Concerta: Approved For Adult ADHD

Taken once and lasting for 12 hours. Whether you’re six years old or 65.

Sounds like this might be a good idea for a new medication. Well, Ortho-MacNeil thought so. And the result is CONCERTA, a new timed-release drug for not only adults with ADHD, but children as well.

Recently approved by the US Food and Drug Administration, for adults, this medication has been on the market (as you probably well know) for children for quite a while. In fact, it was the first of the new generation of time-released drugs for ADHD.

CONCERTA uses a relative new delivery system, called OROS – which stands for Osmotic Release Oral System — to help deliver “poorly soluble drugs” to your body as quickly as possible. Additionally, this method unique to CONCERTA gives your system a consistent dosage of the medication over 12 hours. This is good news not only to get the symptoms alleviated fast, but to avoid those ups and downs that often accompany other medications.

Whether you choose this medication is a decision between you and your doctor. I’m certainly not saying it’s the right medication for you. Now, you know it’s approved for adults.

It’s important to realize something that many people don’t: That ADHD does not simply disappear for many individuals when they reach that magical, legal age of 18. In fact, research shows that up to 70 percent of children are still affected with ADHD once they hit adulthood!

Statistics show that adult ADHD affects some 8 million people – or one in 20 of us! – on a daily basis. Those who do have it know exactly what I’m talking about – even if your co-workers or supervisors don’t. For adults, ADHD may get in the way of not only career development, but social relationships as well as personal relationships.

Public health officials generally label a mental health condition a “disorder” and recommend treatment when the symptoms impair your daily life patterns. The fact that you now have the option at least to have your symptoms lessened for a full 12 hours is not necessarily a bad thing!

Options are usually quite desirable!

What is the impact of CONCERTA being approved for Adults?

My experience is that most Psychiatrists who are experts in ADHD were already using this medication for Adult ADHD. However, having this approval (or ‘indication’) for adult ADHD means that more physicians will feel comfortable to use it in adults when it is indicated. This may mean that it will be easier for adults to get the medication that they need.

At this time, the following medications are indicated for Adult ADHD:
* Concerta
* Strattera
* Vyvanse
* Adderall XR
* Biphentin (Canada).

There may be some other medicines approved for adults in the USA. As I’m a Canadian doctor, I’m not sure if there are others. Please share your comments or thoughts below.

Dr. Kenny

[tags] Concerta, ADD, ADHD, Medication, Adult ADHD [/tags]

Comments

  1. I have been taking Concerta for years, and it really makes a difference in my every day life.

    However, it does not last 12 hours for me. If I take my tablet around 7am, I get sluggish around 4PM and can feel that it is out of my system by about 5ish.

    I get the best benefits in the morning, and it makes me feel great, productive, and curbs my procrastination!

  2. Hi. I’ve been taking Ritalin/Concerta for about 10 years now and really like Concerta. I finally settled on 3 x 18mg capsules per day “as needed”. Generally, I just take 3 at once but sometimes need to adjust the timing if I’m staying up late. I have a question about Vyanse: do you know if, in the U.S., Vyanse is in the same drug category as Ritalin/Concerta? It’s a hassle for me to get a prescription written for every refill. Since Vyanse is a pro-drug and can’t be abused, is it dispensed like uncontrolled drugs or do I still need the monthly prescription? That alone would be motivation to try Vyanse. Thanks.

  3. Hi Craig,
    The FDA did put Vyvanse in the same category as the stimulants – i.e. it is still a controlled substance.
    Why did they do this?
    I don’t know.
    So, at least for now, you’d have to get a prescription for Vyvanse in the same way as you do for Concerta or other stimulants.
    Best,
    Dr. Kenny

  4. Concerta was the first medication I tried. It was a dismal failure; at 18mg it wore off too soon, and at 36mg it gave me a week-long anxiety attack.

    Dexedrine was next, and it worked really well, but when I started having trouble breaking inertia to go to bed at night, my doctor put me on Strattera instead.

    Strattera gave me dyslexia and reading comprehension problems.

    After I was dxed with depression as well as ADHD, we tried Wellbutrin for a week, but that made me feel like I was going to die.

    So we did Cipralex + Dexedrine for a while. I eventually dropped the Dex and recently went off the Cipralex. (brain zaps=not fun)

    The only one I’d ever go back on is Dexedrine. I had little to no side effects aside from the appetite suppressant (which was helpful as I’m overweight), there was no rebound effect, and I think if I had some 5mg tabs to take in the evening, I’d be able to go to bed on time.

