Concerta questions..

Discussion in 'General Parenting' started by Kjs, Oct 9, 2007.

  1. Kjs

    Kjs Guest

    Ok. Went to psychiatrist today. He agreed to an evaluation. After reading the papers I brought in he talked about ADHD medication. Said it is something that is in your system only for the day.

    He said we could think about it. difficult child then said no. I want to try it. I don't want to feel this way at school anymore. difficult child did state he did not want adderall. Knows kids who sell it, snort it and kids who end up in hospitals because of it.

    He is on the way down with Lamictal. In 8 days will be completely off. Three years of Lamictal.

    Dr. recommended Concerta. Talked to difficult child regarding this. difficult child wants it. I was going to think about it, but difficult child's cry out for help with school made me decide to give it a try.

    I talked to psychiatrist about the side effects. He has to see a cardiologist..Concerta says not to take if you have heart problems. psychiatrist didn't seem worried about that. difficult child has a lot of anxiety, psychiatrist didn't seem worried about that. I read that Concerta slows growth. He is already the smallest kid in class, does this affect height as well as weight? Will it prevent him from growing?

    psychiatrist suggested we try it on the weekend so we know how it affects him before we send him off to school with a new medication and not knowing how he will tolerate it. He is starting with 37mg's for one week, then two capsules the second week. Then a return visit to psychiatrist.

    Those who have kids taking Concerta..Does it cause their heart to race? Does it slow their growth? We still have a few days before we give it a try so I would really like input. What about when you don't take it. psychiatrist said you don't need to take it on days off from school, vacation or in the summer. Can you just quit as he says or does that cause problems? When I read about it then it scares me. I am looking for some personal experience.
    He has his head full of wires for the 48hr EEG right now, then the end of the month he sees the Cardiologist. It worries me to start this medication before the cardiologist. But difficult child really was begging to try it because he doesn't like the way he feels at school.
  2. nlg319

    nlg319 New Member

    Please take what I say lightly, I'm not a doctor or a nurse, I can only tell you my experience and my understanding. difficult child#2 was on Concerta for a while then one day I got a call from the school nurse telling me that difficult child#2 was in the office complaining of a racing heart. She took his heart rate and it was quite elevated. She thought I should take him right to psychiatrist, which I did. psychiatrist wanted school nurse to track his heart rate off and on Concerta. We did this for 2 weeks. The results were not very significant but psychiatrist referred us to a cardiologist. Cardiologist did a complete workup and found nothing abnormal about difficult child#2's heart. difficult child#2 stayed on Concerta for just a short period of time after that and ended because it seemed to stop working effectively.

    My understanding is that all of these stimulants(Adderal,Concerta,Ritalin,Metadate) are all forms of ritalin which IS a stimulant so if you think about it,any stimulant, whether it be caffeine or a prescribed medication, WILL increase your heart rate.

    difficult child#2 has not had any more problems with racing heart. in my humble opinion, I would wait until he sees the cardiologist, especially with his history of anxiety. I feel bad since your difficult child really wants to try it and is able to have insight as to how he feels and wants to change it!
  3. OpenWindow

    OpenWindow Active Member

    My difficult child tried Concerta and didn't have any problems with a racing heart. It didn't do anything for him though.

    We've found some success with other forms of ritalin, though. With any form of ritalin, missing doses is fine. It's quick in and quick out of your system, and doesn't need to build up in your body to work like other forms of medications. There are no withdrawals either, because it's quick in/quick out.
  4. smallworld

    smallworld Moderator

    Eight days to wean off 150 mg Lamictal is very quick. I think you might want to research weaning more slowly from anticonvulsant/mood stabilizers. My understanding is that discontinuing too quickly can actually cause seizures.

    There is no 37 mg Concerta. The doses are 18 mg, 27 mg, 36 mg and 54 mg. Most psychiatrists recommend starting at 18 mg and working up if that dose is not effective. The dose that works is not at all correlated to weight or age. It depends upon how each individual reacts to it.

    My son was on Concerta for 1.5 years at ages 10 and 11. We discontinued it because his mood was becoming depressed. He trialed other stimulants and now is on Focalin XR for school days. We have always taken medication breaks on weekends, school vacations and over the summer. My son mainly has inattentive ADHD and needs stimulants to concentrate on schoolwork. So we don't bother using it when he isn't in school.

    Side effects for Concerta can include a racing heart, increased anxiety, decreased appetite and slow growth. My son was pretty thin while taking Concerta. He has short stature, but that is genetic rather than due to medications. He gained a lot of weight on mood medications so he is overweight at this point. Focalin XR affects his appetite at lunchtime, but he makes up for it in the morning before medications and when the medications wear off in the evening.

