The max dose recommended (based on testing) for concerta is 2mg/kg body weight per day.
http://www.concerta.net/concerta/pages/hcp/dosing.jsp
Docs can prescribe outside the labeling of a medicine (this is the practice of medicine called off label use). Just prescribing a med that is approved for kids to an adult is off-label use for most ADHD meds.
It may be that the doc would rather try another med than to go above the max suggested dose. If it turns out that none of the meds are fully effective (but show some effectiveness without side effects) then the doc may go above the max suggested dose. Also, 72mg is the largest the make and the doc may be reluctant to prescribe more than one pill a day unless that is the only option. This should be discussed with the doc. Most docs are open about thier prefered plan of treatment and the posible treatment options.
I hope this helps.
Hi soberx,
Please read my post under "Tolerance to Stimulants." It talks about the issue of doctors using "standard" therapuetic doses to prescribe by. I am not a doctor, this is my lay opinion, but there are a subset of people with ADHD who do not respond to "standard" doses. Brain chemistry and metabolism is different with everyone. My son requires high dose Concerta. He has done beautifully on 162 mg for over a year. I know another parent of a child who has done well for years at 216 mg. You have to have a doctor who is a pharmacology expert managing your meds. They know doses and drug combos that work for the more complex ADHD cases.
Okiemom
I am also taking Effexor XR 150 mg/day..are you saying taking an antidepressent makes a stimulant less effective? I'm am upping to 36 mg. tomorrow AM.I forgot something else...if I don't do well on concerta, are other forms of the same drug still an option? (i.e. can focalin, ritalin, etc. work better for me than concerta even though it's the same drug?)Other forms of the same med can work differently for a person. It will depend on which delivery system is optimal for you. Also, focalin is only the dextromethylphenidate form so has less side effects for some people. You have options, so see what works and does not work with the concerta and then if you need to, try something else.I can see Concerta (r) not working if you are taking only 54.6 mg (correct me on the dose please) o.d. concomitantly with one or more antidepressants, which I have found through personal experience, to be very ineffective. Furthermore, if you do not respond to antidepressant(s) medication(s) i.e., it(they) made you more depressed (hence the new FDA warning regarding antidepressant use: see http://www.rxlist.com/cgi/generic/cymbalta.htm), then you will not 'experience' any therapeutic value from such a small dose.
I have never seen nor heard of Concerta (r) prescribed at doses exceeding 100mg+. Wow! This raises a question I have regarding what is considered the 'legal' maximum a physician can prescribe for a CII medication? Based on what I've read here in this particular thread, are you/your child, seeking medical help from a psychiatrist or a GP (i.e., family physician)? Depending on the specialty, reducing oral informaton down to a written RX using a specialized script (triplicates are no longer accepted by pharmacies, nor do physicians have access to them as such have been discontinued for security reasons) to be taken to the pharmacy where the medication is dispensed as written and filed, varies. In other words, GPs are more likely to (at least mine does) to prescribe only the maximum dose the pharmaceutical company recommends as opposed to some psychiatrists who will prescribe more than the recommended dose for that same medication.
For example, my last physician (I 'fired' and will never see another psychiatrist again after nearly 10 years of heartache; long story) prescribed 100mg of Adderall XR. Since this particular medication is now available in new strengths of 5mg, 10mg, 15mg, 20mg, 25mg, and 30mg in the extended release form, I found it rather odd that my psych. did not write the RX for 25mg q4h. I inquired as to why she did not write it out this way, and she responded that 'they', being the DEA, would have 'issues' with an RX written out as 25mg, q4h (i.e., 25mg 4 times a day in 4 hour intervals). Instead, she wrote the RX on 2 (two) different scripts. One script was Adderall XR, 30mg, tid, 2 caps PO/AM, 1 cap PO/NOON, and her second script was written Adderall, 10mg/PO/NOON.
Now, I did not find this logical because the 2 aforementioned dispensing 'methods' are synonomous. The DEA will still interpret this as her having prescribed 100mg. I have no clue on this one. But, I no longer take Adderall XR, esp. at a horrifying dose of 100mg, nor antidepressants. I now take Dexedrine (r) 15mg tid and 25mg of Vistaril bid prn for anxiety as prescribed by my GP.
I hope this helps other readers...
Okay, I increased to 36 mg. this morning but I still feel like I just drank a cup of coffee. The only difference is it lasts longer. I don't think my focus is any better. I have a big problem with reading , esp. what I'm not interested in, and I tried reading something just to test it out but it's the same. Caffeine doesn't help my focus--neither is this. My mind is racing even more-just like drinking coffee-and my heart is going a little faster but that's about it. I'm not getting side effects either, it's like I didn't even take it. The highest I can go is 72 mg. and I don't know if it's even working. Right now, I'm starving. My mind is racing, even though I think what would really help is if I had a med that calmed my mind down. That's why I can't sleep at night, my thoughts are too "hyperactive". I can't tell when it's wearing off, since there's nothing to wear off of. What usually happens when a med isn't working?Just keep plugging along...my daughter (26 years old) was started on Concerta, and felt no effects at 36mg either, but at 54, she does.
As vickie said, if concerta does not work, ritalin, ritalin LA, or one of the other ritalin based meds may very well do the trick. My son started on concerta, and when the effectiveness stopped after 9 months or so, we switched to ritalin LA, and he says it works better (for him) than concerta ever did.