try to use sustained-release stimulants, if you can. They work more smoothly, for many people, and they often cause FEWER side-effects than several doses of short-acting stimulants. Some stimulant side-effects are worsened because of the higher peak levels that short-acting medicines can sometimes reach, and some side-effects actually relate to the medication wearing off! So, if your medicine wears off 3 or 4 times a day, there is a much greater chance that you will experience uneven coverage and/or more side-effects. Grouchiness or tearfulness when short-acting medication wears off is a good example. In the 1980s and 1990s, I used to see that side effect quite often, just as children were getting home from school, and their 11 am-Noon dose of short-acting stimulant was just wearing off. Since about 2000, when Concerta became available, the treatment of ADHD has been dramatically different (and better, happily). If you haven't tried a new treatment since 2000, you should. We have many more options, and can tailor your treatment to meet your specific needs. I have had a total of only ONE patient since 2000 whose parents noted grouchiness as their son's medication wore off! So, to apply this advice to your situation, if your daughter is going to try Focalin, I'd recommend Focalin-XR, the long-acting version.
4. Although stimulants seem to be the most effective class of medications for treating ADHD, there are some non-stimulants that work well for people who can't tolerate full doses of stimulants. Sometimes, you can take a non-stimulant with a low dose of stimulants, and get an adequate therapeutic effect with fewer side-effects than you had on a full dose of stimulants. The trick is NOT to settle for a treatment that makes you miserable because of unacceptable side-effects, unless you have tried EVERY option available. And these days, there are MANY options, and more are becoming available each year! (For example, the methylphenidate skin patch, Daytrana, is a new product that was approved by the FDA only 4 days ago. It may be helpful fior some children who have problems swallowing pills.)
5. Be sure that your doctor is knowledgeable and comfortable with the many available treatments for ADHD. If the first thing you try doesn't work, and your doctor doesn't know what else to do, try to see a psychopharmacology specialist who is familiar with ALL of the available medical treatments. Be wary of doctors who believe that Concerta always is "better" than Adderall-XR, or vice-versa. They are both excellent medications, for the right patients. However, if your doctor doesn't use both medications a lot, he/she may not be familiar with how to use them best! If you are getting frustrated, ask for a referral to a psychopharmacology specialist.
Good luck!
Posted by SLS on April 10, 2006, at 21:18:05
In reply to Re: Lynne: (Re: Focalin XR vs Concerta » motherof2plustwins, posted by ADHDdoc on April 10, 2006, at 19:13:49
Hi.
What place do you feel Strattera has in the treatment of pediatric ADD versus adult ADD?
Thanks.
- Scott
Posted by alohashirt on April 10, 2006, at 22:09:10
In reply to Re: Lynne: (Re: Focalin XR vs Concerta » Lynne, posted by motherof2plustwins on April 9, 2006, at 2:03:50
MotherOfTwo,
I agree with ADHD Doctor - you should see an ADHD specialist that you trust.
I'm an adult with ADHD - and meds are less effective than for kids.
I see a psychiatrist who specializes in ADHD. I've tried Strattera, Ritalin, Focalin, Focalin XR, Metadate CD, Concerta, Dexedrine, Adderall XR, Adderall. I personallly get subdued affect with Concerta that feels like a "flatness." Focalin IR made me moody, Focalin XR was a sharper version of Concerta, probably the best, consistent medication.Good luck - get a doctor you can trust, then trust him or her and let them know you are willing to try out different choices.
Posted by SLS on April 11, 2006, at 6:22:21
In reply to MotherOfTwo ( Re: Focalin XR vs Concerta, posted by alohashirt on April 10, 2006, at 22:09:10
Have you ever tried a tricyclic antidepressant like imipramine or desipramine?
- Scott
Posted by ADHDdoc on April 12, 2006, at 11:15:42
In reply to Re: Lynne: (Re: Focalin XR vs Concerta » ADHDdoc, posted by SLS on April 10, 2006, at 21:18:05
> Hi.
>
> What place do you feel Strattera has in the treatment of pediatric ADD versus adult ADD?
>
> Thanks.
>
>
> - Scott
Strattera (atomoxetine) seems to be a good choice for those who need a non-stimulant. It doesn't seem to be quite as effective as the stimulants for treating ADHD. Therefore, most of the time, in a typical new patient who never has tried any medical treatment for their ADHD, I'd probably recommend a stimulant first, unless I had a good reason to do otherwise. The effect size in at least one of the adult double-blind studies was disappointingly low, but there are some methodological reasons why this alone may not tell the entire story. I certainly know of many physicians who treat both adults and children with Strattera.For those of us who have been treating patients with ADHD for a while, it certainly is nice to have Strattera as one of the options available as an alternative to patients who can't/shouldn't/don't wish to take stimulants. Prior to the arrival of Strattera, which has a pretty safe profile of common side-effects, our best non-stimulant option were ("off label," or non-FDA-approved) the tricyclic antidepressants. They have a much less favorable record of safety, particularly regarding cardiovascular problems, and they required periodic blood tests and EKGs for long-term monitoring.
I also have had some modest success using a combination of Strattera and a less-than-therapeutic dose of a stimulant, for those whose optimal response to stimulants occurs at a dose that also gives them too many side-effects.
So, I'm very glad that Strattera is available, but I use it selectively. I'd keep an open mind. Hope this helps.
Posted by ed_uk on April 12, 2006, at 12:55:09
In reply to Re: MotherOfTwo ( Re: Focalin XR vs Concerta » alohashirt, posted by SLS on April 11, 2006, at 6:22:21
Hi Scott
Due to the concerns RE side effects of desipramine in children, I imagine it's used mainly in adults.
Ed
Posted by alohashirt on April 12, 2006, at 20:36:48
In reply to Re: MotherOfTwo ( Re: Focalin XR vs Concerta » alohashirt, posted by SLS on April 11, 2006, at 6:22:21
My doc reckoned that Strattera is superior to desipramine. Strattera had a slight positive effect for me but also left me feeling sad. John Ratey has an interesting six year old paper on his site that reviews ADHD meds and he is very positive about desipramine in small doses.I'd be inetersted in trying it at sometime. When I was in Europe I tried Adrafinil. I've also tried alternative supplements (picamilon, ginko, magnesium, zinc, fish oil, hydergine, huperzine, vipocitine, piracetam, vitamins, 5-HTP, SAMe, Galantamine, acetyl-l-carnitine ...) The fish oil is the only oner I have stuck with.
Coaching and exercise help me as much as medication.
> Have you ever tried a tricyclic antidepressant like imipramine or desipramine?
>
>
> - Scott
Posted by theo on April 15, 2006, at 14:01:30
In reply to Re: MotherOfTwo ( Re: Focalin XR vs Concerta, posted by alohashirt on April 12, 2006, at 20:36:48
What was your experience like with piracetam?
Posted by alohashirt on April 15, 2006, at 19:59:08
In reply to Re: MotherOfTwo ( Re: Focalin XR vs Concerta » alohashirt, posted by theo on April 15, 2006, at 14:01:30
> What was your experience like with piracetam?
I didn't observe an effect. Note that at the time I was already taking 72mg Concerta and 50mg Strattera. I actually tried a couple of the racetams
Posted by Sarah T. on April 16, 2006, at 6:43:57
In reply to Re: Lynne: (Re: Focalin XR vs Concerta » motherof2plustwins, posted by ADHDdoc on April 10, 2006, at 19:13:49
Thanks very much for taking the time to help us. You sound like a terrific doctor. Are you sure you don't want to treat adults?
This is the end of the thread.
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