View Full Version : Too many side effects?


NorthTeacher
03-20-17, 07:40 PM
I am very happy that I have found this forum as this has been a very difficult couple of weeks for my family. My son, 9 years old, was recently diagnosed with ADHD. This was not a shock to me, Although I do think we have been in denial. I was terrified to give him his Meds (18mg of the generic Concerta). He only took them three days. By the third day he was experiencing excessive talking, dizziness, light headed, tremors in his hands, and some general anxiety. I can't believe that his is normal with this medication? I really hope that it is not...how can I give this to my child when it makes him feel this way.
I have called his doctor who will see him next week. What should I expect from this visit?

Postulate
03-20-17, 09:31 PM
Excessive talking is not a side effect, it's your son expressing himself adequately, possibly for the first time. Anxiety is normal especially at his age. It's due to him noticing other aspects of his reality he wasn't noticing before...and this also means these items of reality are new or foreign, thus, the anxiety of getting to know them.

Dizziness, light headed, tremors in his hands are worrisome but I'm not sure how you came up with the first two. Is it by observation or did he complain, or did he fall down, or not keeping balance?

namazu
03-20-17, 10:10 PM
Excessive talking and hyperactivity, as well as anxiety and jitteriness, can indeed be side effects of stimulants, especially if they come on suddenly after starting the medication or increasing the dose.

Since 18mg is the lowest dose of Concerta, it seems possible that your son is very sensitive to methylphenidate, or to stimulants in general.

A lower dose of methylphenidate (not Concerta, but another formulation that allows for smaller doses), or another medication altogether, might be better for him.

While it's possible that these side effects will dissipate, they are not something to ignore.

At the next visit, be sure to communicate what you've seen clearly, both in terms of any beneficial effects and in terms of side effects. Your son should also relay his experiences (positive and/or negative). Then you can discuss alternatives with the doctor.

I hope the appointment goes well, and that you're able to find something that benefits your son without the troublesome side effects.

NorthTeacher
03-21-17, 06:42 AM
Postulate, I came up with those side effects simply buy observing my son. We just finished Mach Break here which allowed me to observe him closely as I spent the break with my kids. He told me everything he was feeling and I observed the excessive talking and the hand tremors.

NorthTeacher
03-21-17, 06:45 AM
Namath, I am wondering if it makes a difference if the med is generic or brand? Maybe he is getting too much of the med and it is not bing released slowly enough? I am very new to all of this and the decision to put him on Meds did not come lightly. I guess this is why he concern it's the side effects.

namazu
03-21-17, 01:08 PM
Namath, I am wondering if it makes a difference if the med is generic or brand? Maybe he is getting too much of the med and it is not bing released slowly enough? I am very new to all of this and the decision to put him on Meds did not come lightly. I guess this is why he concern it's the side effects.
In theory, generic vs. brand shouldn't make a difference. In practice, some people do report more side effects with certain generics than with others (and this often differs from person to person -- some people prefer a generic that other people can't tolerate, and vice-versa, and some people prefer to stick with the brand-name medication).

I'm also under the impression that the Concerta generics sold in Canada are different from the Concerta generics sold in the U.S., and that the Canadian versions may be less similar to the brand-name Concerta than the U.S. generics. This may be old information, but it's a relevant question to ask if side effects are a problem. Perhaps a change to brand-name Concerta would reduce side-effects, if it is some issue with the generic's rate of release.

When you talk to the doctor, it's worth asking about brand vs. generic and whether that might explain the side effects. (If the side effects haven't gone away yet.)

My inclination -- and again, I'm not a medical doctor -- would be to try something with the option of a lower starting dose, even if it's a shorter-acting medication. If he tolerated that OK, then I'd worry about duration. But I'd want to be sure that he wasn't experiencing markedly increased anxiety and jitteriness first.

It's possible that if he tried something with a lower starting dose for a while, it might allow him to adjust to the point that he could take something like 18mg Concerta without experiencing side effects. But maybe a lower dose or a different medication would serve him better.

Medication response is tricky, unfortunately, and depends on the individual as well as the medication and how it is introduced.

Anyway, I hope your doctor will have some good thoughts on this and help you figure out the next steps. Best wishes!

Postulate
03-21-17, 01:46 PM
Postulate, I came up with those side effects simply buy observing my son. We just finished Mach Break here which allowed me to observe him closely as I spent the break with my kids. He told me everything he was feeling and I observed the excessive talking and the hand tremors.

Did he ever lose balance or fall down, or told you mom I feel weird the room is spinning?

Caco3girl
03-21-17, 03:01 PM
Postulate, I came up with those side effects simply buy observing my son. We just finished Mach Break here which allowed me to observe him closely as I spent the break with my kids. He told me everything he was feeling and I observed the excessive talking and the hand tremors.

I would agree excessive talking can be a side effect. Perhaps it's easier explained as "He's talking a mile a minute like he's had 5 cups of coffee?"

My kid does VERY well on concerta but at the full 54mg dose....it did make him a bit dizzy for a couple of days but not too bad. He did NOT do well on Vyvanse so there really is process on these medicines..it can be a merry-go-round trying to find the right one. Keep trying and hang in there!

