Archive for ADD Medication

ADHD Medication Free Webinar Training

At the end of March 2012, I did a webinar training for ADD Resources.org, called “ADHD Medication Update”.

I’m sharing the video here, and it’s broken into 4 different video segments:

1) Introduction – this is the introduction, and let’s you know what I’ll cover during the training.

2) This is the main teaching – during this session, I cover WHY we use ADHD medications, and help you to understand that there are really only 4 types of ADHD medication – a) methylphenidate medicines, b) amphetamine medications, c) non-stimulant atomoxetine, d) non stimulant guanfacine.

We’ll cover how to make decisions around changing or adjusting medication, as well as a discussion about tolerance to ADHD medication

3) In the third video, I share some information on the ADHD Medication Shortage in the US, and strategies you can use to help yourself during this struggle.

4) In the fourth and final video, I share a summary of the ‘Ritalin Gone Wrong’ article, and share some responses to that.

I hope you enjoy the videos. Please feel free to pass them along, and type any comments in below.

Best,
Dr. Kenny

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ADHD Medication: How To Decide

When it comes to making a decision about whether to use a medication for ADD/ADHD or not, many people struggle with this… There is so much misinformation out there, that people are worried about making the wrong decision, and whether they will be judged for it…

In this short video (taken from a presentation I did), I share with you the way to decide if you will take ADD/ADHD medication or not. And this applies whether you are dealing with child/teen ADD/ADHD, or Adult ADD/ADHD.

Please watch this short video, share your comments/thoughts below (and also forward it to friends/family who may appreciate it!).

What do you think? Do you agree with the message of this video?
Best,
Dr. Kenny

p.s. To learn a whole lot more about the safe and effective use of ADD/ADHD medication – take advantage of the special discount on the Medication Mastery Course (special ends on Monday December 5th at 11:59 pm Eastern time) [hyperlink family="Helvetica,Arial,sans-serif" size="20" color="1A12FF" textshadow="1" alignment="center" weight="bold" style="normal" lineheight="110" linkurl="http://medicationmastery.com" linkwindow="_blank"]Click Here To Take Advantage Of The Special Offer[/hyperlink]

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Generic Concerta in Canada

*This article has been updated on May 30, 2010.

Concerta is a long acting preparation of Methylphenidate. It was launched in the US in 2000, and in Canada in 2003.

When a new medication is released, the company which produces it has a patent for a certain number of years. This allows them to market the medication exclusively until the patent runs out. This is important for the company to recoup the money invested in research and development of the new medicine, as well as to earn a profit.

I understand that it is reasonably regular that the generic pharmaceutical companies petition the courts to create a generic version of the medication BEFORE the patent runs out. Companies that create generic medicines are able to take the formula of the medication, and produce it. They then sell it at a lower price than the original medication. Often times, the generic is at a price point that is only 20-30% better than the original medication.

For background on generic medication, I want to point you to these resources:

Concerta Going Generic In Canada:

Concerta was brought to market in Canada by Janssen Ortho. In mid January 2010, Novopharm won a lawsuit in Canada, to be able to start to produce a ‘concerta like’ medication in Canada. The courts essentially overthrew Janssen’s patent on Concerta. Novopharm is planning to market Novo-Methylphenidate ER C, as a replacement for patients taking Concerta.

N.B. In early summer 2010, the name of the generic medicine will change from: Novo-Methylphenidate ER-C to Teva-Methylphenidate ER-C. This article will be updated when the product’s name is fully changed over.

Let’s Review the Pros and Cons of Novo-Methylphenidate ER-C:

Cons of Generic Concerta:

1) Does this medication work equally to Concerta?

Unfortunately, no one knows the answer to that. For a generic company to get approval for a new medication, they simply have to prove that their medication is absorbed within the range of 80% – 125% of the original compound. That is a huge variance.

The problem with that range? This means that the original Ritalin SR could likely meet criteria to be a generic for Concerta.

If you’ve been around long enough to remember Ritalin SR (or if you have not had insurance so it was the most cost effective medication option), you’ll know that Ritalin SR was widely found to be a very ineffective long acting medication. It often did not last longer than short acting methylphenidate in most of my patients. Most of the doctors in the field considered adding Concerta to the medications available in Canada to be a huge improvement, because we could get away from Ritalin SR and its poor efficacy.

