Is there anyone here who has had succeess going above 72 mg? I just started Concerta. Amazingly, I've had no side effects. However, I've had little effect at all. It's sliiiightly stimulating. I was at 18 for 3 days and now am at 36.

I'm pretty tired right now. It works for a shorts period of time (right after I take it), then I no longer notice. I do think this daosage is far too low for me. Already, it seems as if it mayyybe lasts for 8 hours, but possibly less.

I was on 400 mg Provigil before switching. I don't know how they'd convert (because there isn't actually a conversion, they're completely different). I did go from a very high dose of Provigil to a very low dose of Concerta.

When do you get to see your doctor again to ask?

I'm sorry, I have no experience to base an answer on.

The higher the dose of a stimulant you take, the more tired you will be when it wears off. It is like throwing a ball up into the air. The higher up you toss it, the farther it has to come crashing back down.

Higher doses may not be the answer. (Just as taking 100 aspirin will never work the same as morphine, if that is the more correct chemical for your pain.)

Higher doses of a med will tend to send SE (side effects) up, too.

What is it about Concerta that is not working for you yet?

I'm very tired right now, which does not improve my concentration. I do notice some improvement for a few hours after taking 36 mg, but it seems to wear off quickly. I'm not worried about rebound fatigue. If I split the dosing to cover the times when I'm active and need to be alert during the day, a sudden drop off at night would actually be a good thing, since I require medication for insomnia. It may allow me to be more productive during the day, and thus tired at night. Hopefully this would help me to need less Lunesta. This was the case with Provigil, before it stopped working.

Hi, I wanted to tell you of my experience with concerta. I'm in the UK and have been taking concerta for 3 months now and went from 18 to 36 in the first 2 months. It also left me feeling so incredibly tired - to the point where my eyes would be practically closing and my concentration felt worse than it was prior to medication. Now I've done what I told myself I would never do - for the last 3 days I have taken 2 tablets (2 x 36) and have noticed a considerable change. My concentration is amazing, lasting all day (I'm at uni and need to take notes etc.) My moods remain very consistant so no more ups and downs, plus, most importantly I am awake all day! I feel completely 'normal', i.e. I'm not buzzing, 'high', aggitated or hyper, just OK. I'm going to have to speak to my GP as I will need another prescription but I'm worried about him thinking I'm self medicating. I can only hope that the results I am feeling will assure him that an increased dose it what I seem to need rather than a decrease. I only wish I had found this out earlier as I've been sleeping my life away for weeks not knowing why I was feeling so drowsy. I hope this helps. Obviously this is early days and I am aware that things could change, plus we are all different and need varying combinations of drugs to suit our needs. I was about to give up on Concerta but now feel I have just been on the wrong dose. Just wanted to say that I wouldn't want to encourage anyone to take more medication than prescribed and that I will be informing my GP so that I can be monitored etc.

The 36mg just 1x a day could be too little for you. Seemings how you were taking 400 mg of Provigil it is possible that you may need more concerta. I would ask the doc if it would be ok to take 2 36mgs (one in the morning and one in the early afternoon) and see how that goes. Let us know what happens...

The higher the dose of a stimulant you take, the more tired you will be when it wears off. It is like throwing a ball up into the air. The higher up you toss it, the farther it has to come crashing back down.

Higher doses may not be the answer. (Just as taking 100 aspirin will never work the same as morphine, if that is the more correct chemical for your pain.)

Higher doses of a med will tend to send SE (side effects) up, too.

What is it about Concerta that is not working for you yet?

I disagree with this 100% OP. I was previously taking 81 mgs of Concerta with NO side effects and NO feeling of tiredness when it wore off. If I had been experiencing a speed-affect from it (which I was not) I would have expected to feel slowed down when it wore off.

Medications and drugs are very different. Stimulant medications are meant to perform a task on the brain that does not include the terms "high" or "crashing". I am not high from my MPH nor do I crash when it wears off.

Anyway, I went over the so-called Max dose for adults and did fine :) before I started tweaking my BP meds. They changed my chemistry and so I changed my stimulant and I expect I will change it again. What's important to note and directly answers your question is that before I began to treat my bipolar II I did JUST FINE on a "really high" dose of Concerta.

HTH! And good luck. Please keep us posted?

Well, I don't have any side effects. However, I get very very little stimulation. I'm very groggy and have diffuculty concentrating on my studies. I end up drinking coffee and diet soda all day just to be functional.