  5. Craig – I believe that Shire, the makers of Vyvanse were very keen to NOT be listed as a controlled substance, but the FDA didn’t cooperate.
    I am sure they will try to apply again, or something. We’ll see.
    Dr. Kenny

  6. Regarding Concerta overall: I’m not a doc, but here are my impressions. I think the ingredient in Concerta is the same as Ritalin, just that Concerta has a time-release system. My personal experience is that Concerta delivers a smooth, sustained dose during the day. When I used Ritalin, I felt the effects were less even, plus I had to remember to take the doses during the day. Getting the right drug/dose is tricky. It took me years of trial and error. You also have to check for things like depression which often co-exists with ADD. For that, I take Effexor and went through some psychotherapy. Overall, I’d advise this: (1) Don’t give up. Keep trying and you’ll find something that works. (2) Focus on improving performance. Do you get more work done? Do you get along well with people? Don’t worry so much about temporary effects. (3) Find a doc who specializes in this stuff to work with you over time.

    Regarding pregnancy, here’s info from http://www.drugs.com/concerta.html:
    FDA pregnancy category C. Concerta may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Concerta passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
    Long-term use of Concerta can slow a child’s growth. Tell your doctor if the child using this medication is not growing or gaining weight properly.

    Do not give Concerta to a child younger than 6 years old without the advice of a doctor.

  7. Why does Ortho-MacNeil not make a 72 mg Concerta tablet? Any indication that they ever will? Just curious b/c my Dr. recently increased my dose from 54 mg to 72 mg and the price difference is huge since he now prescribes 2 36 mg tablets or a 54 mg + 18 mg tablet. Just curious about that.

    Also, is it likely the FDA will approve Concerta for adults higher than 72 mg? My Dr. stated that he could prescribe higher than 72 mg if I don’t see good results from 72, but that my insurance may not cover anything about 72 mg. Thanks.

  8. I take 72mg/d of Concerta but it is so expensive I wonder if there is a more cost effective combination that would deliver a similar or slightly higher dose… I take a 54mg & an 18 mg each AM. The cost of an 18mg pill of concerta is similar to the 54mg pill. 72mg/d costs about $260 US a month!

    Do any of the other long acting meds come in a one pill doses that are similar to 72mg of Concerta? Are any of the other long acting med combinations that are more affordable? Have you ever combined a 54mg/d concerta dose with methaphenidate 5 or 10 mg 3x/d dose so a patient can have an adult dose for less cost?

  9. Frank and Greg,
    - I don’t know if the FDA will ever approve higher than 72 mg for adults with ADHD. This more likely has to do with the company – i.e. is it worth the expense of applying to the FDA to get approval for a higher dose? I don’t know the answer to that…
    - Regarding cost of 72 mg of Concerta – it can either be 2 x 36 mg tablets, or a 54 mg with an 18 mg. I think the cost is about the same. When it comes to the ‘new generation’ ADHD medications – in general, each tablet/capsule is around the same price, and it gets much more expensive when you have to take two of them. I don’t have any experience with Vyvanse (because it hasn’t made it to Canada yet), but Adderall XR seems to be better at getting 1 dose to work rather than needing two pills. i.e. Concerta 72 mg may work out to be around Adderall XR 25 mg or 30 mg. You can ask your doctor about that.
    THanks for contributing to this blog,
    Dr. Kenny
    p.s. you can also join great ADHD discussions at http://www.adhdworld.com

  10. Concerta: Approved For Adult ADHD | ADD ADHD Blog.com…

    Sounds like this might be a good idea for a new medication. Well, Ortho-MacNeil thought so. And the result is CONCERTA, a new timed-release drug for not only adults with ADHD, but children as well….

  11. Concerta: Approved For Adult ADHD…

    Sounds like this might be a good idea for a new medication. Well, Ortho-MacNeil thought so. And the result is CONCERTA, a new timed-release drug for not only adults with ADHD, but children as well….

  12. Concerta: Approved For Adult ADHD | ADD ADHD Blog.com…

    Sounds like this might be a good idea for a new medication. Well, Ortho-MacNeil thought so. And the result is CONCERTA, a new timed-release drug for not only adults with ADHD, but children as well….