I have been unable to get any scientific data (and neither have any of my colleagues) to demonstrate how Novo-Methylphenidate ER-C works. For all we know, it could work like Ritalin SR – which essentially means that it won’t work very well at all.

Concerta has a lot of technology in each little pill. Each pill has a laser drilled hole in it. There is short acting Methylphenidate on the outside of the pill, and then there is an osmotic capsule (meaning that water can come into the capsule from the gut). The water from the gut comes into the capsule, and expands a polymer, which then pushes the medication out of the pre-drilled laser hole – in a researched process which delivers the medication in a fashion which has been shown to work best for people.

Has Novopharm invested what is needed to develop this complex a medication delivery system?
No – they haven’t.

2) Will you be able to control which medication you get?

Let’s say a member of your family is doing very well with Concerta as a treatment for their ADHD. Now that there is a generic product – can you guarantee that you can keep this product as your monthly medication?

Not necessarily.

As of late April 2010, the Ontario government has deemed Novomethylphenidate ER-C interchangeable with Concerta.

When a medicine is deemed interchangeable, then pharmacists have an obligation to automatically substitute the generic form of the medicine for the brand name version. in other words, your pharmacist will have to substitute your Concerta with Novo-methylphenidate ER -C.

There are a couple of factors which can impact whether you get Concerta or the Generic:

  • Your insurance: your third party medication insurance may decide that to save cost, they insist that you take the generic Concerta, and they may not cover the real Concerta. If the generic doesn’t work for you, you may have to either pay for it out of pocket, or just stick with the generic.
  • If you are on a government provincial drug plan – they may insist on the generic version, and not cover the name brand Concerta any more (Ontario has just forced automatic substitution on their plan).
  • What your pharmacy carries: some pharmacies may order in ONLY the generic version, and stop carrying the name brand Concerta. In this case, you may have to go to another pharmacy to get the medication you need.
  • How your doctor writes the prescription: If your doctor just writes the prescription for ‘Concerta’, the pharmacy can substitute it automatically for the generic. If your doctor writes the words: NO SUBSTITUTION on the prescription, then the pharmacy will have to give you the name brand Concerta.

Pros of Generic Concerta:

  • If this generic works well, then this means there will be a lower cost long acting medication option for people who can’t afford the more costly brand name Concerta. It seems that the price reduction is in the range of 50%.

Overall, as you might have gathered, I feel very uncomfortable with the Generic Concerta at this time (Novo-Methylphenidate ER-C). Most people that I see in my office have had a long and/or challenging road to get to the diagnosis and treatment of ADHD. Often taking a medication for ADHD is a huge decision, and arriving at a medication which works well with few side effects is beneficial and often a relief for concerned parents and family. To have that medication changed and become less effective would be very detrimental to my patients – and create a huge disruption to their lives.

Will Novo-Methylphenidate ER-C work well?

I don’t think anyone knows right now. Where is the scientific data?

I don’t know anyone who has seen it yet. And despite this, pharmacies across Canada can start stocking this and replacing it for regular Concerta (and they don’t even have to get your permission).

What do I recommend you do if you or a family member take Concerta?

  • Ask your doctor to write a prescription for Concerta NO SUBSTITUTION (it doesn’t have to be capitalized – I am adding that for emphasis). Your doctor can even write: No Sub (which is faster!). It has to be in handwriting. If it is a stamp, or some other form of automated process, then the pharmacist can ignore it.
  • Talk to your pharmacist about this – to check if you can still get the name brand medication
  • Look closely at your prescription bottle – to see if the medication is: Concerta, or ‘Novo-Methylphenidate ER-C’
  • If needed, check with your third party insurance for medication – to see if you are still able to get the name brand Concerta covered
  • If you start to notice that Concerta isn’t working as well as it used to – look closely at the bottle, and realize that your prescription may have been substituted for the generic.

As this is a significant change to medication for ADHD in Canada, and one which came as a surprise – I wanted to provide you with some background. I’ll be happy to update this blog as more information comes out, and I know more about this.