    Hope that helps.
  5. crazymama30

    crazymama30 Active Member

    My difficult child was on Concerta, and it did not cause his heart to race, did not do anything. Positive or negative. I believe that is always a risk with stims though
  6. neednewtechnique

    neednewtechnique New Member

    We did not have a good experience with Concerta, but that is because our difficult child is not fact, I think the Concerta is what finally made us realize that she was BIPOLAR and did not have adhd...

    As far as some of the side effects, as for growth goes, I know that pretty much any of the stims will cause that result, so it isn't a matter of which one you choose for that reason. Our difficult child is 13 now, and is already nearly 5 feet 6 inches tall and has taken Concerta or another stimulant for most of her life. She is VERY skinny (stims can cause loss of appetite and make you not want to eat as much), but never had any height growth problems.

    psychiatrist is right, though, about this medication not staying in your system. It is like tylenol, once its worn out itself, its done and does not leave any residual ANYTHING behind, so it is a fresh start every day.

    As for the racing heart, I don't really think our difficult child ever experienced this, but if your difficult child has heart problems, I would definitely contact his cardiologist and see what he things. It is likely that he will be okay with it, but it is VERY IMPORTANT that he know before your difficult child starts taking the medications, as it may be cause for additional monitoring on the cardiologist's part. If possible, try to sign a release for the two docs to communicate. You may get lucky if you have good doctors and they will communicate and try to coordinate their schedules so that when psychiatrist wants to increase dosages or something, then cardiologist can see your difficult child soon after to check for any affects to the heart. Some doctors are good about this kind of communication, others, are just NOT, so don't expect miracles, but it certainly can't hurt to try. :smile:

    I do think that starting out with the 36 mg is a very high place to start, maybe suggest to psychiatrist that with son's heart problems, you would be more comfortable starting with the 18 mg and see how things go from there. Besides, heart problems or NO heart problems, over-medicating a child is almost as bad as them being on the wrong medication or not being on any medication at all, sometimes even worse! Better safe than sorry. If you start at the bottom and work your way up, at least you will know what works and what doesn't.

    Good luck, beginning the search for the right drug can take time and lots of medication checks, but eventually you will get there and there will be something that will click with your child. Another thought is, they DO make a NON STIMULANT adhd medication now (Straterra), maybe with heart problems, this might be the better place to start?????
  7. branbran

    branbran New Member

    My daughter has been on and off Concerta for about 5 years. With regards to her ADHD it really does help, it slows her down, she is very calm, very quiet, however it really irritates her, she is very agitated when it is in her system. She loves this medication, I have been fighting with her for years to stop taking it and try another ADHD medication, but she is dead set on taking it. Until now, she was taken off of it a few days ago, hopefully we will be trying a new mood stabilizer soon. We'll see, if the dr ever calls me back. Anyway, she loves this medication because it really keeps her weight down. I tried one once I didn't eat anything the entire day, it really takes your appetite away. They should market this as a weight loss pill. lol She was also on Ritalin many years ago, that was actually her first medication ever, she then went to Adderal, neither worked to well for her. The main gripe I have with Concerta is that it puts my daughter in a bad mood, she gets very snippy and inpatient.

    Every medication affects each child differently. Good luck. :smile:
  8. neednewtechnique

    neednewtechnique New Member

    Yes, our difficult child's psychiatrist told me that Concerta is not a good choice for children with mood disorders (bipolar) because it CAN cause the irritability problems. Some children wtih mood disorders can even become violent on Concerta. Branbran raises a very good point that before you try a stimulant, especially concerta,in addition to speaking with the cardiologist, it would be a good idea for psychiatrist to rule out any possibility of a mood disorder, otherwise, you may be in for a total NIGHTMARE. This was the problem with our difficult child. Only, instead of co-existing adhd and bipolar, she just didn't have adhd, which I am sure made this side-effect worse, but I have heard horror stories about mood disordered kids taking Concerta....scary.
  9. smallworld

    smallworld Moderator

    Any stimulant, not just Concerta, can be a nightmare for kids with mood disorders. But other kids with mood disorders, particularly if they are stabilized on mood medications, do just fine on stimulants. It just depends on the individual child.
  10. susiestar

    susiestar Roll With It

    My son did not have any heart problems we knew about, but this was before the recommendation was there to see cardio befoer use.

    Concerta did not change my sons growth, he was on a fairly normal growth pattern for our family.

