I have a Ritalin Question for all of you experts

[StressedM0mma]

So, difficult child had a psychiatrist appointment. on Thursday, and difficult child explained how the Concerta was wearing off around 1:30 or 2. And how she was having a hard time getting H.W. done in the evening. So, psychiatrist added 5mg of ritalin in the morning, and 10mg of it at 3. difficult child said she doesn't like the way it makes her feel when it wears off. She said it makes her feel "icky". Is this something that is a side effect that will go away, or is this just what happens when it wears off? She doesn't have that feeling when the Concerta wears off.

The Ritalin seems to help, but she can't eat. She said that her head told she was hungry, but her stomach doesn't want food. Will she become more "tolerant" of the Ritalin, or should I just ask for a Concerta increase instead? Would an increase in Concerta make it last longer?

Any suggestions on what might help?

 

[Dixies_fire]

From my understanding Ritalin is legal speed. It makes sense for her to say it makes her feel icky when it is wearing off. Ritalin, aderall anything that gives a big rush is legal speed. I don't know of the concerta is or not. Over time she should get used to the Ritalin as long as it is taken at the correct time every day no misses and no forgetting. With the 10mg at 3 I am surprised she can sleep, taking it that late in the afternoon may cause problems and they may need to play with that dosage or do away with it all together. Also surprised they aren't doing 10mg in the morning and trying the 5 later in the afternoon that seems to make more sense to me but I'm not a doctor.

 

[buddy]

She could do a lower dose of Ritalin in the pm .

Q has taken a second and smaller concerta dose six hours after taking the early morning dose so while the first dose was ramping down, the second was going up, then that smaller dose wore of slowly. Concerta has never caused him eating issues though. Lately, we do the ritalin but he gets two doses, and it is cut in half for the second dose.

It is well known that ritalin has a rebound effect so it makes sense what she says. It actually seems good that she can tell you.

 

[DammitJanet]

I hate that term "legal speed" because ritalin is not amphetamine. That is speed. Ritalin works on a different transmitter in the brain than plain amphetamine and in ADHD kids it works the way it is supposed to work. In a person who doesnt have ADHD, they would have no effect unless they took a great deal of it. I was pharmacy tech years ago and we were taught about the stimulants back then. You would actually have to study quite a bit on neuropsychopharmocology to really get into the details but it is interesting. Cory went to see a doctor whose specialty was in that once and we had a fascinating talk.

 

[Dixies_fire]

Well one thing I have seen first hand even and especially for people who are diagnosed ADHD if you don't take it regularly and play around with it, it's just a stimulant, and it does produce a crash, like amphetamines. I'm sorry if my word choice was offensive.

 

[buddy]

Not our experience....day one my son responded positively and it was beneficial. Not taking it regularly in one day. I got a call from his teachers, he sat with the other kids and listened to a story, he was always just walking around the room and digging in toys before that. We vary if he takes it at night depending on activities.

The short acting form lasts in general for four hours. My son has rebound if we wait that long so at three and a half hours he gets the next dose since it takes thirty minutes to kick in for him.

It certainly can be abused, even by kids with adhd, happens all the time. They take too much and can get high. They sell to kids without adhd, who take varying amounts to get high.

Ritalin does not contain amphetamine. Adderal does. They are all psychostimulants. Their method of action is different in the brain but all can be abused. In some people they can be very therapeutic and helpful. In others, terrible, even if they have adhd. If their addictive challenges are too much, so they can't use the medicine, then they have to find alternatives.

For some it works, for some it doesn't, for some it does but the side effects are intolerable.

Everyone is different.

 

[InsaneCdn]

OK, we're a methylphenidate family... we've been on generic-short-acting, brand-name Ritalin, and Concerta.

ALL of them have similar appetite-suppression effects.
So, I'm surprised she doesn't think the Concerta does...

Ritalin loses significant effect in 3.5 to 4 hours. This means that if she is taking it at 3... it DEFINITELY affects supper. When the kids were on straight Ritalin, their second dose was lunch, and it was worn off before supper. I take my second dose WITH supper - maybe I should start taking it an hour before, just to get the appetite suppression effect!?!? What time does she shut down at night? Would it work for her to do homework after supper? Another option is to take quick-acting Ritalin for her early-morning dose, and delay taking the Concerta until 30-60 minutes before school starts (depending on how long it takes for HER to get therapeutic effect)... and maybe gain a bit of evening time?

 

[StressedM0mma]

Thanks guys. I think the Ritalin is just not the right drug of choice for her. She just keeps talking about how "icky" she feels, and how completely exhausted it makes her feel. (After hearing what you guys have said I am guessing that is the crash) I think I am going to call the psychiatrist and tell her this is a no for difficult child. difficult child actually said she doesn't want to take it, and she is the one that is very compliant with her medications.

So, my main question is about the Concerta then. Would a higher dose last longer, or could she take a small dose of it at 3 when she gets home and still be able to sleep? (And eat) The only reason we are not having "food issues" is that she is making up her lost calories in the evening after the concerta wears off.

 

[InsaneCdn]

Yes an overlapping dose of Concerta would affect both appetite and sleep.
She's taking her current dose at what, 7? 6:30... so she's getting about the normal 8 hours of effective dose.

Perhaps she needs a different booster... like strattera. Yes, you can be on both. Our psychiatrist says that strattera alone usually isn't effective, but it can be paired with methylphenidate and/or other stims (it's a non-stimulant). Strattera is a build-up medication, but once it kicks in, it provides a 24/7 baseline. And it doesn't seem to affect appetite.

 

[buddy]

Quin did do another dose for years, BUT, they timed it for when dose one starts to reduce....at about six hours, so he took the 2nd dose at school, plus it was a small dose comparatively speaking. He took it at one o'clock. So it was worn down by nine for him. As I said, for him, it didn't affect hunger....he eats better because he can sit down and attend to the meal, lol. He also can take even ritalin, and fall asleep, so he is not typical that way.

But one day..like a Friday...of trying a low dose Concerta six hours after the first dose could be something to try...(the psychiatrist who did that worked at mayo on research about bioavailabiliy etc....it all made sense at the time and it worked)

Just increasing it will not extend the time it is effective as I understand it. The medication is more equal in how it is in the blood than taking short acting ritalin ....but it is not totally even....it is only 30% ish at the beginning and end....there are other long acting forms like a patch and others...so you can ask about that too.

 

[StressedM0mma]

Thanks Buddy. That is what I thought. difficult child is positive she does not want to take the Concerta either. I would like to see her on it, but I am putting this in a C basket. I figure if she quits taking it, maybe she can see the difference and realize how helpful it has been. I didn't give it to her this morning, and we are having more of a battle than usual. So, we will see.