One of the things that has been very helpful to many people on this blog – is that readers like you share their stories in the comments below (as you saw with the link about Adderall XR going generic in the US). So, I ask you to share your thoughts, experiences and comments below. Let’s help one another figure out how this new medication works, as well as what is going on in pharmacies, and with insurance coverage, etc. Thanks in advance for your contribution to this post.

New Updates:

Janssen Ortho Releases A Program To Help To Keep You on Brand Name Concerta:

Janssen Ortho is the company making Concerta. They have invested a lot of resources into developing Concerta, as well as educating doctors, educators, and patients and their families about ADHD and its potential impact on people’s lives.

The acceptance of the generic medicine as ‘interchangeable’ is leading to people being taken off of Concerta and being put on the generic very quickly.

Janssen has created a program which can help you to stay on the brand name product. It is called the: “Concerta Co-Pay Assist Program”.

What happens is this:

  1. You get a prescription from your doctor that says: Concerta No Substitution
  2. You go to the pharmacy, and give in the prescription – and insist that you get the brand name product.
  3. If the pharmacy says that your insurance will only cover the generic product, and you have to pay the difference – then you give the pharmacy a ‘Concerta Co-Pay Assist Card, and then Janssen Ortho will pay the difference between the generic medicine and the brand name medicine.

In other words, when you give one of these cards to the pharmacist – you won’t have to pay any extra above the costs of the generic medicine. This applies whether you are on the Ontario Drug Benefit Card, or whether you are on private insurance (i.e. from your work), or even if you are a cash payer.

Here is an image of the card:

ConcertaCoPayAssistCard Generic Concerta in Canada

You’ll notice that the card says: ‘Multi Use Patient Co-Pay Assist Program’.

This means that you can use the card over and over again, as long as you are taking Concerta (and as long as Janssen continues to run the program – which seems to be for the duration at this time). Logistically, you can either leave the card at your pharmacy, or take it with you – just make sure you still have it when you need to refill your prescription.

Now the big question you may have is: where do you get these cards?

These cards are being give out to doctors, as well as to pharmacies. So, ask your doctor if he or she has a card for you. If he or she doesn’t, you can either ask at your pharmacy, or ask your doctor to contact his or her representative from Janssen Ortho to get a card for you.

Hopefully, it will be easy for you to get a card to continue on the brand name Concerta.

***Please note – that at this time – these cards are only available in the following provinces: British  Columbia, New Brunswick, Newfoundland, Nova Scotia, and Ontario,.

Another Update: Potential For Abuse:

One of the risks with Methylphenidate medicines is that the medicines can be abused. Kids in school yards can sell ritalin (or short acting methylphenidate medicines) for $5 per pill. Many people will take the tablet – and crush it, so that they may snort it. When they change the route of delivery to the brain (i.e. when the medicine is absorbed via the nose vs. via the stomach), it can increase the speed of the medicine getting to the brain and it can then increase the abuse potential – i.e. people can get a ‘high’ from it when they snort it.

Concerta has a polymer inside, and a hard outer capsule. When it is crushed, there is no powder which can be snorted.
However, the Novo-methylphenidate ER-C can be crushed easily.

Look at the picture below which shows two 54 mg capsules – Novo-Methylphenidate ER C on the left, and Concerta on the right.

Generic Concerta Canada Generic Concerta in Canada

Generic Concerta versus NovoMethylphenidate ER C

You can clearly see that the Generic medicine is easily crushed into a powder which could increase the chances of the medicine being abused.
There are studies done which show that with Concerta, there is less risk of abuse. There aren’t any studies done on Novomethylphenidate ER C yet, but, as they say – a picture is worth a thousand words. This picture shows that it can be crushed into a fine powder – thus increasing the risk of abuse.

Best,

Dr. Kenny

p.s. regarding dosing – Novo-Methylphenidate ER-C will be available in the same doses as Concerta:

  • Novo-Methylphenidate ER-C 18 mg
  • Novo-Methylphenidate ER-C 27 mg
  • Novo-Methylphenidate ER-C 36 mg
  • Novo-Methylphenidate ER-C 54 mg

p.p.s. A comment from me about this blog post: I am not being reimbursed by Janssen Ortho for this blog post. I do not own any of their stocks. I use this blog to post my opinions and to share updates to science, research and general ‘goings on’ in the field of ADHD. That is what is happening here. I happen to feel very strongly about the generic Concerta not working as well as the brand name product – and that is why I am working hard in my office to support people staying on the product, and using this blog to get the information out to a broader audience as well.