    Is your son bipolar? The general guidelines for treating bipolar and adhd callfor mood stabilzer first, then stimulant if it is still needed. I don't think topomax is a first line mood stabilizer, but you will want to double check that.

    Is there any possibility that what seems like adhd is really mania or mixed mood? I have seen a number of kids around here (kids with- same therapist or same school) who have NOT gotten the desired relief from stimulants because they needed mood stabilizersw. What the docs said was adhd, was actually mood problem When they were off stims and then on mood stabilizers, things improved. But it was trial and error, and a LONG time for 2 boys I know.

    Concerta, ritalin , adderall, allseem to be very short lived in the body. Out of the system quickly. As for not taking them on vacation, off school days, well, wouldyou let him go off of insulin just because they weren't having cake at school that day? in my humble opinion, if my kid needs the medications, he needs them every day. IF he doesn't, then he does not.

    Much of the growth studies I have seen indicate that when a child is taken off the medications (and sooner or later they all seem to need to be adjusted or whatever) they catch up to what is "normal" for them, given genetics, etc... Not sure if the papers I have seen this in are reporting studies that are properly done, might want to PM Sara about this. She really knows her stuff.

    We had pretty good result with concerta until he took it with zoloft. For some reason that was a totally explosive combo, resulted in huge increases in violence. But that is problem just my son.

    I would push for depakote or litium first. You may want to at least ask your doctor about them. The adults here who have bipolar have made comments in the past about antideppressants and toher medications making things worse, until they got moods stabilized. Explain to your sonthat concerta or other adhd medications may make things a whole lot worse.

    Hope this helps,

  11. smallworld

    smallworld Moderator

    In terms of using Concerta or other stimualants on school days only, I would say only that it depends what you are using the medications for. For my son, who has inattentive ADHD, he is fine using stimulants on school days only because he needs them to focus on schoolwork. He doesn't need or even want stimulants on non-school days (and he is old enough to have a say in medication decisions). And our psychiatrist said it is perfectly acceptable to use stimulants in this manner. In fact, there are some studies that say you prolong the effectiveness of the stimulant dose by periodically taking a break from them.
  12. mum2JK&TH

    mum2JK&TH New Member

    We have had great success with the Concerta. difficult child is on the 27mgs, 36mgs does seem awfully high to start him on especially if he's small. We haven't dealt with a racing heart but have had the moodiness after taking it for long periods of time. We took him off of it during the summer and I will probably do it during the xmas break this year too. difficult child is on the tall side but this is only his second year on medications continuously. His appetite isn't really suppressed but we don't tell him the side effects, and I think it does have something to do with it. There are times when he's not hungry but when he is hungry, we let him eat.

    At the end of the day it has done him good because he doesn't stand out at school anymore and he can continue with his hockey, so we get what we want with the school and he gets what he wants with the hockey.
  13. trinityroyal

    trinityroyal Well-Known Member

    My difficult child has been on Concerta for the last several years, and until recently it was working very well for him.

    As others have said, the doses are 18mg, 36mg, 54mg. difficult child's psychiatrist also said that you can add a final dose of 72mg by combining an 18mg and a 54mg tablet. That is the highest dose that any doctor is willing to give.

    difficult child has never had any issues with racing heart, nor has he had any height growth issues. He's had a couple of growth spurts while on Concerta, is 6 ft 4 (and still growing...yikes!) He is very thin, but his appetite is huge.

    As for taking your difficult child off medications on weekends and holidays, I would not recommend that at all. difficult child's behaviour deteriorates terribly when he doesn't get his medications. He has a rebound effect that makes him even more out of control than he would have been if there were no medications in the picture at all.

    One very important thing difficult child's psychiatrist said about Concerta, since it's slow release, and metabolizes quickly (gone from his system by end of day), it's very important to give the medication to him by the clock. If he takes it at 7 am today, then he takes it at 7 am every day, even on weekends. We usually see a significant deterioration in difficult child's behaviour if we deviate too much from that schedule. Even an hour or 2 makes a big difference, because the rebound effect has a chance to take hold.

    difficult child's medications have not kept up with his growth. We are in the process of re-evaluating everything, to figure out what will work best for him now. But we had great results with Concerta for about 5 years.

    Hope this helps,
  14. smallworld

    smallworld Moderator

    There is also a 27 mg dose.

    As I said before, it depends on the child and what you're using the medication for to determine whether it is a good idea to skip non-school days. We have no problem doing it this way, and neither does our psychiatrist.
  15. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    My son was on 18 mg for a little over a year. We did not have good results when he went from 18 to 27. But, that was my son. He did very well on the 18. He is now on 10 mg of adderall (and has had great success with adderall for the last four years).