Postulate
03-21-17, 05:41 PM
I would agree excessive talking can be a side effect. Perhaps it's easier explained as "He's talking a mile a minute like he's had 5 cups of coffee?"

My kid does VERY well on concerta but at the full 54mg dose....it did make him a bit dizzy for a couple of days but not too bad. He did NOT do well on Vyvanse so there really is process on these medicines..it can be a merry-go-round trying to find the right one. Keep trying and hang in there!

Keep in mind that people have different definitions for "excessive talking". I don't know how much talking we're talking about here, so let's not label the kid as being high on speed so fast.

NorthTeacher
03-21-17, 05:43 PM
Did he ever lose balance or fall down, or told you mom I feel weird the room is spinning?

No, he didn't fall down due to losing balance or anything but he me that he felt dizzy and in his words he room was spinning. I also remember him saying hat his face, fingers and legs felt weird. When I asked him to explain he said it felt like the tngling you get in your limbs when they fall asleep.

NorthTeacher
03-21-17, 05:44 PM
Yes! That is a much better way to describe it...the mile a minute talking!

NorthTeacher
03-21-17, 05:49 PM
Well, it another poster said it the way we observed, like he was talking a mile a minute and barely took breaths in between. He is not a talker normally...he literally talks barely taking a breath for about 2 hours straight and then just stopped abruptly. Excessive is the best way I can describe it.

NorthTeacher
03-21-17, 05:51 PM
Thank you for your response, I find it very helpful. I feel as though we are just keeping our head above water with this diagnosis so your thoughts are very helpful

Postulate
03-21-17, 05:55 PM
No, he didn't fall down due to losing balance or anything but he me that he felt dizzy and in his words he room was spinning. I also remember him saying hat his face, fingers and legs felt weird. When I asked him to explain he said it felt like the tngling you get in your limbs when they fall asleep.

Discontinue immediately, don't give him another pill. He was definitely high. Then tell your doctor about the things in bold.

NorthTeacher
03-21-17, 07:45 PM
Discontinue immediately, don't give him another pill. He was definitely high. Then tell your doctor about the things in bold.

Your response makes me feel a little sick and gives me some mommy guilt :( I felt in my gut that he should not feel that way but I wasn't sure since this was his first time on this med. Thanks for your response...I will for sure mention those side effects to his doc.

Postulate
03-22-17, 12:05 AM
Your response makes me feel a little sick and gives me some mommy guilt :( I felt in my gut that he should not feel that way but I wasn't sure since this was his first time on this med. Thanks for your response...I will for sure mention those side effects to his doc.

That's not your fault, your doctor took your son's blood pressure before prescribing the medication and judged that there was room for an increase. You need to be literate with the following things:

Signs and symptoms of hypertensive crisis:


Chest pain
Arrhythmias
Headache
Epistaxis
Dyspnea
Faintness or vertigo (room spinning)

Severe anxiety
Agitation
Altered mental status
Paresthesias (tingling/numbness without cause)

Vomiting


Also the symptoms of Ritalin overdose:

The symptoms of a moderate acute overdose on methylphenidate primarily arise from central nervous system overstimulation; these symptoms include: vomiting, agitation, tremors, hyperreflexia, muscle twitching, euphoria, confusion, hallucinations, delirium, hyperthermia, sweating, flushing, headache, tachycardia, heart palpitations, cardiac arrhythmias, hypertension, mydriasis, and dryness of mucous membranes.[49][67]


Also the symptoms of Ritalin acute overdose:

A severe overdose may involve symptoms such as hyperpyrexia, sympathomimetic toxidrome, convulsions, paranoia, stereotypy (a repetitive movement disorder), rapid muscle breakdown, coma, and circulatory collapse.

Caco3girl
03-22-17, 08:06 AM
The poster said she stopped the meds on day 3.

I'm sure her doctor will try something different.

namazu
03-22-17, 01:07 PM
While I agree with Postulate that it's wise to be aware of the possible serious side effects, however rare, and to watch for them, I think it's also important not to panic unnecessarily. Stimulants (even the long-acting ones) leave the body fairly quickly. Side effects like those your son experienced are generally fleeting and entirely reversible once the medication has left his system.

There's always Mommy-guilt when our kids are feeling unwell, especially if it's in response to a medication we decided to give them. But it sounds as though you didn't come to the decision to give him medication lightly, at all. So presumably he was struggling in other ways before, and you were trying to help.

Most likely, this is a fixable problem. It may take some trial and error to find a medication and dose that works without causing side effects. But as long as you're working closely with your doctor to help your son, you're alert to possible side effects, you're not relying on medication alone to be a panacea, and you're listening carefully to your son's perspective, there's no reason to feel guilty. (...Not that a lack of reason means the guilt doesn't flow, anyway, alas!)

You might appreciate Sarahsweets' post (a sticky in this section) about her experience deciding to give her son medication for another perspective.

sarahsweets
03-24-17, 03:52 AM
Your response makes me feel a little sick and gives me some mommy guilt :( I felt in my gut that he should not feel that way but I wasn't sure since this was his first time on this med. Thanks for your response...I will for sure mention those side effects to his doc.