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Concerta and Ritalin: Can they be Combined?

I recently posted a blog post about Ritalin. Although it often ‘gets a bad rap’, it’s a medication which can still be very helpful for ADD/ADHD. Of course, the newer medicines (which are long acting) seem to be better for a good treatment response, though Ritalin can still play a role.
In that article, I mentioned the concept of taking Ritalin with Concerta – i.e. together. When someone commented on that post, I realized that I should share more specifics and details about how this can be done safely and effectively.

For background information, you can reference these previous blog posts about Ritalin and Concerta:

The Concept Behind Concerta’s Formulation:

Concerta, as the first long acting ADHD medication, was developed using a fascinating approach. The scientists put kids with ADHD into an ‘analogue classroom’ – meaning a research environment which simulates a school classroom. So, children were given tasks which would occur in a regular school day, and they were monitored by experts in  ADHD. These kids were given an IV line, which allowed for the researchers to draw blood HOURLY, so they could establish the blood levels of the medication throughout the day – and they could correlate the blood levels of the medication to the behavior (and ADHD symptoms) observed throughout the day.

The researchers tried different approaches with the medication. The children were given short acting Methylphenidate (i.e. the medicine in Ritalin). By giving different amounts of medicine on a very frequent basis, they were able to create different levels of blood concentration through the day.This was called a ‘sipping study’. They were giving little bits of Ritalin throughout the day, very frequently – like you would ‘sip’ a soda. By monitoring the blood levels, they created different ‘profiles’ of blood concentration.

The first concentration approach was: FLAT. This meant that the medicine was given to reach a ‘plateau’ level of blood concentration, and the rest of the doses throughout the day were set up to maintain that level of concentration in the blood.

The second concentration approach was: ASCENDING. This meant that the doses were set up to increase the blood concentration slightly, hour by hour throughout the day.

The third concentration approach was: DESCENDING. This meant that the doses were given to create an initial spike up, and then the blood concentration would drop through the course of the day.

Guess which concentration approach was proven to be most helpful in controlling symptoms of ADHD through the course of the day?

ASCENDING worked best.

Thus, Concerta was developed to create an ascending profile of blood concentration throughout the day. This means that when the 22% of immediate release methylphenidate is absorbed, it creates a spike in blood concentration in the first hour, and then the Concerta is formulated to increase the concentration of methylphenidate in the blood, so that hour by hour, there is more medicine in the system. The concentration level increases for the first approximately 8 hours of the day, and then it begins its drop. It thus gives approximately 12 hours of symptom control.

Why does an ascending profile seem to work well?

The researchers suggested that there is ‘acute tachyphylaxis’, or ‘acute tolerance’. They suggest that if the blood level of the medication is the same at 11 am as it was at 10 am, the brain is becoming tolerant to that level of medicine that quickly, and it is less effective at 11 am as it was at 10 am. Concerta was formulated to overcome this, by having slightly higher concentrations of medicine throughout the day. Under the theory of acute tachyphylaxis, the system of ‘tolerance’ to the medication would reset itself each night, as the medicine wears out of the system.

Back to combining Concerta with Ritalin:

Explaining the science of Concerta was important to explain the rationale for what I’ll say next about combining Ritalin (or short acting Methylphenidate) with Concerta.

It is important, because if the ‘ascending profile’ theory is correct – then adding Ritalin to Concerta first thing in the morning will ruin the unique formulation of Concerta, and essentially ruin the ascending profile of concentration.
In other words – if Concerta is formulated so that a certain amount of it is immediate release (i.e. 22%), then the rest of the pill supports that to create the ascending profile. If one takes a short acting Ritalin with the Concerta in the morning – then the ascending concentration profile in the blood becomes a descending profile, because the initial spike will be so big, that it would throw off the concentration profile for the rest of the day.

So, the ‘Concerta purists’ (if you could call them that) would say that you should never add regular Ritalin to Concerta first thing in the morning. If someone isn’t getting a strong enough response first thing in the morning, then they need a higher dose of Concerta.

