I have heard much about the tolerance issues associated with Adderall, and comparatively little about tolerance to Concerta. Is tolerance less of a concern with Concerta? Any information of your own experiences with tolerance and Concerta, however anecdotal, would be greatly appreciated.

A second question: Is cross-tolerance an issue when switching between Adderall and Concerta? Are they pretty much linearly related, or can you reduce tolerance issues by regularly switching between the two (say, every three months or so)?

I'm confused. I thought Concerta was Methylphenidate, and Adderall was Dextroamphetamine. Aren't those completely different stimulants?

Aren't those completely different stimulants? Yes. My second question was, does tolerance to one stimulant reflect in any way as tolerance on the other? That they are different chemicals doesn't rule out this possibility: They may affect the brain in similar ways, and the brain's development of tolerance to one may be felt as cross-tolerance in the other.

Regardless of the similarities or differences between the drugs, I was also asking about Concerta tolerance in general. Is it an issue? If so, how drastic is tolerance with Concerta in general? Does it compare to tolerance with Adderall, which I have heard can have quite an effect after a few months of use?

No, you can easily develop it for both.

And no, they are indeed diffrent compounds, having diffrent methods of action. If you switch to adderall from concerta, you are having the full effects of adderall, and vice versa. They effect diffrent responders. About the same as taking an advil and then having a caffine pill.

I'm reasonably sure that cross-tolerance develops. I've seen many studies indicating such on pubmed. Think about it. One way or another, they both increase dopamine, one by releasing more dopamine and mildly inhibiting re-uptake (amphetamine). The other, by aggressively inhibiting re-uptake (methylphenidate) of dopamine. In both cases, you have dopamine receptors getting more dopamine than they're used to. The body responds by reducing the sensitivity of the dopamine receptors, which is called down-regulation.

Regarding tolerance to stimulants in general, it's a problem for some people and not a problem for others. I don't believe we're sure why. I think if tolerance is a reality, then it can be minimized by minimally taking the drug, i.e. taking it 6 days a week instead of 7. Skipping the evening dose and just being content with 8 hours of coverage/day instead of 12-14, etc.

Its due to prossessing that tolerance develops. The drugs were designed to be compleatly out of the system by 8-12 hours. That inst the case most of the time.

Now the cross tolerance issue has been well documented. There is no such tolerance. Drinking milk also effects the dopamine in the brain, as does carb heavy food. As does droves of other factors. Now if you alwase get sleepy after eating a big meal, does that mean in a few months it wont effect you any more?

Actualy, ive known of a few people who develop a tolerance to stimulants quite quickly (usualy a month or so) that have adderall one month, then ritalin the other. Worked quite well for them. But it doesnt sound like somthing I would want to go threw.

Actualy I think I should say that technically you are correct, almost anything that stimulates the dopamine in the brain will cause that to some degree, but the methods of action, as diffrent as they are, make the effect almost unknown, or compleatly in some cases. As does quite a few other products. But its so small, that there could never be the chance for you developing a tollerance to the other medication.

I know that some people do switch meds in order to get around the tolerance problem that can develope in some people. Not everyone has issues with tolerance, but it does seem to occur - I've read about it and heard anicdotal evidence from people here.

Cross tolerance is not something to discount so readily. See these studies:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6791199

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=978464

If anyone has access to this study, please share its conclusion!

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11773663

And this study too might require special access privileges:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7301057

From a paper by Dr. Mary Ann Block

In humans, chronic administration of Ritalin produced tolerance and showed cross-tolerance with cocaine and amphetamines.
And if you look at the study you posted,

Administration of d-amphetamine (2.5 mg/kg) or methylphenidate (20 mg/kg) decreased milk consumption in rats.
Thats quite a bit of product.

But under normal usage, there is no known cross-tollerance issues. Perscribing two diffrent substances is pretty common. Its not what most Dr.'s prefer to do, but its done none the less when it is needed.

Daven, you as well as I know, "no known issues" doesn't mean no issues. It simply means we cannot conclude either way. Regarding your quote by Ann Block, this seems to support a theory that you might be trying to debunk. Chronic does not necessarily mean high. Chronic simply means every day. I take amphetamine, chronically.

Daven, you as well as I know, "no known issues" doesn't mean no issues. It simply means we cannot conclude either way. Regarding your quote by Ann Block, this seems to support a theory that you might be trying to debunk. Chronic does not necessarily mean high. Chronic simply means every day. I take amphetamine, chronically."All case studies, the average dose of the common mixed salt amphetamine was 200mg over the average of five months."

My point in that was yes it is posible, as I stated earlier, but under normal sercumstances, it will never happen. Tolerances are very fickle. Under general cercumstances, an tollerance to adderall can be gone in as little as 3 weeks. But some abusers report never being able to recover. Same goes with alcohol.

yes you are correct,

Lack of evidence does not mean lack of condition. But all the personal stories, and those made by psychologist, and the evidence thus far points to there being no such thing as a cross tollerance in normal cases.