  13. Dr. Kenny,

    I’m curious about the difference between Cipralex & Concerta. My doctor put me on Concerta (36mg) as I definately have ADD/ADHD but also suffered from depression. Concerta helped me with the depression and basically leveled me out – which was nice, great actually. It also calmed my anxiety but I still couldn’t focus or concentrate. So it took care of part of my problem but not all. Because of that, she decided to try me on Cipralex – wow what a difference on immediate effect (physically). While on Concerta, I felt nothing yet felt very at ease and very happy. You notice a difference without noticing – if you can understand that one. But Cipralex, I did NOT like how I felt on that AT ALL and I only took one (today). It hits you so hard I feel like I’m drunk all the time.
    What I’m wondering is, I liked Concerta, but maybe it just wasn’t the right amount of dosage? Maybe 54mg would of been better? What is the difference between Concerta & Cipralex? Which one is better? I suffer from depression, anxiety, ADD/ADHD. I find Concerta was nice and easy while Cipralex is hard. I’m trying to figure out which one is better and better for me (obviously) and what the difference is between them both.
    Thanks,
    REK

  14. Hi REK,
    My 2 cents on your Cipralex post. I am not a doctor, but I have ADHD. My doctor says that Effexor, an antidepressant, has a positive effect on ADHD symptoms, but I am not sure the mechanism, so you might discuss that with your doctor. My personal experience is that anxiety is a component of ADHD. I tend to become more and more “tense” as the day wears on, especially if I’m surrounded by lights, noise, and contact with people. You might be experiencing something like that. I always take about 20 minutes of down-time after I come home from work, and that seems to help. I also remember reading that depression and/or dysthymia (low level chronic depression) may accompany ADHD. You might talk with your doctor about methods to address both ADHD and/or depression by adding an anti-depressant and perhaps behavioral therapy or talk therapy. Best of luck.

  15. Wow, I’m just confused with all of this. My main problem is not being able to focus, concentrate and stick to one thing at a time. As well, anxiety and depression. Concerta was nice, I didn’t feel any effects, I was happy and didn’t experience any depression for as long as I was on it (which is the longest time for me). But this Cipralex, wow, I just feel like I’m dragging myself around. I have no mood whatsoever. I’m just….blah. I don’t think I have slept as much as I have on this medication – ever! I don’t like this med at all.
    I know its going to take time to find the right medication for the right individual but I have only tried the two so far, and honestly, Concerta was good, I just don’t think it was the right amount of dosage.
    Thanks for your help!
    REK

  16. Hi REK,
    Hang in there. :) It’s worth it to keep trying until you find the right meds. I finally settled on 54mg Concerta and 75mg of Effexor for dysthymia. I also used behavioral therapy to overcome social anxiety, shyness, etc. and found that helped me in many ways. I went to regular talk therapy and eventually depression was no longer an issue and I was able to stop taking Effexor. The main point is that sometimes depressive symptoms can accompany ADHD. One thing that occurs to me (and I’m a layman, not a doctor) is that depression can result in the inability to focus and concentrate, so maybe the doc was trying to treat your depression as a means of helping your lack of ability to concentrate. The case sounds so complicated that, if it were me, I’d seek out a psychiatrist (MD) specializing in ADHD for advice and referral to a psychologist for therapy. Might be time get some specialized help to sort things out. Best of luck.

  17. Hello!
    I’m an adult who has ADD – although I wasn’t diagnosed through testing but rather through conversations with my family doctor and a questionnaire he gave me. But, I have two kids with it and also family members with ‘textbook’ behaviors and symptoms. I have read and researched over the years and I pretty much fit the criteria. It has affected my entire life – from my performance in school as a kid, right up to adulthood and how I live my every day life. I was always told I was stupid, lazy and unmotivated by teachers and I figured I was a loser. I know that many people will be able to relate to this, especially those adults who either dropped out of school or just scraped by. It’s only recently that I decided to ask my doctor for medication because I am starting a new job that requires sustained concentration, organization and dealing with a lot of people. I just took my first dose of Concerta this morning. That was approximately 2 hours ago but I can’t say I ‘feel’ anything as of yet. I am hoping that it’s the answer I have been looking for, but it sounds like it can be tricky, figuring out the right dose – from the other posts here. Cheers!