    Here is what our experience has been. The concerta is a little longer acting so his appetite was affected greater by the concerta than it is with the adderall. With the adderall, he will eat some lunch and by the time he comes home from school, he is hungry. With the concerta, he ate very little during the day and wasn't hungry until 7 or so. He also had more trouble falling asleep with the concerta than with the adderall.

    Now, please remember that all our kids react differently to these stimulants. Our experience may not be yours, or the family next doors'.

    I will say that I suggest you speak with the doctor and go and get a script for the 18. You could start him on Sat and then keep him on it for a week and see if it makes a difference. I, as well as most here who have had kids on stims, would say it is better to start out at the minimum and go from there rather than start high and have potential issues.

    Good luck.

  16. MelissaH

    MelissaH New Member

    My 10 year old is on Concerta and has been for awhile now. We have had great success with it. As far as height, he has continued to grow and while it says that it suppresses appetite we have seen a little of this but nothing significant. We started on 18 then moved to 27 and are now at 36 and it is great. He has no withdrawal symptoms if he doesn't take it one day and it is usually worn off by the end of the day.

    On the days that he doesn't take it we see a huge difference in his attitude. He is very ADHD and ODD and the days he does take it you can actually have a conversation with him. He still gets ticked off and everything but he is easier to parent.
  17. Kjs

    Kjs Guest

    WEll, difficult child has been on Lamictal for anger issues for 3 years. Added in topomax(by neurologist) to prevent headaches.
    We do not see the anger we once saw. He is no longer angry.

    Ifyou saw my post about parent / teacher questionaire you would see how evey teacher rated him. psychiatrist brought out the lists of Adhd medication. difficult child refused adderall. but was real interested in concerta. I was quite hesitent and he told me to think about it. difficult child said NO,I am sick of getting in trouble at school. So we chose concerta. psychiatrist suggested startingon the weekend to see how does. Well, difficult child begged for it thismorning. So, I gave it to him. ONly 3 hours of school today. Talked to him after school. He was really excited. He said "I think that medicine DID help me He is taking 50mg's Lamictal for three days then Lamictal 25mgs for 4 days. Then we are done. psychiatrist didn't think this class of medication would intefere with Lamictal.
    MOst of the time when there is no school, we don't have a problem. He seems just fine. H had a half day of school today. Called me. He was excited to tell me he thinks the medicine must of helped. He did real good in class.
    Next week psychiatrist wans to have him take two of those pills.. Then fill our this same sheets again Then I can see if there is any impprovment thanks for all your expert advice.
  18. Sara PA

    Sara PA New Member

    How does your son not want to feel like at school anymore?

    Is the Topamax making him stupid? Could it be he can't focus or concentrate because of cognitive dulling caused by the Topamax?
  19. Kjs

    Kjs Guest

    difficult child said he doesn't want to feel like every class will be a fight. He said he knows everyday that when he gets to class they will kick him out. He says he feels bored. Says he can't sit that long, his back hurts. Said he wants to do better in school without the teachers always yelling at him or kicking him out.

    Topomax - Dr. said he is on a very low dose and this should not affect him that way.

    He is not stupid. He passes all the test with good grades, A's or B's. it is the daily work and homework that he just doesn't do. Teachers have even commented that at times he doesn't look like he is paying attention but when they call on him he knows the answer.

    As for the Concerta, psychiatrist said to give him one pill for a week, then increase to two pills for the second week and return to visit him. He is on 27mg's I believe. Maybe I will see how it goes and just keep him on one pill a day.

    Mood stabalizer - he has been on Lamictal for mood stabalizer for 3 years. He was never tested for anything. Dr. saw how he was when we were there, heard me talk of things that were going on. School counselor also attended the first meeting with me three years ago. He has since become much better. We do not see the anger we once did. Seems more to be frustration. Which then leads to more frustration between both difficult child and teacher. Teachers don't seem to want to deal with him. He doesn't understand something, he wants help..teachers won't take the time to help. Then he gets frustrated and says he's not doing it. Then teachers kick him out. in my opinion - if they would quit kicking him out maybe he would learn what he was suppose to do and wouldn't be frustrated. He understand the concepts as a whole, but doesn't understand how the daily assignments are to be done. If he doesn't do them the correct way, they hand them back. When he asks for help, they don't have time. Just a vicious circle.
  20. Sara PA

    Sara PA New Member

    The doctor is mistaken. Fifty mgs of Topamax can cause cognitive dulling. But your son's description of the problem doesn't sound like cognitive dulling.