But then again, right now Its generaly up to the persons oppinion, there doesnt seem to be a definitive answer given yet, so this is a case where we just have to agree to disagre.

I cannot express how happy I am to have found this forum and this thread. I have been searching and searching for information about "tolerance" and have finally found something! Both my daughter's pediatrician and neurologist feel that tolerance does not take place. They say it is a matter of finding the proper dosage. I disagree.

I have four children. Two with ADHD, one with ADD/inattentive type, and another with Autism. The one experiencing a problem with tolerance is my 8-year old daughter with ADHD. She has been on Concerta for the past year and a half and is now up to 54 mg. and now it is no longer working. She is very small (47 lbs. 48" tall) and I worry about her being on this high of a dose of medication. I would say her medication works at about 65-70 % effectiveness, but enough of a decline to be getting calls from school.

She has an appointment with her neuro next month and I'm so afraid he's going to increase her dose to 72 mg. Maybe I can show him this information and he will consider alternating medications for her.

I would appreciate any further discussion, as well as opinions on her dosage compared to her body size. I am worried about long term risks (heart, etc.)

Thank you.

Kim

Now the cross tolerance issue has been well documented. There is no such tolerance.
I want to bump this thread as I have been trying to get an answer to the question whether Ritalin holidays on Adderall will work??? Given my scientific knowledge, I suspect it would work well - however there are people who emphatically say that you will develop cross tolerances from one to another. But that doesn't make sense as they (Ritalin and Adderall) both act on different receptors, etc. We won't even get into the differences in metabolic tolerance.

Can you take a "holiday" from Adderall with Ritalin and vice-versa??

The answer to this would help LOTS of people on this board. Tolerance is an enemy of effective medication. Those of us adults with ADD don't easily have the option of "not being able to get it together" a couple days a week, etc.

Now Dr.'s don't readily prescribe both meds to patients most likely due to concerns of liability - they don't want to risk a patient taking both at once. Dr.'s are very much about liability - athough a few are enlighened healers - just a few. I wouldn't expect a reliable answer from a Dr. But then I have become very cynical of medicine over the years - with good reason.

Any ideas - anyone?

From a paper by Dr. Mary Ann Block

In humans, chronic administration of Ritalin produced tolerance and showed cross-tolerance with cocaine and amphetamines.


You guys kill me. Dr. Block? Dr. Block who wrote the book No More ADHD and now has her new home program called, "breaking free from ADHD".
http://blockcenter.com/#events
Tell me there is no bias there. Too funny.

Kids who take Ritalin, they don't seem to develop tolerance as you folks describe it. I work with kids who have been on it for years. I have never heard one student say, my ritalin doesn't work anymore. Come on this board and it seems that every second post is on this subject.

ohhh and she links to this page http://www.labelbuster.com/

My other two children do not have a problem with tolerance, just my 8-year old does. The rebound she goes through is much worse as well... it lasts 2 days instead of the 2 hours you'd expect. There is definitely something going on with tolerance with her. She is taking the same dose as my 15 year old son!

Also, I came to this board looking for answers to this problem. If there is no problem, then there is no reason to look for answers. That should explain why this issue is discussed at length on this board.

Dossage level really is all about the the individual's personal reaction to the drug. I'm not sure if there is evidence that indicates that higher levels of stimulants are needed for those with a greater severity of the disorder...but I have heard that thought many times.

Tolerance is a loaded word associated with drug addiction. The word should be used with care. Here is a thread on the topic of "tolerance" and "dependency" with regards to theraputic levels of stimulants. There should be plenty of answers there for folks who haven't read it.

http://www.addforums.com/forums/showthread.php?t=17742


Welcome to the forums, sixmurphys :)

More on Dr. Block from her website.

Dr. Mary Ann Block is an international expert on the treatment of attention and behavior problems without drugs and a recognized healthcare leader for her natural and practical approach to children's health. Dr. Block is the author of the top-selling books, No More ADHD, No More Antibiotics: Treating Ear and Respiratory Infections The Natural Way, No More Ritalin and Today I Will Not Die, the story of how she helped her mother survive terminal lung cancer in 1991.

...and

Dr. Block's credentials are not quite as impressive as those of the CHADD Advisory Board. She does, however, serve as a medical consultant for the Citizen's Commission on Human Rights. Founded in 1969 by the Church of Scientology, the CCHR defines itself as "a non-profit, public benefit organization dedicated to exposing and eradicating criminal acts and human rights abuses by psychiatry." The group is extremely Anti-ADD and views the treatment and medication of ADD/ADHD people as a human rights abuse which exists, in part, to provide income for pharmaceutical companies. Vice President Marla Filidei told me that it is the CCHR's job to see to it that the information - the "truth" - about the psychiatric profession and the ADD/ADHD diagnosis in general be made public.

and...