  18. I was taking 66 mg of ritalin (36 of concerta)+20mg ritalin imeddiate release in Am and a 10mg tab in afternoon. To reduce expenses, a new MD prescribed me 30mg ritalin immediate release 2x daily vs previous schedule. I also take an MAO inhibitor for depression, has anyone had luck wity 2x daily dosing? I feel I focus well,maybe better than with the concerta, but I’m concerned the 2x daily schedule won’t last into early evening.

  19. Jen,

    Dosing can be tricky with ADD meds,even with concerta. Sometimes doctors will add an imediate release form in the morning(concerta starts to peak in hours 4-7) or in the afternoon.

    Sometimes depending on your schedule at work or school, you might consider taking your concerta earlier or later as well. Ask your MD.

    Good Luck!

  20. Hi Dr Handelman

    I was diagnosed with inattentive ADD and put on Concerta XL. I have been on it almost 6 months and even on 56mg I have never really seen or felt much of a difference to my symptoms. The only thing I have observed is my appetite is slightly supressed and I don’t feel the need to snack as much.

    I felt a sense of relief when diagnosed as it explained a lot and how, despite my intelligence, I struggle with the basic everyday tasks other people seem to do with ease. I wondered though, can you still have ADD and find medications don’t help with the symptoms? All the things I have read suggest people have noticed a real difference on concerta quite quickly but I didn’t experience this at all.

    I wondered if maybe the fact it hasn’t made a difference means I don’t have ADD after all…

    I also wondered about dosage. I exercise and weight train regularly and weigh a lot more than I look like I do and have quite a muscular build. Could this mean I need a higher dose than 56mg once a day?

    I would appreciate your advice as I was diagnosed at the Maudsley in London and when I phoned to ask a question they said I wasn’t funded for follow up appointments… which apparently includes asking a quick question over the phone. My GP is great but doesn’t know a lot about ADD. I would appreciate any advise as I feel upset that it hasn’t worked for me when it seems to work so well for others.

  21. I am convinced my son has adult ADHD. He was an extremely hyper child – from the time he was born. Fighting to stay awake, irritable baby, walked early, ran and climbed constanly, darted in front of cars. We kept him in a harness and leash for his own safety when out shopping etc. (And got many dirty looks and negative comments- but he would dart away suddenly and could run fast!) He was put in special ed in school, but was very intelligent – so I took him out of school, homeschooled him and he flourished – reading at above grade level, doing many creative things. I didn’t realize he had adhd then because I didn’t know about hyperfocusing. He was able to concentrate for hours on his music (is talented musician and songwriter) and also taught himself web design – which took hours of concentration. However I can see that as an adult (23) he has serious problems.

    When he was at home he worked as a carpenter for my husbands business, and also as an entertainer in different venues. He had his mom to keep him organized, scheduled, remind him of things. Once on his own it has been a disaster. In the past year he has gone through all his money, gone through three jobs, lived with two different women, has been experimenting with drugs (including cocaine which terrifies me) and started smoking. He has asked if he can come home for a short time to get his life more organized. I want him to get treatment. Where I live it can literally take months to get in to see a specialist. I wonder if family doctors can diagnose and treat this. If he is to try meds I would like him to do it here when he has someone to watch for side effects etc.

    His main problem is being extremely impulsive, without any regard to future consequences. I am really beating myself up here as I feel I have contributed to his problems by not recognizing this when he was younger. I love my son very much and want him to be a happy adult who can be proud of his strengths and creativity. Any suggestions will be much appreciated.

  22. I was in denial too about my add but i finall went to the doctor and got help i am taking concerta 18 mg i never felt so good about my life and every thing before this pill is a magic pill. let you son go and get help he will love the out come.

  23. I’m a high-functioning autist with attentional deficits and was first prescribed Ritalin, which worked very well. Unfortunately, my life partner would steal them and abuse them, leaving me with no meds for most of the time, no matter how hard I tried to hide them.

    After discussion with my doctor, I switched to Concerta, which also works quite well, although I have to take a somewhat higher dose of Concerta to get the appropriate effects. I quite like Concerta. It is very smooth, and with very little rebound at day’s end. My partner also leaves it alone as he gets no “buzz” from it.

    However, as a side effect, it causes me to have acne on my face, chest and back. The acne is serious enough that shaving is problematic. Might it be worth it to try biphentin? I had never heard of it until I found your blog tonight. Non-abusability is of the utmost importance due to my partners foibles, and biphentin seems to fit that bill. Do you think it may cause acne, too?

    Also, do you have any idea how or why one version of methylphenidate would cause acne, but not another? Perhaps it’s because I had to take a larger dose of Concerta than the Ritalin?

