Big Guy & Concerta | ADHD Information

New to the forum.  Was Diagnosed about 4 months ago and started on Concerta.  Started with the 26mg and was bumbed to 54mg after a month.  It worked great for about a month, but now it seems like the effects have slowly started to decrease. 

I am a pretty big guy (6'1" and about 260), and my Doctor had made a comment about my size and dosage when I first started taking it, but that was like 4 months ago....  Is it possible that my size is an issue with the declining effects of the medication?  And does size play a roll in the normal dosing recomendations?

 

 

 

Banker

When your effects decreased, how did that manifest itself? The reason I ask this is that many confuse the initial euphoric effect of stim meds with effectiveness. These euphoric side-effects go away but you should still receive a focus and attention benefit, especially if you were receiving one previously.

My opinion is that size is not a factor in declining effectiveness. However, initial dosing might be. Unfortunately, there are no real guidelines about height/weight based dosing, or even if h/w play a role. (Note: My weight is close to yours.)

The bottom-line is that when you find an effective dose, that should continue to be effective for you. There are a variety of factors which can influence the effectiveness such as stress, diet, sleep, etc.

MaxDad
There have been studies by researchers at Harvard showing that some adults require about  1.5 mg per kg per day. That means if someone ways 100 kg (220 lbs), the dose could be 150 mg of methylphenidate (ritalin or concerta) per day.

There were also recent ADHD Canadian practice guidelines which suggested that a maximum dose of Concerta for adults could be 108 mg per day. You can see the website at www.caddra.ca. Here is a direct link to a pdf report.

Note - this is info for doctors - so you will obviously need to discuss this with your own doctor before your treatment can be changed.

Click here, and look at page 10 in the pdf report.
Kenny

Excellent post.

If you have a link to the Harvard research please send that to me. What I've heard about it (secondhand from my doctor) is that they came up with "effective theraputic range" based on weight for the mainstream ADD meds. It was my understanding that they didn't go as far to include an absolute maximum because their findings were based on reviews of other studies versus a specific study.

If I recall the effective theraputic range range for Ritalin was something like .3mg - .8mg per kilo of body weight. Adderal was .3mg - 1.0mg per kilo of body weight. (Note: I may be off on these figures so please don't assume that these are correct.) Essentially this means that the daily dose that should be effective will fall into these ranges. I personally exceed the Adderall range but it's a dose level that works for me.

Thanks again for the post.

MaxDad

Thanks for the compliment.

Here is the study in adults - from 1995
This one uses 1.0 mg per kg per day of methylphenidate.
Sorry, I remembered incorrectly.

The major point here is that for many adults, having 1 mg/kg is higher than the recommended doses that most doctors will use.

Here is a more recent study, published in 2005

Warmly,
Kenny