Holden's Mom wrote:
I also find it interesting (Luv), that you said dosing has nothing to do with weight, because in all of the literature that accompanies these meds
Psychostimulant Medications
Medication does not cure AD/HD; when effective, it alleviates AD/HD symptoms during the time it is active. Thus it is not like an antibiotic that may cure a bacterial infection, but more like eyeglasses that help to improve vision only during the time the eyeglasses are actually worn. After reviewing the scientific evidence, the AMA reported that "pharmacotherapy, particularly stimulants, has been extensively studied. Medication alone generally provides significant short-term symptomatic and academic improvement" and "the risk-benefit ratio of stimulant treatment in AD/HD must be evaluated and monitored on an ongoing basis in each case, but in general is highly favorable."14
Common psychostimulant medications used in the treatment of AD/HD include methylphenidate (Ritalin, Concerta, Metadate, Focalin), mixed salts of a single-entity amphetamine product (Adderall, Adderall XR), and dextroamphetamine (Dexedrine, Dextrostat). Methylphenidate, amphetamine, and mixed salts of amphetamine are now available as both short- and long-acting preparations. Short-acting preparations generally last approximately 4 hours; long-acting preparations are more variable in duration - with some preparations lasting 6-8 hours, and newer preparations lasting 10-12 hours. Of course, there can be wide individual variation that cannot be predicted and will only become evident once the medication is tried.
The specific dose and timing of medication must be determined for each individual. However, there are no consistent relationships between height, age and clinical response to a medication. A medication trial is often used to determine the most beneficial dosage. The trial usually begins with a low dose that is gradually increased at 3-7 day intervals until clinical benefits are achieved. It is common for the dosage to be raised several times during the trial.
In addition, the individual is monitored both on and off the medication. For children, observations are collected from parents and teachers, even coaches and tutors, and parent and teacher rating scales are often used. In all cases, the appropriate dose must be tailored to the individual patient and monitored by the prescribing medical professional to make any needed adjustments
Thanks Logan's Mom. That's reassuring. I know quite a few moms around here that thought 20mg didn't sound like it was anywhere near a dangerous dosage for my son.I agree, seek a specialist. That's the only way to really know if a medication will work. If a doctor is too scared to experiment a little with the dose then you need to seek someone who is more comfortable with it. That's what it takes to get these meds right!
I don't know anything about what the correct dose for any other child should be but I can tell you that Adderall XR 20mg is what my son was on at 4 years old. I've also read about many kids on this board that are much younger than yours taking higher doses of Concerta. For what it's worth...
Welcome to the board Holden's Mom
ADHD stimulant medications flush out of the system not too long after effectiveness has worn off so the body does not build a tolerance. Stimulant med's are not blood level medications. However, around puberty time due to hormonal changes, the medication or dose may need to be changed. With the exception of which is a non stimulant and a blood level medication, stimulant medication dosing is not determined by weight. . The most effective dose for each patient is very individual and is determined by the metabolic rate of absorption.
The doctor is following protocol and the protocol is to start at the lowest dose and move up from there depending on the patients response in terms of effectiveness. The goal is maximum benefit, minimal side effects at the lowest dose possible. The only way to determine whether the med and dose is correct is by the individual response. Observe your son's response and keep an open dialogue with the doctor and your son's teachers. That's the only way to determine which med and dose fits your son best. Good luck
I understand that docs are following protocol, but I've read about kids taking much larger doses than my son was, and my doctor wouldn't go above 36mg for Concerta, or 20mg for Adderall XR. I'm just thinking that perhaps these medications would continue to be effective if we were allowed to increase the dosage. I guess maybe it's just time to see a psychiatrist instead of a family doctor. < id="gwProxy" ="">< ="jsCall();" id="jsProxy" ="">The correct dose for the individual equates with effectiveness, not continued increased doses. For some a lower dose of a med is more effective. I agree that its time for you to seek out a specialist in med management. A family MD is just not qualfied int terms of med managment for ADHD.
My son is 11 (almost 12) and has been taking different meds for ADHD for the past year. He was on Concerta first and at 27 mg it worked like a dream. Unfortunately he quickly built up a tolerance, and it was then increased to 36 mg. Although it still had some effect, it was never as helpful as those first few months, and our doc wouldn't bump his dose over 36mg.