View Full Version : 4 yr old crashing after 3 hours on Ritalin IR!


tamelao
08-23-11, 03:39 PM
Hello,

My 4 year old is on Ritalin IR 5 mg at 7:00 am and then 10:30 am. His school is reporting that right around 9:45-10:00 am, he becomes emotional, anxious, and rebellious. Today, he threw his pencil across the room, told the teacher he wanted to go home and would not cooperate. However, BEFORE that time, the teacher reports his behavior is AWESOME. She said he stays on task and is very pleasant. His school work is completely different on the Ritalin and I prefer not to take him off. However, I am concerned about the negative behavior just 3 hours after dosing. I have contacted his doc today about this. What are your thoughts?

Lady Lark
08-23-11, 08:50 PM
He's probably suffering from rebound before the second dose is given. It gives you that up and down roller coaster effect. You can do/try several things. Give him the second dose sooner, increase the first dose, or try an extended release. I would talk to the doc about what will be best for him.

Turbochica
08-23-11, 09:57 PM
He's probably suffering from rebound before the second dose is given. It gives you that up and down roller coaster effect. You can do/try several things. Give him the second dose sooner, increase the first dose, or try an extended release. I would talk to the doc about what will be best for him.

I tried ritalin only once and HATED the rebound. I switched to Concerta xr and liked that much better.
I was so glad my daughter never took ritalin. (She was diagnosed and on meds before me.)

Imnapl
08-23-11, 11:11 PM
I am a mature adult and I have taken regular Ritalin on a daily basis since 1996. There are days when I feel the Ritalin wear off at three hours and other days when I don't notice it has worn off after four hours. My son and daughter are adults and both experience the same thing. There are several adults (some of them moderators) who need to take regular Ritalin more frequently than even every three hours.

According to research, regular Ritalin starts to take affect in our brains about 30 to 60 minutes after we take it. We reach a peak effect for approximately the next two hours (for several people) and then it starts to decline. The drug info tells us to take a dose every four hours, but those guidelines are not set in stone - one of the advantages of taking a regular release medication.

Good advice to discuss this with your child's prescribing physician. Please remember to tell him that the stuff is working really well, according to your son's teacher, but you may need to adjust the dosing schedule. Isn't it great when meds work for someone?

tamelao
08-24-11, 01:33 AM
Thank you everyone for your responses. I did not hear back from the doctor today and I am a bit peeved about it. However, when I picked up my son today, the teacher told me he went from this pleasant child to an uncooperative one in an instant. That definitely sounds like a crash to me.

I am curious as to why giving him a stronger dose initially will help with rebound? He would still crash at 3 hours, correct?

StoicNate
08-24-11, 02:14 AM
A stronger dose won't make Ritalin last longer. It will only cause him to have a harder rebound, which won't help him.

Is it possible to give him a tablet right after his morning dose wears off? OR have a lunch time tablet?

OR maybe a longer acting form of Ritalin would be better like: Concerta, Metadate CD, Ritalin LA.

tamelao
08-24-11, 08:05 AM
StoicNate,

I am sorry but I should have mentioned she did give him another 5mg dose BUT it was after the rebound and it took 2 HOURS for him to come around.

happytexas
08-24-11, 08:42 AM
As a pp said, a second dose not a stronger dose, and it would have to be given before his "regularly scheduled" crash.

I would ask his doctor about the extended release Ritalin (Ritalin LA) which is meant to avoid these types of problems (it can be more expensive which is one reason the short acting may be prescribed). It may be that he metabolizes the medication more quickly than the average person.

When you can your Dr. I would tell the receptionist what action you expect--such as you consider this an urgent matter and would like a call back today (in case you didn't). It would be a good idea to check the fee schedule for the Dr. so there are no surprises; ds' new psych has charges differently depending on the length and complexity of calls he is involved with directly (as opposed to just leaving a message for a new prescription).

tamelao
08-24-11, 12:27 PM
Good News! The teacher gave him his dose an hour and 15 minutes earlier and his day has been awesome! I guess now I need to research which LA version to put him on. He has been on focalin and that was a hot mess!

happytexas
08-24-11, 01:28 PM
Good News! The teacher gave him his dose an hour and 15 minutes earlier and his day has been awesome! I guess now I need to research which LA version to put him on. He has been on focalin and that was a hot mess!

