senco-forum Concerta medication

> Concerta is a sustained-release pill. The dose most suitable is

David, I have been following this thread with great interest and I apologise
in advance if you have already covered this point and I have missed it.  We
have a boy in year 7 who has recently, in the last two weeks, changed from
conventional Ritalin to Concerta.  He is on the nearest dosage, 18mgs daily,
but there has been a marked deterioration in his behaviour.  Have I
understood that the medication will take some time to embed, or is it that
his behaviour should show signs of, if not improvement, then stabilisation,
throughout the course of one day?  I would appreciate your help in this as
you do explain thongs to the lay-man!

Thanks and best wishes

Ang
----- Original Message -----
From: David Bowles <dbowles at educationsupport.fsnet.co.uk>
To: <senco-forum at ngfl.gov.uk>
Sent: Monday, November 04, 2002 11:06 PM
Subject: Re: senco-forum Concerta medication

> > Concerta is a sustained-release pill. The dose most suitable is
> > the one nearest to their original daily TOTAL.
>
> In theory yes, but in practice the dosing regime of Concerta may still
> need re-titrating.  This is because the slow-release mechanism of
> Concerta is different from the 'release it all in one go' regime of
> conventional Ritalin.
>
> This requirement for re-titration was especially applicable to the
> original 'Ritalin SR' (the slow release version available for many
> years in the US).  However I've been told by many parents they find
> the  dose sizing of 'Concerta' seems to be less critical than for
> either 'Ritalin SR' or 'regular Ritalin'.
>
> Why is the dosing of Concerta less critical?  Probably this is
> because of the manner in which methylphenidate is released by this
> particular medication.  Methylphenidate is the active ingredient
> within Ritalin (both SR and regular) and Concerta as well.  Now with
> Concerta the release profile more closely resembles conventional
> Ritalin - when compared with the old SR version.  This is because
> Concerta tablets contain both ordinary Ritalin (which gets released
> immediately) plus also Ritalin that's bound up in a new more effective
> slow-release mechanism.  With Ritalin SR it takes longer for the
> methylphenidate release to build up to an optimal therapeutic level
> within the child's system.
>
> Original Ritalin tablets are also scored, which makes them easy cut or
> break in half for the purpose of creating smaller increments in
> the dose size. Conventional Ritalin is also available in a liquid
> form, although I'm told this is far more expensive.  On the other hand
> Concerta tablets (or capsules?) should never be chewed or cut in half,
> which of course makes it harder to vary the dose by smaller increments.
>
> Incidentally, I've been told by some highly experienced ADHD
> specialists that dose size tends to be far more critical in younger
> children.  Sometimes it's extremely difficult to establish an optimal
> dose in the youngest children, and as a consequence this medication may
> be stopped.  However more stable highly therapeutic results can often
> be achieved when the medication is re-tried a year or so later.
>
> With regard to Angela's point...
>
> >  He was much improved but now Mum has reduced his dose to 18mg [of
> > Concerta] because of the worry again about the level of toxins.
>
> ...this parent's worry about a build up of toxins is probably her
> subjective perception that's not founded in fact.  As far as I know
> toxin build up is a myth - the sort of FUD (fear uncertainty and
> doubt) tactic that's put out by the 'against Ritalin on principal'
> lobby.  Stimulant medication is certainly no panacea, so one has
> to weigh up any risk associated with taking this medication against
> the real and often greater risk of producing a highly negative
> outcome by default if this medication is not taken by the child.
>
> Another factor this parent needs to consider it the potential
> for problems associated with inconsistent or spuriously changing
> variations in their child's dosing regime.  The best strategy here
> may be to give this parent regular feedback as to the efficacy of
> their child's medication while at school ...and do this not just
> when a new dosing regime is working less well.
>
> One final point: ADHD has a strong hereditary component and so it's
> likely that one or both of the parents are likely to have some degree
> of ADHD themselves.  Now ADHD children are not known for their
> consistency or management prowess, and the same often applies to
> their possibly ADHD parents.  You might find it useful if you walk
> them through an informal retrospective cost-benefit analysis each
> time they change the dosing regime.
>
> David Bowles
> Education
>
> PS:  Do please bare in mind that I'm not a doctor.  However I do have
> considerable personal experience using these medication and I hope
> you find this useful.
>
>
>