These ‘Concerta purists’ would be fine with adding regular Ritalin to Concerta at the end of the day – if a little ‘bump’ is needed to make the medicine last longer. For example – if the Concerta lasts for 12 hours, but on certain nights, night school classes are taken, adding a 10 mg Ritalin tablet at the end of the day on those nights would be completely reasonable.

So Why Do Some Doctors Add Ritalin To Concerta In the Morning?

Despite what the researchers may say, and what studies may show in those circumstances, each person is an individual, and people have different responses to medication.

In my years of clinical experience, do I believe the ‘ascending profile’ story of Concerta to be 100% true and accurate for everyone?  No – I don’t. I have seen people for whom Concerta was a miracle medicine, and I have seen people for whom Concerta didn’t work at all. I have certainly (and regularly) seen people who add Ritalin to Concerta at the end of the day.

Concerta and Ritalin together in the morning? Not generally my practice, though I have colleagues who have done this with reported success.

The most important point for YOU:

Your treatment needs to be individualized.

I hope that you can discuss with your doctor the strategies which may help you to optimize your medication treatment for ADHD. Heck – if you’re going to take medication for ADHD, you want it to work the best it can, right?
Combining Ritalin and Concerta may just be an ‘advanced strategy’ for managing your medications that will help you and your doctor to find the right treatment.

A final point about safety: When combining Concerta and Ritalin, remember that these are the same medication, and that higher doses of methylphenidate can cause more side effects, particularly cardiovascular ones – i.e. increase blood pressure, or increase heart rate. Be sure to talk to your doctor about the ‘total daily dose’ to make sure that it is safe for you.

Please share your experiences and thoughts below.

All the best,

Dr. Kenny

p.s. I have just put together a new video on how to use ADHD Medications both safely and effectively. You can get access to that video by visiting here.

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Metadate CD for ADHD

A prescription medication to treat ADD/ADHD, Metadate CD, is variety of the stimulant methylphenidate extended-release. In this specific instance Metadata CD is designed to release one third of its medication upon initial usage. The other 70 percent is then released throughout your system slowly. This allows for only a once daily dosage.

Metadate CD is manufactured in the form of a capsule. Inside this capsule are very small beads, a percentage of which are created to dissolve at a certain rate once you take them. Because of these beads, it’s not recommended that you either chew or crush this medication.

You may, however, if you have difficulty swallowing pills, open the capsules and sprinkle the beads on a spoonful of applesauce. But, you need to take the medication immediately after it has been open. And you should avoid chewing the spoonful of applesauce. Be sure also to follow this with a drink of water or other beverage.

It’s best to take Metadate CD before breakfast. Taking it following your meal can actually delay the effect of the medication.

Metadate CD has a duration of action of about 8 hours. It’s available in six capsule strengths. They include 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, or 60 mg.

The exact dosage your doctor prescribes for you depends in large part on your age, any other medications you’ve tried in the past for you ADD/ADHD problems. Your dosage also reflects your age, as well as any other medical disorders you may currently have and any other medications you’re presently taking.

Metadate CD Side Effects

Every prescription drug on the market contains some risk. Metadate CD is no different. Side effects of this drug may include high blood pressure, to name just one problem. For the most part, people on this drug have discovered the increase in blood pressure is only temporary and usually goes back within a healthy range on its own.

The most common side effects are a decreased appetite and insomnia.

If you or your child is prone to seizures, be sure to speak to your doctor about your ability to take this drug. This medication may increase your chances of having seizures.

Other side effects include stomach pain as well as headaches, loss of and inability to sleep as well as burred or other vision problems.

If your child is taking this medication, it may also be responsible for severe and persistent dizziness, as well as chest pain, or an irregular heart beat.

You and your personal physician are best able to make the decision if this medication is right for your particular situation and condition.

Has Metadate CD worked well for you or your child? Please share your thoughts, comments and experiences below.

Best,
Dr. Kenny

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Ritalin LA: Update to Ritalin

Ritalin LA, a version of the original methylphenidate with the similar brand name is also a stimulant medicine. The difference between Ritalin LA and Ritalin is that the LA version is a sustained release medication.

Taken by mouth only once a day, it’s best given at breakfast. This capsule should be swallowed whole. Don’t crush or chew its contents, because you may be destroying the long-lasting aspect of the drug. Either crushing or chewing may also increase the risk of developing adverse side effects.