Having said what I said above, I'm also a fan of not rocking the boat. If the teacher can be relied on to give him the second dose at the earlier time everyday, you may want to stick with it as long as its working. I'd just keep note (I use a large "teacher style" binder calendar) of how he does each day so you can note any downward behavior trends.

tamelao
08-24-11, 01:50 PM
HappyTexas, thank you for your response. I should add that he needs to stay medicated until 4:00 everyday. The problem is he prescription is only for for twice a day because the doctor thought it would last him 8 hours. However, since we see that it is only lasting 3 hours, he needs an additional dose or doses.

tamelao
08-24-11, 02:36 PM
Update: I just spoke with the doctor and she wants to put him on Concerta 18mg which equates to Ritalin IR 5mg 3x a day. I am nervous...........

geus412
08-24-11, 10:24 PM
Dont be nervious.. My son had the same issue on the ritalin... and his afternoon dose NEVER affected his behaviour.. the AM wore off and it was a BAD day after that. We went to Concerta and amazing results... he gets it about 7-8am and is good usually til about 7pm. He is also taking risperdol for anger. My son's doc gave him Clonadine(sp) to help with the crash effect at night when on Ritalin... he helped him calm down and sleep. Good luck!





Update: I just spoke with the doctor and she wants to put him on Concerta 18mg which equates to Ritalin IR 5mg 3x a day. I am nervous...........

Lady Lark
08-24-11, 10:41 PM
Actually I suggested a stronger dose as a possibility because I have seen several members here over the years say that helped them, even though it sounds counter to what would be normal. It's just one possibility that I threw out there. :)

tamelao
08-24-11, 10:56 PM
Dont be nervious.. My son had the same issue on the ritalin... and his afternoon dose NEVER affected his behaviour.. the AM wore off and it was a BAD day after that. We went to Concerta and amazing results... he gets it about 7-8am and is good usually til about 7pm. He is also taking risperdol for anger. My son's doc gave him Clonadine(sp) to help with the crash effect at night when on Ritalin... he helped him calm down and sleep. Good luck!

Thank you for your response. What does is your son on? Also, what dose of Ritalin was he on?

happytexas
08-25-11, 09:21 AM
Update: I just spoke with the doctor and she wants to put him on Concerta 18mg which equates to Ritalin IR 5mg 3x a day. I am nervous...........

So three short acting Ritalin won't work, or is the doctor trying to make things easier? If you are interested in staying with the short acting Ritalin I would ask about it; you can question the Dr's suggestions; sometimes what you want to do would work fine but they just think their suggestion is easier/better. I just wanted you to know that you have the option to ask why or say no :o. I fell into a pattern with ds' psychiatrist that I said no the first time she suggested a change, but usually said yes by the next appointment--now it seems like she was being proactive but I was waiting to make changes until it felt necessary to me.

I don't have any direct experience with Ritalin, but ds did start out on Concerta (ds was pretty much equal parts aggression, hyperactivity, and impulsivity).

Concerta was a HUGE improvement for ds over not being medicated. 18mg didn't do much so we went to 36mg. Then his impulsivity got out of control and we tried 54mg--that made things much worse, so we switched to Vyvanse--it seems that doctors tend to try Concerta first and then move to Vyvanse if Concerta isn't working.

Vyvanse worked well, but ds was still having impulsive/aggressive incidents--usually having to do with classmates who really knew how to push his buttons. So we upped the dose from 40mg to 50mg and that helped a bit more, then I added the Dr. Sears Omega-3 DHA chews back in (I stopped for awhile because ds had found my stash and had eaten a couple dozen) and ds started doing great the last few weeks of school.

Ds had been in school 3 days and I haven't heard a peep about his behavior:D though the first two weeks tend to be a honeymoon anyway. It seems to me that just the passage of time is helping ds a lot. 4 years old was a really difficult year for him and us; I wish we had known about the ADHD back then.

Has he seen an OT? ADHD children frequently have sensory issues as well. Ds' OT had us start joint compressions & brushing his limbs and back (with a "special" plastic therapy brush); I noticed ds started going to sleep more quickly when we did this. I've also added rubbing J&J's Lavender Lotion after I brush, the smell of Lavender is supposed to be relaxing. Ds also takes a 3mg time-release Melatonin, and we use room-darkening curtains that we bought at Walmart (Target has more of the girly colors and are more expensive).

tamelao
08-25-11, 10:24 AM
So three short acting Ritalin won't work, or is the doctor trying to make things easier? If you are interested in staying with the short acting Ritalin I would ask about it; you can question the Dr's suggestions; sometimes what you want to do would work fine but they just think their suggestion is easier/better. I just wanted you to know that you have the option to ask why or say no :o. I fell into a pattern with ds' psychiatrist that I said no the first time she suggested a change, but usually said yes by the next appointment--now it seems like she was being proactive but I was waiting to make changes until it felt necessary to me.

I don't have any direct experience with Ritalin, but ds did start out on Concerta (ds was pretty much equal parts aggression, hyperactivity, and impulsivity).

Concerta was a HUGE improvement for ds over not being medicated. 18mg didn't do much so we went to 36mg. Then his impulsivity got out of control and we tried 54mg--that made things much worse, so we switched to Vyvanse--it seems that doctors tend to try Concerta first and then move to Vyvanse if Concerta isn't working.