Your son WAS not high. He was either on the wrong dose or wrong med. He is what, 9? or did you say 11? He was not high. Saying he was high is a poor way to word that he was having side effects.
My feelings on concerta and other long acting meds are...when they work its awesome but when they dont BOY do you know it. My gut instinct was to tell you that maybe the lowest dose of instant release ritalin (5mg) would be good for him. This way even if he has bad side effects, the IR meds are out of your system in 4 hours so he wouldnt have to suffer hours more while waiting for the meds to wear off. I have a pet peeve with doctors who start a kid out on extended release meds, It bugs me. I say start out with the type of med you want, in the lowest, quickest dose and go from there. JMO.

Caco3girl
03-24-17, 09:02 AM
Your son WAS not high. He was either on the wrong dose or wrong med. He is what, 9? or did you say 11? He was not high. Saying he was high is a poor way to word that he was having side effects.
My feelings on concerta and other long acting meds are...when they work its awesome but when they dont BOY do you know it. My gut instinct was to tell you that maybe the lowest dose of instant release ritalin (5mg) would be good for him. This way even if he has bad side effects, the IR meds are out of your system in 4 hours so he wouldnt have to suffer hours more while waiting for the meds to wear off. I have a pet peeve with doctors who start a kid out on extended release meds, It bugs me. I say start out with the type of med you want, in the lowest, quickest dose and go from there. JMO.

I had this exact talk with my sons doctor and asked her why she started out with XR. She said she always starts off with the XR for three reasons:

1. They are less likely to be addictive than the immediate release medicine.
2. The kids don't have to dose at school which can be problematic, i.e. parents have to get medicine there (kids can't bring it), children have to remember to go take it, having a controlled substance at school...etc.
3. The child has a better chance of sleeping at night if there is one dose given in the morning, rather than multiple doses given throughout the day.

sarahsweets
03-24-17, 09:14 AM
I agree with you completely and I should have clarified: I feel that the very first time a child takes a medication IMO starting out with an instant release at a lower dose makes sense. Once you determine the child can handle the med, it makes complete sense to work towards the XR versions like you mentioned. I just dont see the point in starting right out of the gate with something long acting before you even know it works. Im a huge fan of xr meds and I think they are best for most long term management of adhd-at least for me they are.

I had this exact talk with my sons doctor and asked her why she started out with XR. She said she always starts off with the XR for three reasons:

1. They are less likely to be addictive than the immediate release medicine.
2. The kids don't have to dose at school which can be problematic, i.e. parents have to get medicine there (kids can't bring it), children have to remember to go take it, having a controlled substance at school...etc.
3. The child has a better chance of sleeping at night if there is one dose given in the morning, rather than multiple doses given throughout the day.

Postulate
03-24-17, 12:44 PM
I agree with you completely and I should have clarified: I feel that the very first time a child takes a medication IMO starting out with an instant release at a lower dose makes sense. Once you determine the child can handle the med, it makes complete sense to work towards the XR versions like you mentioned. I just dont see the point in starting right out of the gate with something long acting before you even know it works. Im a huge fan of xr meds and I think they are best for most long term management of adhd-at least for me they are.

That's not true because the only time when it is recommended to begin treatment with an IR version is when the child is epileptic. And that's because if the first peak triggers epilepsy, you don't want a second peak to follow. In all other cases, it is recommended to start with an XR and the doctor was right.

You have to look at the symptoms and see if they match CNS overstimulation. If so, it means, he took too much.

It's no big deal, at the beginning it's a trial and error.

Caco3girl
03-24-17, 03:24 PM
That's not true because the only time when it is recommended to begin treatment with an IR version is when the child is epileptic. And that's because if the first peak triggers epilepsy, you don't want a second peak to follow. In all other cases, it is recommended to start with an XR and the doctor was right.

You have to look at the symptoms and see if they match CNS overstimulation. If so, it means, he took too much.

It's no big deal, at the beginning it's a trial and error.

That is a sentence I can agree with 100%!

sarahsweets
03-25-17, 03:11 AM
That's not true because the only time when it is recommended to begin treatment with an IR version is when the child is epileptic. And that's because if the first peak triggers epilepsy, you don't want a second peak to follow. In all other cases, it is recommended to start with an XR and the doctor was right.

You have to look at the symptoms and see if they match CNS overstimulation. If so, it means, he took too much.

It's no big deal, at the beginning it's a trial and error.

I dont know if I was clear but I should have said IME I think the IR should be tried first in a child taking meds for the first time.

Sylvan
03-25-17, 08:26 PM
I know this post is a few days old now, but just to add some support: each time my son started a new medication or new dose of the same medication, we would notice an intense 'come on', while he acclimatized to the medication. This would start about an hour after taking the medication and would last about a week... excessive talking was the main thing we noticed. Yes, as though he was 'high'. As I mentioned though, this would subside as he became accustomed to the new dose or new med. Do not feel guilty. You are trying everything you can to help your child and medication can be very beneficial once you find the right med / right dose.