If you or your child has problems swallowing medication, you can, however, (depending on the specific brand you purchase), open the capsule and sprinkle the contents into applesauce. Before you do this, consult with your pharmacist to make sure you have the proper variety of drug.

More than likely, your physician will start you out on a dosage of 20 mg daily. If you previously had been using another methylpenidate medication, then your doctor will probably have you begin with the same total dosage as your previous prescription.

But keep in mind the specific dose of Ritalin LA, your health care provider prescribes actually depends on a number of factors, including your age, any other medication you may currently be taking, as well as other ADD/ADHD medications you’ve tried in the past.

Your physician may adjust your dosage in increments of 10 mg up to a maximum of 60 mg daily. Of course, just how long this drug lasts in your system depends on your circumstances, but it was designed to last about 8 hours.

Be patient. You may not notice any change in behavior in the first two weeks of use. According to some medical experts, that’s how long it may be before Ritalin LA takes effect in your system.

Ritalin LA Side Effects

When you take Ritalin LA, you should be aware of the side effects, which are quite similar (not surprisingly) to other Ritalin medications. Some individuals for example, have complained of stomach problems, loss of appetite as well as nausea while on the medications.

Other side effects including difficulty in sleeping, dizziness, lightheadedness as well as dry mouth. But that’s not all, in some cases side effects, such as blurred vision, irritability and nervousness have also arisen. And in a few cases, people have even complained of constipation or drowsiness. If you experience any of these conditions while on Ritalin LA, you should notify your doctor immediately.

Ritalin LA is extremely convenient for those who have trouble remembering to take up to three pills daily. And, like other long lasting medications, children don’t have the embarrassment or the hassle of visiting the school nurse in the middle of the day in order to take their necessary medication.

How has Ritalin LA worked for you? Please share your comments and experiences below in the comments section.

Best,
Dr. Kenny

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Focalin XR: Medicine for ADHD

Focalin xr

Focalin XR is a relatively new ADD/ADHD medication. Its chemical name is dexmethylphenidate hydrochloride. This long-acting version of Focalin can be used to treat not only children, but teens and adults as well.

Each capsule of this medication, like so several other attention deficit drugs, is filled with beads in a precise ratio set to release the drug at specific intervals. In the case of Focalin XR, half of one capsule (regardless of the dosage) is filled with beads designed to release immediately. The other half of the beads is enteric-coated, delayed-release set to provide another dose of the medication at a later time.

Your physician can prescribe this version of the drug in different strengths: 5, 10, 15, 20, and 30 mg capsules. One of the assets to these increments of 5 mg is that adjustments in medications can be more finely tuned.

Some doctors have prescribed daily doses as high as 30 to 40 mg. To give you an idea of the strength of the dosage, compare it to that of Concerta. If these were “translated” into an equivalent dosage of Concerta, for example, it would be somewhere between 54 and 72 mg.

This longer-acting version of Focalin lasts about 8 hours in the body compared to the 5 hours of regular Focalin. The latest studies reveal that it’s approximately 70 percent effective in alleviating ADD/ADHD symptoms.

Perhaps the most welcome aspect of this drug, though, especially for younger children is that it requires only 30 minutes before it starts working on a system. This provides children with some relieve and help in the early hours of the morning, when they first start waking up and preparing for the school day itself…

Many parents say that the mornings are the most difficult for children with ADD/ADHD. Results of a survey conducted several years ago seem to bear these observations out with some statistics. This survey revealed that out of a total of 16 specific behaviors investigated parents or caregivers reported 12 of them were worse before the start of school.

These behaviors included speaking out of turn, failure to complete tasks, poor concentration, messiness, and interrupting others, to name just a few.

According to some specialists, this quick acting onset also helps children academically at the start of the school day as well.

If you experience any of the following side effects of Focalin XR, consult your physician. The symptoms include: dry mouth, heartburn, stomach pain, headache, difficulty or change in sleeping pattern, loss of appetite, weight loss or nervousness.

Is Focalin xr a good choice for your specific situation and symptoms? Only you and your physician can decide that.

Do you have personal experience with Focalin XR? Please share it below to help other people learn more.

