Archive for Concerta

Methylphenidate Shortage in Canada

methylphenidate 300x200 Methylphenidate Shortage in CanadaMarch 12, 2014

There has been a recent shortage of the short acting Methylphenidate medication in Canada. This is listed on the website DrugShortages.ca (and you can visit that site to check if the shortage is still an issue).

Methylphenidate is a stimulant medication used to treat ADHD. It is the active ingredient in the following medications: Ritalin, Ritalin SR, Biphentin and Concerta. However, the only form of this medication which is impacted by the shortage is the short acting version. Specifically, the 10 mg tablets, and the 20 mg tablets.

This shortage does not impact the availability of the long acting versions of methylphenidate such as Biphentin and Concerta.

Although it’s generally recommended that the long acting medications (such as Concerta and Biphentin) should be used to treat ADHD, as they work better for individuals with ADHD, there are still occassions that doctors will use a short acting stimulant medication.

These could include:

  • Using a long acting methylphenidate medication in the morning and then taking a short acting in the evening when it has been a particularly long day (i.e. topping up the medication for night school)
  • When a teen sleeps in on the weekend and gets up too late to take a long acting medication, they may take a short acting mid-day on the weekend to have some stimulant treatment
  • There are some patients (in my experience this is very few) who don’t do as well with a long acting medication as they do with a short acting version

If you or your child is taking a short acting version of Methylphenidate, you may have a hard time refilling the prescription. The pharmacist will likely tell you that the product is ‘back ordered’. However, if the pharmacy still has stock on their shelves, then you should be able to fill the prescription.

Here’s what you can do if you are stuck and cannot refill your prescription for methylphenidate:

  1. Ask the pharmacist to call other pharmacies to see if they have stock on their shelves (i.e. they will be able to call other pharmacies in their ‘chain’ (such as Shopper’s Drug Mart) and if another pharmacy has stock, they may be able to get it for you)
  2. Phone other local pharmacies and see if they have stock on their shelves, and then take your prescription to that pharmacy (you would have to take an actual prescription, as pharmacies cannot transfer prescriptions for methylphenidate from one pharmacy to another).
  3. Check if your pharmacy can order in the 5 mg tablet of Methylphenidate. If they are able to, contact your doctor’s office and explain that you need the doctor to change the prescription to the 5 mg tablets because of the medication shortage.

If none of these strategies work, then be sure to see if you can take either of Biphentin, Concerta, or even Ritalin SR to see if they can help you. Alternatively, you may benefit from a trial of an amphetamine medication – such as Vyvanse, Adderall XR, or Dexedrine. That would be an issue you’ll have to discuss with your doctor.

Please share any experiences you’ve had – particularly if you have a strategy which could be helpful to others.

Best,

Dr. Kenny

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How To Tell The Difference Between Concerta and Generic Concerta

In Canada, there is a generic Concerta available. It’s called: Teva-Methylphenidate ER-C (it was formerly called: Novo-Methylphenidate ER-C). Many people have had trouble with this generic, and it is widely accepted by doctors in Canada and patients that the generic doesn’t work as well as the brand name concerta.

One question which has been sent in to me a number of times is: How do I tell the difference between the brand name Concerta and the generic Teva-Methylphenidate ER-C?

When someone isn’t medically trained, it can be very confusing. I have tried to explain to people over the phone (or in blog comments!) how to tell the difference. And then I thought of the saying: “A picture is worth 1,000 words”. I was able to find an image which clearly shows the difference between the two medications. I was able to get permission from Janssen (the maker of Concerta) to share this image with you.

To tell the difference between the brand Concerta compared to the generic, notice a few features:

  • The brand Concerta has the word ‘Alza’ typed in black on its side; the Generic Teva MPH ER-C does not have this typed word on it
  • The brand Concerta looks more rounded like a little soda can, compared to the generic which is an oval pill
genericconcertacanada 801x1024 How To Tell The Difference Between Concerta and Generic Concerta

Generic Concerta vs. Brand Name Concerta in Canada

Please share any comments below. And feel free to share this with anyone who may benefit from knowing about this.

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 the US

Article updated on May 11, 2011:

A recent new report shows that Watson Pharmaceuticals is cleared to create a generic form of Concerta for the US. A recent court of appeal decision is reported to have said that the patent on Concerta is invalid and that Watson is cleared to make their own version of the drug. Johnson and Johnson, the parent company which makes Concerta, had worldwide sales of $1.33 billion of Concerta last year.

Update:

According to this report, Watson is now authorized to sell a generic version of Concerta. This report shares the fact that the sales of Concerta totaled $1.5 billion in the year ending Feb 28, 2011 (it is unclear if that is worldwide or US data).

The report says:

Johnson & Johnson’s Ortho-McNeil-Janssen Pharmaceutical unit is making and supplying the drug, and it will receive a share of the revenue from sales. Watson will market and distribute the generic.

The agreement lasts until the end of 2014. Watson can launch its own generic version when the deal ends.

What does this mean for you?

If you take Concerta (and you are in the USA), then it appears that you will be able to get a generic version of the drug which is sold by Watson, and manufactured by Ortho-McNeil. In other words – this should be the exact same medicine. This will last until 2014 – at which time this deal ends, and Watson will be creating its own version of generic Concerta.