Vyvanse worked well, but ds was still having impulsive/aggressive incidents--usually having to do with classmates who really knew how to push his buttons. So we upped the dose from 40mg to 50mg and that helped a bit more, then I added the Dr. Sears Omega-3 DHA chews back in (I stopped for awhile because ds had found my stash and had eaten a couple dozen) and ds started doing great the last few weeks of school.

Ds had been in school 3 days and I haven't heard a peep about his behavior:D though the first two weeks tend to be a honeymoon anyway. It seems to me that just the passage of time is helping ds a lot. 4 years old was a really difficult year for him and us; I wish we had known about the ADHD back then.

Has he seen an OT? ADHD children frequently have sensory issues as well. Ds' OT had us start joint compressions & brushing his limbs and back (with a "special" plastic therapy brush); I noticed ds started going to sleep more quickly when we did this. I've also added rubbing J&J's Lavender Lotion after I brush, the smell of Lavender is supposed to be relaxing. Ds also takes a 3mg time-release Melatonin, and we use room-darkening curtains that we bought at Walmart (Target has more of the girly colors and are more expensive).

My DS just started OT. He has a fine motor skills issue. I do agree that sensory issues and adhd go hand in hand.

As far as the Ritalin, she was open to either way. However, she was concerned that the Ritalin would not last long enough considering how quick it runs through his body. I picked up the script for 18 mg but I have not filled it. I am going to fill it and see how he acts over the weekend. I am actually trying the dose of Ritalin IR 3 times today. He is doing it at 7, 9, and 12:15. If he crashes, I am going to pick him up.

tamelao
08-26-11, 11:06 AM
So, the teacher calls last night and informs me that DS was zombied after the 3rd dose at 12:15. She wants him to skip that dose but I am scared he is going to rebound.

happytexas
08-26-11, 10:19 PM
So, the teacher calls last night and informs me that DS was zombied after the 3rd dose at 12:15. She wants him to skip that dose but I am scared he is going to rebound.

In that case, I'd consider his doctor's recommendation to change medications.

tamelao
08-26-11, 11:11 PM
In that case, I'd consider his doctor's recommendation to change medications.

See here is the thing, she calls me today around 12:30 and says he is showing signs he needs that 3rd dose and she gave it to him. I filled the script for Concerta 18mg tonight and will give it to him in the morning. I am going to talk to the doc about daytrana cuz I heard concerta works short term and then stops.

tamelao
08-28-11, 01:26 AM
Update:started him on concerta today and he was sluggish and sleepy all day. Now it is after midnight and he is WIDE awake! Concerta is of the DEVIL!

happytexas
08-28-11, 09:54 AM
Update:started him on concerta today and he was sluggish and sleepy all day. Now it is after midnight and he is WIDE awake! Concerta is of the DEVIL!


:( I'm sorry it didn't work right out of the gate. Sometimes it actually works better to give the stimulant in the evening--since it made him sleepy in the day and awake at night, this may be one of those times.

angora
08-28-11, 10:49 AM
Tamelao,

I would try the concerta for a few more days. I find it takes my body three or four days to get used to a new stimulant medication.

Ritalin made my son and I, tired and sleepy and gave us headaches for three days when we first started it and when we increased the amount. We have none of those side effects now.

My son takes concerta now. It works for him and is much easier.

Am I correct in assuming that your son just started on ritalin this week?

tamelao
08-29-11, 12:44 AM
Yes, he just started on Ritalin IR this week and did not have have the same effects. However, the concerta, not so much. Unfortunately, he has school tomorrow and there is no way he can take concerta and function. I am forced to give him the Ritalin IR foe tomorrow.

happytexas
08-29-11, 09:30 AM
Yes, he just started on Ritalin IR this week and did not have have the same effects. However, the concerta, not so much. Unfortunately, he has school tomorrow and there is no way he can take concerta and function. I am forced to give him the Ritalin IR foe tomorrow.

Perhaps you can pick him up early until you have the med situation sorted out? and try out new meds on the week ends. On the one hand I know it can take time to adjust to a med, on the other ds needed to be able to at least be able to not assault people or have major meltdowns in school.

tamelao
09-06-11, 11:03 PM
Thank you Happy Texas! He went and saw the Psch and he is of the belief that DS cannot take long acting meds at this time. He wants him to remain on Ritalin IR but warned we may have to up the dose or switch back to adderall or something else short acting because he will build up a tolerance. Right now, it seems to be working fine. He seems to have adjusted well in his class. No more meltdowns and his work looks really good.

geus412
09-23-11, 08:08 AM
Thank you for your response. What does is your son on? Also, what dose of Ritalin was he on?


He was on the lowest dose of Ritalin 5mg i think.. cant remember.. 2 x's a day.. then we uped that dose to giving it 2 in the morning and 1 afternoon with 1/2 his clonadine.. and he honestly, went nuts!!
Concerta worked for about a month... then he started to get hyper active again.. we increased the dosage and total meltdown.. so back to square one for us... Good luck!