Best,
Dr. Kenny

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Daytrana: The ADHD Patch

This particular medication, Daytrana is the only medication authorized to be applied as “patch” for ADD/ADHD treatment. Its chemical name is methylphenidate transdermal system, and it stimulates the central nervous system. It is often called the ‘Daytrana patch’, the ‘ADHD patch’, and it’s even called the ‘Ritalin patch’.

If you have been using the oral form of methylphenidate prior to this and are changing to the skin patch, your doctor may advice you to start out with a low-dose of the patch. Your schedule then may call for a stronger patch with each succeeding prescription. Of course, it goes without saying (or should) that you shouldn’t change the dosage of your Daytrana with the express consent of your doctor.

The dosage most recommended fro children with ADD/ADHD is 20 mg applied once daily in the morning. More than likely your physician will start with this, and increase the dosage in weekly sessions if warranted.

To use the patch effectively, you’ll start by opening the sealed pouch. Then you’ll remove the protective liner. Press the patch onto the skin (most physicians recommend to do this in the hip area) and hold it down with your hand for about 30 seconds to help ensure its adherence.

Make sure that the patch is particularly well sealed around its edges. If you’ve applied this patch properly, you should have no concerns about using it either when bathing or swimming.

Within two hours of applying this medication, it should begin working for you. Daytrana is manufactured to last approximately nine hours — and after this time you should remove it. You should not take this medication for more than nine hours daily by the way, even if you had to replace a partially used one because it fell off.

The effects of this medication can be felt throughout your system for another three hours, after your remove it.

This particular medication actually comes with a chart to help you track when you’ve applied them and removed them.

The 10 mg patch releases about 1.1 mg of the medication per hour. This means that entire patch contains approximately 27.5 mg. Additionally, there’s a 15 mg patch, a 20 mg version as well as a 30 mg patch.
Some people discover that they have problems sleeping at night or even notice a loss of appetite while using this form of ADD/ADHD medication. One method to remedy this is to put it on earlier in the day, or alternatively take it off earlier at the end of the day.

<h2>Daytrana Side Effects</h2>

Some people report that they experience impaired vision while on Daytrana; others say that the drug makes them drowsy. One of the side effects of this patch is variation in sleeping patterns. Some people, for example, complain of insomnia while on it.

Other side effects of Daytrana may include milk skin redness where the patch has been placed. This includes the presence of bumps or itching. Some individuals report nausea or vomiting while on this drug; others report weight loss and a loss of appetite. Still others complain of a stuffy nose and sore throat. Talk to your doctor about any side effects or concerns with this medicine.

What’s your experience with Daytrana been? Is it a good alternative to pills? Please share your comments below.
Best,

Dr. Kenny

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Concerta: The First Long Acting ADHD Medicine

As ADD/ADHD medications go, Concerta is a relatively new drug.  But in the short time it’s been available, it seems to be an extremely popular choice. Concerta contains the same active ingredient that Ritalin has, the stimulant methylphenidate.

The advantage of this drug over many of the others is that you — or your child — only need to take it once a day.  In fact, when it was introduced to the pubic, it was the only time-released formula available.  And now you can see why it gained popularity so very quickly

One single tablet provides up to 12-hour coverage. But more importantly, in the eyes of those who created it, Concerta provides an evenly dispersed amount of coverage.  When children take Ritalin several times throughout the day, they’ll experience the normal peaks and valleys that naturally come with the rising and falling of the medication in their bloodstream.

Concerta may be prescribed in four distinct dosing levels.  Your physician may start you or your child out on the smallest dose, 18 mg.   The other three dosages are:  27 mg, 36 mg and 54 mg.

And it’s this single use ease of the pill that sets it up as being unique from other ADD/ADHD medications when it was first released. Now there are other once daily ADHD medications as well. But it’s also this delayed release mechanism that may cause concerns for some people taking it.

Quickly let’s look at what the difference involved in taking 20 mg of Ritalin three times a day, to taking a 54 mg single pill of Concerta once a day.  When looking at Concerta doses, it’s important to know that 22% of the medicine is released immediately, and the rest of the pill supports that dose. That means that the 54 mg dose of concerta is like taking regular Ritalin 12 mg three times per day. This is obviously quite lower than Ritalin 20 mg per day. This is why it is important that your doctor get the dose right when using Concerta.

