Concerta Dose: Getting It Right

Concerta is a newer, long acting preparation of Methylphenidate – which is the medication name for Ritalin.

It has been out for several years in the USA and Canada, and many other countries in the world.

Despite the fact that it has been around for quite some time, I still see dosing mistakes in patients who are sent to my office.

Allow me to explain to you how Concerta should be dosed.

To start off, we need to go back to the original Ritalin.

Here are the dosing guidelines for Ritalin:

Recommended daily max = 60 mg
Timing: as each dose only lasts 3-4 hours, it is generally dosed 3 times daily – i.e. morning, noon and 4 pm
It is not dosed too late in the day, as it may lead to insomnia
Children would be started at 5 mg twice to three times daily, and the dose would be increased upwards as needed.

When Concerta was developed, they used a fascinating technology called OROS. OROS refers to: osmotic-controlled release oral delivery system. What OROS does, is use the water in the gut to cause the medicine to be absorbed gradually, through osmosis. Suffice it to say that this new pill takes a medicine that has to be taken 3 times daily, and makes it once per day. You can see a short video of how this works here.

Concerta comes in 4 doses:

18 mg
27 mg
36 mg
54 mg

The way to convert Concerta doses into the equivalent of Ritalin doses is this:
Take 22% of the Concerta dose, and that becomes the effective Ritalin dose, three times daily. In other words, the initial 22% is quickly released, and the whole rest of the pill supports that dose.

You need to remember that not all of the medicine is released from the Concerta pill – about 10% is not absorbed.

Why?

Just picture a ketchup bottle – can you ever get the last bit out?

So, here is a conversion:

18 mg Concerta = 4 mg Ritalin 3 times per day
27 mg Concerta = 6 mg Ritalin 3 times per day
36 mg Concerta = 8 mg Ritalin 3 times per day
54 mg Concerta = 12 mg Ritalin 3 times per day

Here is an example of how some people get into trouble:

Let’s say that a teen required 60 mg of Ritalin per day – i.e. 20 mg three times daily.

If the doctor converts the dose of 60 mg Ritalin to 54 mg of Concerta – because they seem close, this can have dire consequences.

54 mg of Concerta is like 12 mg of Ritalin 3 times per day, so there would be a significant dose drop from 20 mg 3 times per day to 12 mg 3 times per day (i.e. a 40 % dose reduction!). It would be no surprise if the people noticed a change and felt that Concerta wasn’t working.

In the recent past, there has been approval in the US for 72 mg of Concerta for teenagers if needed.

Recent ADHD practice guidelines published by CADDRA – the Canadian ADHD Resource Alliance, suggest that teens and adults with ADHD may require up to 108 mg of Concerta daily.

To put these doses into perspective:

72 mg Concerta = 16 mg 3 times per day
90 mg Concerta = 20 mg 3 times per day
108 mg Concerta = 24 mg 3 times per day

To achieve these doses, you can use:

72 mg Concerta = two 36 mg tablets, or 54 mg + 18 mg
90 mg Concerta = 54 mg tablet + 36 mg tablet
108 mg Concerta = two 54 mg tablets

What’s the bottom line ?

If you or your loved one was switched from another form of methylphenidate to Concerta, and it seemed that Concerta didn’t work, please consider the information above.

You may even want to print this article, so that you can take it with you to your next doctor’s appointment.

Concerta is a great preparation of methylphenidate, and can work very well.
Don’t give up on it unless you are sure you have had the right dose.

Comments

  1. Hello

    I started taking concerta 18mg about a month ago. It makes me incredibly sleepy, even zombie like. I stopped taking it and my doc today said that I need to increase my dosage to not feel so sleepy. I am afraid to take the new 36mg rx because I do not want to be zombie like again. What do you think? Will taking a higher dose actually make me feel more alert than tired?

    • Concerta ER @ 18 mg made me feel kind of sleepy the first few days to week when I began to take it. But it also made it hard for me to fall asleep at night. Besides for that and my mouth feeling dry, I didn’t feel any other effects. I tend to be very sensitive to medication, so I tried for a week by cutting the med in half (that defeats the capsules mechanism) but it helped me w trouble sleeping at night. By the third week, I was ok with a full capsule. After bumping it up to 36 mg a month later. I started feeling really depressed and agitated. My Doctor claims she’s never observed such side effects. But I’ve read from forums that lots of people have had similar experiences.
      Jeri I wanted to write to let you know these medications make different people feel differently. The doctors I’ve seen and articles I’ve read all seem to say they “don’t exactly know how these medications work, and side effects vary.” You may or may not have these side effects, and maybe you’ll get used to the sleepiness. Perhaps consult with your doctor if you can try cutting the pill in half for a few days, then trying it full again. Just be careful and mindful of how this and any medication makes you feel, consult your doctor to try different doses or medication.
      Btw, I didn’t want to mention what I’m on now to prevent you from giving up hope on Concerta (some people really like it and find it helpful). But it may be helpful to let you know.. I started taking Ritalin and it made me so tired by the end of the day / early evening. Within the first week, that phased out. And I realized this sleepy-tranquil feeling was almost calming. I think that’s what focus and non-adhd feels like. It was pretty interesting. Unfortunately, that seemed to have stopped working, I may have to bump up my dose. But anyway, I wanted to mention this because that sleepiness went away within a week with both medications (for me). And I’m concluding that this “sleepiness” may transmute itself to a calming effect – essentially, what the medication’s supposed to do! :) good luck to you Jeri.

  2. I am a 57 year old man and I’m currently taking 36 mg of Concerta. I started taking this at 27 mg back in October. The first week was probably the best week that I could remember having in terms of energy, focus, getting a lot done, increased confidence, more talkative, and reduced fear of public speaking. I have had attention issues my whole life but one once tried Ritalin when I was like 10 years old but my parents took me off it because my mother said it made me like a zombie. I don’t really remember what the effects were like back then. So I learned to live with it and did well in my school work although it took more effort but I did fine. I have never been much of a book reader, mainly shorter articles, newspapers, magazines, etc. I would finish one chapter of a book and pat myself on the back and never pick it up again. I used to get sleepy often, especially a problem when driving. The Concerta solved that problem. I also have Ritalin 10 mg that I take occasionally when I need it. The biggest problem that I have suffered from, most noticeably the last 10 years, is social anxiety. I would embarrass myself sometimes because I felt uneasy and would over compensate being friendly or smiling, etc. and come off being creepy. The Concerta 36 and Ritalin have helped me with these issues more than anything. This morning I didn’t have my Concerta 36 so I took 20 mg Ritalin, now I read above that is equivalent to Concerta 90 initial dose!! Before I read this I took 20 mg again and I’m doing fine. Concerta 36 may not seen the same tomorrow, LOL. BTW, I don’t think it is the best thing to cut a Concerta tablet in half because of the way that the tablet is constructed. One half is the medicine in two different dosage strengths and the other half is a substance that expands to slowly push the medicine out over time. I look forward to your replies and to read your experience with Concerta and Ritalin.

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