Concerta: A Guide for ADHD Treatment Across Age Groups
Introduction:
Concerta is one of the longest-studied stimulants in the treatment of ADHD and has been noted for its tolerability among many of Dr. Danish's patients. Its flexible dosing options allow for tailored treatment plans that can adapt to the varying needs of individuals across different age groups. This adaptability, combined with its well-documented efficacy, makes Concerta a preferred choice for managing ADHD symptoms effectively.
What Percentage of Patients Benefit?
Approximately 70% to 80% of children and adults with ADHD respond positively to medications like Concerta. This medication has been used successfully and safely for over 25 years in treating ADHD.
Dosing Information:
Concerta is available in several strengths: 18 mg, 27 mg, 36 mg, and 54 mg. The starting dosage for children ages 6 to 12 years is typically 18 mg once daily, which may be increased based on the doctor's assessment.
For adolescents and adults, the dosage can start at 18 mg or 27 mg and may be increased to a maximum of 72 mg per day.
Best Time to Take Concerta:
Concerta should be taken once a day in the morning. This timing helps maintain its effectiveness throughout the day, aiding focus and behavior management from school or work hours through the evening.
It's important to not cut, chew or crush the tablets, as they are designed to release the medication slowly over time.
Do not take Concerta after lunch, as it will likely lead to insomnia.
Potential Side Effects:
Possible side effects can include decreased appetite, weight loss, dry mouth, headache, increased heart rate or blood pressure, difficulty sleeping, and irritability. Irritability can occur when the medication wears off in the afternoon in some cases. Some patients may also experience nausea or stomach upset but this is lessened by taking with food. This often improves after taking the medication for a week.
Less commonly, it can cause more serious side effects such as mood changes, aggression, circulation problems, heart rhythm changes (arrhythmias), or uncontrolled movements or vocal outbursts (tics).
If you or your immediate family members have a history of arrhythmias or heart attacks, please get an EKG before starting this or any other stimulant medication.
For a more comprehensive list of side effects, please visit this blog.
Potential Contraindications:
Concerta (and all stimulants) should be avoided in patients who have certain pre-existing heart conditions, including certain arrhythmias. If you or a first degree relative have a heart condition, please obtain clearance from a cardiologist prior to using stimulant medications which can worsen certain arrhythmias.
Concerta is not recommended for individuals with severe anxiety, tension, agitation, or those with a history of certain types of drug or alcohol dependency.
It should be avoided in individuals with glaucoma.
It may exacerbate motor tics, or bring on new tics in a patient with a family history of Tourette syndrome.
FDA Approval Information:
Concerta has been approved by the FDA for the treatment of ADHD in children aged 6 years and older, as well as adults up to the age of 65. This approval is based on extensive clinical trials demonstrating its efficacy and safety.
Off-Label Benefits Supported by Research:
While primarily used for ADHD, research has shown that stimulants like methylphenidate, the active ingredient in Concerta, may also help manage symptoms of other disorders such as anger/IED, DMDD, narcolepsy, OCD, and certain cases of depression, although these uses are considered off-label.
Wear-Off Irritability: What to do?
"Wear-off" irritability with Concerta occurs as the medication's effects diminish, typically leading to a resurgence of ADHD symptoms such as irritability and mood swings. This phenomenon, often referred to as a "medication rebound," can be particularly challenging in the late afternoon as the stimulant exits the system. It's crucial to communicate with your healthcare provider if you notice these symptoms persistently]. For more detailed strategies and understanding, please refer to Dr. Danish’s blog on rebound irritability from stimulants for ADHD.