Side Effects of Concerta

Of course, Concerta like any other prescription medication administered for any disorder or disease, is not free from adverse side effects.  According to the medical community, the side effects of Concerta are less pronounced than some of the ones that accompany the use of the older medications.  Some people not only complain of physical side effects, like abdominal pain, dizziness, and headaches.  But some of the known effects of Concerta also include an increased feeling of aggravation, nervousness and even a pronounced hostility.

Others have reported, as a consequence of taking this drug, inability to sleep, loss of appetite, as coughing and the presence of sinusitis.  Other side effects may include vomiting, allergic reactions as well as increased level of blood pressure.

Some individuals have even complained of experiencing symptoms most closely associated with psychosis, such as abnormal thinking or hallucinations.  If when you’re taking this medication, you experience any of these side effects, let your doctor know immediately.

Concerta can be a real hope for many people — especially children — who only want to take one pill a day.  For many students, this single tablet alleviates the need to visit the school nurse at noon.  And that can mean so much in the way of self esteem.

Not taking it now, but think it might be right for you?  Check with your doctor.  He’ll be able to provide specific recommendations for your personal situation.

Please share any of your comments or experiences below.

Best,

Dr. Kenny

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Ritalin – Still a Viable Option

Although there are many newer medicines available for ADHD, Ritalin is still prescribed regularly, and it often gets a lot of media attention.

As a parent — or an adult — with attention deficit disorder you’re doing the smart thing by researching the medication you’re taking for your condition. I’m a firm believer that knowledge is power. And the more you understand the mechanisms by which Ritalin and other medications work, then in the long run, you’re far more likely to control your ADD/ADHD than have it control you.

It seems ironic, doesn’t it? That many individuals with ADD/ADHD whose symptoms include hyperactivity would be given medication classed as a stimulant to help calm them. Ritalin is just one class of stimulant drug providing relief for you and hundreds of thousands of others.

Ritalin is also known by its chemical name of methylphenidate. Ritalin is the trade or brand name under which it’s sold. With only a four hour duration, you’ll discover that the individual with ADD/ADHD will need to take this prescription drug in the morning, at noontime as well as a dose at roughly 4 p.m.

These three separate doses provide you with coverage for a 12-hour period. That’s a good portion of a functioning day in anyone’s book. And it gives the individual just about the maximum coverage for the day.

While Ritalin may be short acting, your personal care physician may want to eventually combine it with another drug to help extend its effectiveness. He may prescribe Ritalin as well as a longer-acting methylphenidate preparation. Perhaps he believes your Ritalin isn’t working as effectively as it should.

He may request that you also try using Concerta in the morning with your Ritalin. Your dosage may look something like this then. In the morning, you take Ritalin and a specific dose of Concerta. This dosage is created solely for your specific situation. He may also ask that you take this second form of stimulant at the second dosage.

Many individuals have a medication schedule that include both Ritalin and Concerta in the morning and the afternoon (or at either time period) to help length the effects of this medication. Usually then they take Ritalin only in the evening.

Difference Between Ritalin And Ritalin SR

There is another, second variety of Ritalin available as well. It’s called Ritalin SR. the SR stands for slow release. It’s the same formula as the original, except in the slow release form, the medication is placed in a waxy substance to allow it to release in a steadier, more gradual rate.

This medication isn’t side effect free however. While your son or daughter is taking it you may notice some these more common adverse side effects. Among the most common of these are insomnia and decreased appetite. And do let your physician know if you or your child is experiencing either of these. The two common effects can easily be managed through the careful timing and dosing of the medication itself.

Some individuals get a skin rash, fever, headaches, anorexia nervosa, drowsiness, nausea, abdominal pain and dizziness. If you experience any of these conditions while you’re using Ritalin, be sure to notify your health care professional

Ritalin was the first prescription to be given for the treatment of ADD/ADHD and it was first used in 1958. To this day it’s still the medication most widely associated with the disorder.

While many people have a ‘knee-jerk’ negative reaction to Ritalin, it may still play a role in a reasonable treatment plan for ADHD.

Please share your thoughts below.

Dr. Kenny

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