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.

    • I took the 36 mg for something like 6 years, and it’s been good for me. But then again, different drugs work for different people, so if you’re feeling like a zombie, maybe your body just doesn’t like Concerta. Everyone reacts differently, so it doesn’t hurt to at least try the higher dosage and see

      • Great advice. I’m on year 7 and feel like I too can help people. We gather so much information from such experiences.

        Anyway, thank you for your comments. If you ever feel you need to talk, 12thmanriles7189@gmail.com,. Real personal info like name, location is unnecessary.

        Just in case your initial thought of me is:

        “yikes what a flirty douche who only likes my picture.”

        You being so pretty matters not. I really did enjoy what you wrote. Very well done.

        Mine is under R. Todd Riley from today’s date. Read if you’re not too busy. I love all feedback, good and not nice. People are meanies :)

    • Well the above article wasn’t about Adderall whatsoever…it was about Ritalin and concerta. Your comment clearly shows that you are seeking out the medication that will get you high. That is so sad and I just really hope you don’t have children. Best of luck fighting your battle Mr. Harmon!

      • Well now wait a second here, let’s not jump to conclusions. It may be that he finds that his current medication regimen is no longer helping him and he needs some guidance in finding something new from people who share the same struggles as he does. Some people don’t feel the need to share their entire story in order to ask a question. We need to be supportive of one another. I wish I could answer this question, but I can’t. Just felt the need to defend, because that could really hurt a person’s feelings.

    • As each medication works differently, you would have to start at the smallest dose and thrn titrate up as instructed by your doctor on a monthly/bi-weekly basis.

  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.

  3. I take 54mg Concerta and have a similar experience to you Paul i.e., similar age, the Concerta has helped with my attention and I have social anxiety. I find that the Concerta makes me initially jittery in the morning but wears off by mid-day. Except if I’m overtired I am realizing that and I am more jittery than usual throughout the day. Sometimes my heart is pounding and I am very anxious. Today though, after a good night’s sleep I am less jittery. The Concerta seems to have helped with keeping me on task when I am working on something. I still struggle with executive functioning at times, understanding and processing things that are said to me . I believe (though not confirmed) that I also have a Learning Disability.

    I’m interested in knowing more about the ritalin PRN option as it might help me. I did once take 18mg concerta in the late morning after taking 36 mg at 7am and it made me quite jittery.

  4. Alo my child is using 18mg concerta she did not eat or she did not sleep at night now its about 3months she stil using it and act like a normal child play sleeps well eat again is it because the mg is now low for her must she be on a higher dose now?????

  5. I was fortunate to have worked with a Psychiatrist/MD who had advanced medication insight. He was of the opinion that Concerta was a literal life saver vs IR stimulants. Lower abuse potential, flexibility of dosing, with a slow enough release it reduces euphoric activity (euphoria increases irresponsible use).

    ADD and ADHD brothers and sisters, start engaging your doctor in conversations regarding Concerta. Take articles like the one above. Autonomy is critical in the patient/doctor, trusting relationship. Self advocate. Show passion while showing all due respect. Contention breeds chaos which then is the focus

    My apologies for the length of my comments. I hope it helps in some way.

    RTR – Diagnosed with PTSD, major depression, panic & anxiety disorders, as well as a form of bipolar II, 7-years ago. I’m a writer working on a new book. My brand new Twitter is @rtoddoriginal

  6. Hi there
    I currently have 18 mg of concerta to help ease my very anxious self !! But I am so scared to take it as my anxiety makes me think bad thoughts !!what if ,what if ??? So I have it here in my hand try to take it every Morninv but my anxiety goes through the roof and I put it aside …… Can anyone help me make me feel a little more at ease to take this medication ???? Maybe tell me how I will feel how it will hit me what I will feel like tonight ??? If anyone can help would be much appreciated

  7. I am a mother of a 8 year old boy who we can not seem to get on the right meds! He is a extremely clever child, but battles to concentrate at school! He has been on it all you can say! Ritalin, concerta, risperdal ect! He gets in trouble at scool because he battles to concentrate! He has been with so many drs, professors, neurologists, developmental pediatricians and the list goes on! He only seems to be hyperactive when the tablets is leaving the system, which is no problem, but tge thing is it is like the meds do not do the job it is supposed to do! He has been ons so many different tablets the last 3 years i fear that it dos not work! Ritalin makes him very aggressive, risperdal makes him very active (apperantly this happens to 1 out of 100), and the concerta at a 27mg is like there is nothing in his system! I have changed him to a 36 mg he has been on it for 3 days now, but i do not see a difference! I do not mind the hyperactive but i do mind him getting in trouble for not being able to focus in class! I give the concerta with the ADDVance vitamin! Please i need advice i hate to see my child suffer like this! And our schools in south africa have big classes, and i know he battles with that! But the remedial schools that i took him to for tests all say the same! He should be able to cope in normal school as he is not a typical candidate for their schools! Sorry for the life story, i am a mother in pain to see my child suffer!

    • High intelligence is absolutely dreadful when combined with ADHD. The individual tends to display alot of aggresive behaviour due to being unable to communicate comfortably.
      When he gets emotional, his ability to reason and undersrand goes out the window leading him to become more frustrated, people will negatively react to his actions and he’ll feel like everybody is against him, leading him to get angrier, rinse, repeat.
      Its hard to regulate your emotion when you can’t think clear and as you mentioned, he’s a smart kid, looking back on times hes acted out and know he was capable of so much better might evoke a feelin of shame for him that makes it harder to talk.

      If the concerta is causing him to be less hyperactive and moreso in the evenings then that might be when the medication is wearing off, maybe speak to your psychiatrist about staggering the dose.
      Can you give more info?
      What time does he take the meds?
      Does he eat regularly? Even when taking meds?
      Sleeps enough? Exercises?
      Does he do anything to keep his mind active?

      • You speak as if you know him! Everything you said is just the way he is!
        He takes meds at half past 6 in the morning, after breakfast! He does not eat enough he weight currently is 21kg! He eats a slice of toast in the morning, does nit eat his lunch at school, and then maybe he will eat at night!
        He is very restless when sleeping! Sometimes he will sleep with no troubles, but other times he can not fall asleep!
        He did play some rugby, but he stoped as it always ended up in a figt as he wants to do his own thing! He loves to draw and that is what he does to keep himself busy! He also likes to build stuff! He is the child who wants to be a Archiologest and open a Museum as he will say, so all can learn what he knows! Other than that he keeps to himself! And you are right, people do not understand him, so they tend to push him away and not like him! It is sad for me as a mom to see this as he tries hard to get their attention

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