    • Greg,
      Biphentin comes in little beads. While it is not that abusable, if someone tried to crush the beads, they could potentially abuse it.
      While your acne could be from the methylphenidate itself (i.e. related to the higher dose), it could also be related to an ‘excipient’, or another chemical just found in the Concerta to help make it the pill that it is.
      Talk to your doctor about trying Biphentin…

  24. @Melanier – your son sounds as if he may have more going on than just ADHD. See if you can convince him to get assessed for Asperger’s or autism spectrum disorder. It’s tough as an adult to get that assessment, though. Good luck to you both.

  25. dr. kenny,
    just to let you in on a little insight i have had concerning the cause of ADHD. my hubby james has been diagnosed with adult ADHD before i ever met him. when we first became roommates, i noticed there was something not quite right with him, and he was always overly eager to please, and moved a little to quickly. also he was very suggestible, not really being able to think for himself. and soon i learned he had been adopted at the age of 2, because his mother was a severe alcoholic and literally burned herself to death by falling asleep with a cigarette in bed because she had passed out drunk. by putting 2 and 2 together, i realized his mother was an extreme alcoholic who probably drank while she was pregnant, and when he was born in 1958, society wasn’t aware of the dangers of drinking while pregnant. so i ask you to research whether ADHD could be caused by fetal alcohol syndrome, which i believe is the cause of james’ ADHD. also, do you know of natural substances that could help? i have learned so far about a combination of DHA, which is found in fish oil, plus ginseng and ginko biloba. any help would be appreciated. my hubby does hard physical labor, and frequently injures himself on the job. i desperately need help before he kills himself. thanks so much, benita

  26. Hi,

    My son is in his last year of high school and often needs to stay up to midnight to get his school work done. He has inattentive ADD. He takes his Concerta (actually a generic brand by Teva) in the morning around 7:30. However, by evening when he starts his homework he finds it extremely difficult to concentrate. I wondered if he took one dose (18 mg) of the drug at 7:30 and another pill (also 18 mg) around noon if that would allow him a longer span of concentration time. What do you think?

    Carol

  27. I have started drinking Concerta 3 days ago. Since it didn’t say on the packing that you should only drink it early in the morning: I dranked it as soon as I got home from the doctor. Around about 3 o’clock. What a mistake. Since then I have tried to find out as much as possible about Concerta (and that you need to drink it early in the morning).

    I do not think I have ADHD. I have a very bad memory and even trying to remember what I did yesterday can leave me stressed. I almost always dream off when people talk to long. It is my opinion that I have auditve processing is slow and when I feel the importance to lisen it feels to me that I can hear people talking but I do not understand what they are saying. My husband often need to explain what they said in a movie or on TV.

    I even forget my words when I talk to people and can not express myself. (I actually feel very proud of this message.) I would turn words around and talk about Cook and Spray instead of Spray and Cook. Pronouncing words wrong.

    I do not think I have ADHD since I am not hiperactive and organizing is actually one of my attributes. I always have a notebook in my hand.

    What is wrong with me?

    Please excuse my long message, but I actually feel better being able to tell someone what is going on in my head.

  28. Hi Dr,

    I’m taking 36mg of Concerta in two daily doses for depression (I don’t tolerate SSRI’s very well). It seems like the first dose helps a bit, but the second dose seems to make me more depressed. I’ve tried taking them together in the morning and I just feel weird. Neither way seems to help very much with the depression. Should I try another stimulant?

    Thanks,

    John

  29. hi im at me wits with my 12 year old daughter she has higher A.D.H.D she taking
    concerta xl 36mg /concerta 27mg atomoxetine : Strattera 28 mg and 10mg I don’t think there are working she still the same don’t know what else to do im pulling me hair out ive tried everythink any one out can help me please it breaking up the family

  30. Hello Dr. Kenny,

    I was wondering if you could speak to what a person might expect to experience when first starting on Concerta? How one might know if they have titrated too quickly/ dose is too high? And the effect (if any) caffeine might have in combination with this drug?

    I ask as I was recently started on Concerta 36mg and titrated up to 54mg. Especially after going to the higher dose, I experienced what I’ll call hot flashes and at other times deeps chills. I also experienced a kind of “fog” that made concentration extremely difficult. These affects were not listed in the possible side effects and I didn’t to know what to make of these.

    Thanks.

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