Yet, research cited by Dr. Block on CNN includes a 1995 study in which eight healthy male volunteers were administered ritalin by injection. Their scans were then compared with those of subjects in previous studies who had been injected with cocaine and found to be similiar. The problem with this study is that ritalin is not intended to be injected and does not come in an injectable form. The author of the study, Nora Volkow, stressed that taking a stimulant orally is very different from injecting or snorting it. Intravenous caffeine also resembles cocaine, she points out.

Her paper warned that similarities between cocaine and Ritalin "should not be used as an argument against the use of methylphenidate." Neither of these points were mentioned in the CNN piece.

from....http://www.skeptictank.org/hs/rit.htm


and more on the bias of Dr. Block.

http://www.fumento.com/adhdblock.html

Oh, and since their is no board policy on personal opinions about Dr.'s.........Dr. Block sounds like a real "block"head. The bias here is so to the extreme, that even folks without a science background, should easily see through her pathetic logic. Anyone claiming to be an expert oh ADHD, like she has, should have their title taken away after publicly stating such obviously bogus viewpoints. Either she is woefully ignorant about the whole field, or purposely ignores all the evidence. Either possibilty should get her disbarred. If we can't trust Dr.'s, who can we trust? I'd like to see a College of Physicians with some real teeth. Someone like Dr. Block takes down the reputation of all Dr.'s.

I did go and try to access the link to her testimony before congress. Ironically, the link didn't work.

Cross tolerance is not something to discount so readily. See these studies:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6791199

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=978464

If anyone has access to this study, please share its conclusion!

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11773663

And this study too might require special access privileges:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7301057

I have no Science background beyond a grade 12 chemistry class but lets look at the links to these studies a little more closely.


1)Self-stimulation and amphetamine: tolerance to d and l isomers and cross tolerance to cocaine and methylphenidate.
Leith NJ, Barrett RJ.

The effects of the d and l isomers of amphetamine on self-stimulation responding were tested following acute and chronic administration. Tolerance and post-drug depression of responding occurred in tests with both isomers, indicating no role for p-hydroxynorephedrine (PHN) which is one of the metabolites of d-amphetamine. In the second experiment, d-amphetamine, methylphenidate and cocaine all produced quantitatively and qualitatively similar effects on self-stimulation responding following acute administration. Following chronic administration of d-amphetamine, animals showed tolerance to all three drugs, indicating cross-tolerance among them. These data are consistent with an hypothesis that tolerance and post-drug depression following chronic amphetamine treatment are the result of decreases in postsynaptic receptor sensitivity, which would lead to a decreased effectiveness of all three drugs, regardless of their pre-synaptic mechanisms.

I'm not an expert here but it looks like the above study looked at "self stimulating" (self administering of stimulants) behaviour of rats. I'd guess that they would have the opportunity to self administer these drugs multiple times over the day, hence the words chronic and acute.


A link describing this classic experiment.
http://www.cerebromente.org.br/n08/doencas/drugs/videorat_i.htm


Another link which seems to find that the self stim effect virtually disappears when the level of stimulant decreases.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=241098&dopt=Abstract


2) The second study, as Draven has already pointed out, looks at massive doses of stimulants. Both studies appear to be looking for answers about drug addiction and tolerance in rats.

3) and 4) are links to titles.


Chadwick,

Under your name on your posts, it states research assistant. That would seem to indicate to people on the board that you may have special knowledge in the field of science and may have direct knowledge in research about ADHD.

When the original discussion on tolerance and theraputic levels of stimulants took place, you made contributions. ( http://www.addforums.com/forums/showthread.php?t=17742 ). You should know better then to continue to make any sort of association between the addictive use of stimulants and the theraputic use of stimulants. That thinking is flawed on a number of levels and appears to show bias. Enough already please. Unsuspecting parents get suckered into believing this garbage as indicated by one of the posts in this thread. Thats just not right.

I believe I've come to the point where I've built up tolerance to Concerta, 72 mg. I've taken it for a year and it works much less well and for only a few hours now. I really miss the effect it used to have, and now I'm going back to my "old self" and having school/work problems. So I tried Adderall XR for a month and it had a VERY minimal effect on me, even at a dose equivalent to Concerta 72 mg.


So for those of us who cannot take a "holiday" because 1. Adderall doesn't work for us at all and 2. We have school and jobs and can't afford to be our ADHD selves because we'll drop out and get fired (trust me, I just took a week long break and it was awful, but when I came back to meds it was the same story as before), what other options are there? Anything?

I just recently started taking meds for my ADD. After day 1 of Adderall I noticed a huge difference in how it helped me perform thoughout the day. By day 3 or 4, it was like I hadn't taken it. I was switched to Concerta, day one was pretty good, day 2 not bad at all. Days 3, 4 ,5 etc all seem like I haven't taken anything. I build up a tolerance immediately and you would have a hard time convincing me otherwise. My doctor is going to do a step program with me (if alternate meds don't work) where i'll continually up my dosage (to a certain point), then when that isn't effective, i'll switch to another med and do the same thing. I think it's going to be a vicious cycle. lol