Need medication adjustment help... | ADHD Information

Diane V is correct about the different delivery methods of methylphenidate being different for a person. And since you saw some positive effects with concerta, trying a different delivery form is a reasonable approach. If the doc does not want to work with you, ask the psychologist for another referral.

Another suggestion would be to discuss with the doc the low dose of concerta with guanfacine (Tenex) to augment. Check out the Tenex thread for more info on this med.

My 9yo son was diagnosed ADHD combined type in March and we decided to try a drug trial.  His ped. wanted to put him on 18mg Concerta for a week, and then go up to 36mg.  I wanted to give the 18mg a little longer, so my son stayed on it for a month.  We did see improvement, but decided to try the 27mg.  He became very irritable and "dark" on the 27, angry, just not himself, especially as he was coming off of it.  He has a great child psychologist who diagnosed him, and upon talking with her(pediatrician said she had never heard of his symptoms before) she suggested we could either give him a Ritalin boost in the afternoon or drop him back to 18mg.  Since summer was almost here we decided to drop to 18mg with the ped. ok.  But, we are finding that 18 is not enough, but 27 is too much.  He has otherwise tolerated Concerta very well, with the only side effect being decreased appetite, but we can deal with that.

Child psychologist recommended a psychiatrist to help get meds figured out.  We saw him on Wednesday.  He said that, typically, a child who has personality changes on one drug will likely have the same issue on another drug in that same class.  He suggested we try Adderall XR 20mg.  DS started it today and it was awful!  He had heart palpitations throughout the day, even nine hours after taking his dose.  His stomach was hurting all day, and he was out of it.  The palpitations made him feel like he couldn't get a good breath, so he was taking deep breaths.  I know that it takes awhile to get adjusted, but I am not giving it to him tomorrow.

What I want to do is call the psychiatrist and tell him that because DS tolerated Concerta well at the lower dose I would like to try to either add some Ritalin during the day, or try another drug such as Ritalin LA that has a different delivery system.   I would even try the patch.  I would like to try the drugs in this class before moving on to the amphetamine based drugs. 

Does anyone have any opinions or advice for me.  I need help to figure this out!

Thanks,
Heather
My daughter took 5 different meds in the methyphedinate family. She was not the same on all of them.  I couldnt believe the difference in her from Ritalin LA and Concerta. For one thing you cannot match dosing, so 20 mg of Ritalin LA and 18 mg of Concerta are not comparable. Also once you change the delivery system things just change. My point is yes I think trying another med in that family is a reasonable request. I personally would try another med before adding a booster during the day, it really sounds like Concerta is not for him. The advanatge to stimulants is you can know within a few days if soemthing is not right and can stop taking them right away.

heatherr1, 

i was on 54 mgs of concerta and it also made me dark, angry and irritable. the dr switched me to 20 mgs of adderall xr and all those side effects went away. since your son was only on 27 mgs of concerta, the jump to 20 mgs of adderall seems a little high to me. the best advise i can give u is start at the lowest dose possible when trying new meds and slowly increase if its not enuff. let us know how the ritalin la is working. 

Thanks for the responses.  I called the psychiatrist today and he wrote a new script for Ritalin LA 20mg, so we are going to give that a try.  I know that DS needs the meds, but I wish it was easier to figure out which one works!

Heather

we all do.

Keep us posted and dont give up!

Also watch his fluid intake during this time of year. The stimulants can act as a diuretic, increasing the posibility of dehydration during the summer. This can increase symptoms or side effects.some people do complain of nausea. If you can stick it out the sedating effect and nausea generally do pass.

Another question...

He took 10 mg this am and seemed very tired (said he was tired) but that could also be b/c I had to get him up early this am and we've slept in all summer! And, he had a hard time falling asleep last night.

BUT, on the way home from a different dr appt this morning, I had to pull over on the side of the road so he could throw up!!!  It was 4 hours after he took 10 mg of Adderall XR. I don't know if it's related or not.

Any experience with this?

I know every child/adult is different and reacts differently to meds, but what is a reasonable amount of time to wait before upping the dosage of Adderall XR? My 8 y.o.  son started 5 mgs of it last Tues and tomorrow will be day 9 and we have seen NO change at all. I'm calling the dr in the am to see if we can increase it...I assume we'll go to 10 mgs next..? What if that doesn't work? How soon should I call the dr again??  Any help/experience would be helpful...this is all brand new to us.

Ask the doctor when you talk to him how long. Personally I think you would know within a week if you were going to get symptom relief. 5 mgs is very small and I'm not surpised you aren't seeing effectiveness. It is the best route to take though to help avoid side effects. Ask if you can "check in" with the doctor in a week. This way you can also double your 5's and not pay for new prescription until you know if it'll work.

I am concerned that the psychiatrist started at 20 mg of Adderrall XR.  I've always heard that it's important to start at the lowest dose and work your way up.  This way, the body has time to adjust.  Espec. since you went with an entirely different drug, there's no way the Concerta dose was transferable to the Adderrall XR dose!  For my child, he's tried two different methylphenidates (Focalin XR and Metadate CD).  The dr. started him on the lowest dose of Metadate CD and we had to work our way up to a therapeutic dose.  The dr. figured we'd end up at 40 mg or 50 mg, but we still had to spend time at 10 mg, 20 mg, etc. to let his body adjust to this new delivery system.

I wouldn't necessarily say that Adderrall XR is the wrong med. for your child.  If the Ritalin LA doesn't work out, maybe try the Adderrall XR again, but start at the lowest dose and slowly work up.

Well, we went to the psychiatrist today and DS is going to try a 20mg Daytrana patch.  His teacher told us that she is seeing a difference in him after only 6 hrs of the medication, so we really need something that will last longer.  We decided not to do the booster with the Ritalin LA right now, but it will be next if the Daytrana doesn't work out.  I did like the Ritalin LA, DS seemed to tolerate it well.

Thanks!
Heather