This is quite a different circumstance than what is going on in Canada.
My experience in Canada is that the new generic Concerta which has surfaced in Canada is quite an inferior drug, and falls short of Concerta in many ways. That didn’t stop Health Canada from approving the medicine, and deeming it interchangeable – which allows pharmacists to automatically substitute the medicine to people, even if they come in with a prescription requesting Concerta. To read more about this, please refer to my article on Generic Concerta in Canada.

As always – the power of this blog comes from the discussion -and from you sharing your experiences and providing real feedback as to what is going on. As your prescription shifts from the ‘brand name’ Concerta to the Generic Concerta (from Watson), please take a moment and let us know if it is working well and if it seems the same to you.

Best,

Dr. Kenny

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ADHD Medication: $4.2 Billion?

A recent news release came out sharing that the global market for ADD/ADHD medications is expected to reach $4.2 Billion (with a ‘B)  worldwide by 2015. It is projected to go up to $3.3 Billion by 2012.

Whenever I see statistics like this, I find myself having a mixed reaction.

On the one hand, I know that there are studies clearly establishing that there are more people who have ADHD and have not been diagnosed and treated, than people who have it and have been diagnosed and treated. So – seeing that the numbers will be up for pharma companies means that there is more awareness and people are getting a diagnosis and the help that they need.

On the other hand – these types of data can seem quite concerning. How many pills are there in $4.2 billion dollars of income? How many people are taking ‘mind altering medication’? That is certainly what the detractors from ADHD will say. Despite the validity of the diagnosis of ADHD, many still question it, and feel that it is not a valid diagnosis. And when they read this type of statistic, they conclude that ADHD really just a fabrication of the pharmaceutical companies to sell more medicine.

All in all, my perspective is this: There are a lot of studies (I mean a LOT) which show that medications work very well for ADD/ADHD. There are a LOT of studies showing the safety of the medication. There are also studies showing that medicines work best when they are part of a combination treatment. People taking medicines is not wrong, or a problem – in my opinion. The only time I see medications for ADHD as a problem is when people haven’t received a proper assessment and diagnosis – and then they are taking ADHD medication when they may not actually need it. If you (or your son/daughter) is taking ADD/ADHD medication after a thorough assessment, and it is being monitored by a doctor, then it is safe, and hopefully quite helpful.

Of course, the other benefit to the increase of prescriptions, is that likely this means that a lot more people are being diagnosed. Hopefully many of the adults with ADHD who thus far have had trouble getting the proper diagnosis and treatment.

So, here’s my question for you: when you see numbers like that – does it freak you out? Are you OK with it? Do you think it fuels the ADHD detractors?

Please share your opinion in the comments below.

Best,

Dr. Kenny

p.s. my goal is to provide information to people to make the best healthcare decisions they can make at the time they need to. That is why I have created some products on using ADHD medication safely and effectively, as well as some products on alternatives for ADHD. You can click through to those sites to learn more.

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Generic Concerta: Health Canada to Review

Generic Concerta was introduced into Canada around February 2010. As I’ve written in my full article about Generic Concerta – I’m quite concerned about the fact that the new generic medicine does not have the same properties as brand name Concerta – and this may lead to problems for patients who are automatically switched from brand name Concerta to Novo-Methylphenidate ER C.

You may wonder – am I against generic medicines?

Not at all.

In fact, I have taken many generic medicines myself, and so have my family members.

The issue is that for most people, taking a generic for stomach issue, or for asthma is often completely fine. It is however different, in my opinion, to take a generic for a psychiatric condition, such as ADHD.

The other big difference is that Concerta was developed based on the principle that its pharmacokinetic profile is different. What does that mean? It means that the way the medicine is absorbed throughout the day has an impact on how the medicine works.

In other words – in this ‘next generation’ medicine – the old rules for how to create a generic shouldn’t really apply. Just assessing whether the new generic has similar medicine absorbed throughout the day misses the fact that the rate of absorption of Concerta is part of what makes it so effective.

Advocacy Works:

Thankfully, our friends at Health Canada are listening. They have at least acknowledged that there may be a difference with how they should evaluate generics when it comes to medicines like Concerta.

Health Canada has created a committee called: The Scientific Advisory Panel on Bioequivalence Requirements for Modified-Release Dosage Forms (SAP-MRDF). Their draft terms include the following wording:

“The Scientific Advisory Panel (SAP) on Bioequivalence Requirements for Modified-Release Dosage Forms (SAP-MRDF) provides advice to Health Canada on appropriate bioequivalence standards for modified-release dosage forms of pharmaceutical drugs. Of particular interest are those drugs where concerns have been raised that existing standards may not be adequate, for example, methylphenidate and nifedipine. The Panel provides Health Canada with advice and recommendations, but the decision-making responsibility remains with Health Canada.”

This committee will be meeting in Ottawa on June 11, 2010 to receive input and submissions to understand the complexity of this issue.

Hopefully, this process will bring forward the science that Novo-Methylphenidate ER-C does NOT have the science behind it to be defined as a generic form of Concerta. This would then change it to be another lower cost option for people to use for ADHD, rather than a medicine which is automatically substituted for Concerta.

I will update this blog with information as I receive it.

Best,

Dr. Kenny

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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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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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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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