I'm sure 36 mg of Concerta is too low for me. I do feel a little difference at first, almost calming, but is soo miniscule and wears off very quickly. I do need a lot of stimulation, as noted by myself and my doctor. However, I don't think simply increasing Concerta's dose will help.

I don't know if this is just my imagination, but whatever help I do get from the drug lasts no more than 3 hours. My own hypothesis is that the time release capsule is not being properly metabolized by my body. Maybe I could switch to a different formulation.

I called my doc last week, but the nurse was being weird about giving him my message, so I've had no contact. I need to talk to him, not the nurse. I think he'll call back on Monday, to straighten things out. I doubt he was notified in a timely manner I'd called. I really wanted to make some changes and speak with him.

Meanwhile, I have other medications that I needed refilled, but the nurse had this odd notion that the script can't be written until after the previous one had run out. Obviously this is wrong, so I'm returning to college without medications because she decided to play doctor. It was definitely a strange conversation and left me hanging out on a limb by myself...

There are some hinky things about prescribing Schedule II drugs. Unless your doc is changing the dosage, you probably cannot get another scrip. If, you go from 36mg/day to 72mg day, he can write a new scrip. If you have a pharmacist you can talk to, ask how the law and scrips work. In Illinois, I have to fill my scrip within 7 days or it is invalid-Schedule II only. There is also a day overlap limit for refills. Sometimes, they have to call the insurance company for an OK on new scrips during the month.

They cannot call in a new Schedule II scrip. It must be mailed or picked up. Hope this helps a bit. But, the nurse or secretary should have given your message to him in timely fashion. Bring this up with your Doc. If he cares, keep him, if not, find another. I have to find another because of some stupid reasons. Otherwise, I really like her.

RADD

Meanwhile, I have other medications that I needed refilled, but the nurse had this odd notion that the script can't be written until after the previous one had run out. Obviously this is wrong, so I'm returning to college without medications because she decided to play doctor. It was definitely a strange conversation and left me hanging out on a limb by myself...Raddmom is correct there is "hinky" things about schedule II. Here in California they can give you more than 1 script a month. I have received more than one script at a time. But if the script is for the same medication, it might be a red flag to the feds for the doctor if they decide to review the doctor. Biggest problem you may have is with the insurance company. The insurance company may decline the second script for the month if it is the same drug and the same strength. For instance, you get an 18mg Concerta script and the doctor decides to increase you to 36mg so you get another 18mg script. The insurance company may give you grief, which of coarse is complete bull since they would fill (60) 18mg pills at one time with no problem. (this scenario happened to me).

well i would say i have went over 200 mg in under 24 hours but then my thread would get locked and i would be warned so im not saying it; its just something i would say. and if i were to do that, i would take 72 mg ever 6-8 hours so theirs no down. im also pretty sure that it would cause a pretty nice crash and cause me to sleep for 12 hours. it would also cause someone to get a 96% on their cell bio final and set the curve.

Well, I finally was able to get more medication, but unfortunately had to go without for about a week. I can't say I noticed a difference. I just took my Provigil during that time (which seemed to have a renewed effect after having stopped for a while). I'm now at 54 mg. I didn't realize that was the largest capsule made. I know 72 mg is the FDA approved max. The 54 mg really is not helping at all. I still supplement with constant coffee and diet sode for the caffeine, and even Provigil, which I'm not supposed to be doing!

I hate to go against my doctor's orders, but the nurse doesn't seem to be conveying my messages properly. If she had, I'm certain he would have called me himself to discuss the matter.Meanwhile, I've failed at least 2 classes, probably more, and may be kicked out of school.

Is it unorthodox to go above FDA limits? My doc seems fairly liberal with me and will do anything that helps. He was almost about to go above 400 mg Provigil because I'd told him I'd been higher in the past. He also prescribes daily Xanax, because I hate SSRI's, most primary care docs would never dream of doing this, especially long-term, at 1 mg t.i.d. So he's not super-strict or cautious.

According to my p-doc, the 72 mgs thing is more of a guideline than an actual limitation for adults with ADHD. Obviously its not illegal to go over 72 mgs, because I did and my insurance paid its part for it (after a little bit of hassle over it, of course, but they did pay in the end).

You can always try things the KZ-ADD Way :D I know it worked for me! You call them several times a day, and be polite but firm. You need for the doctor to get back to you PERSONALLY in reference to a potential increase in a schedule II medication. Lather -- rinse -- repeat, until the nurse gets sick of your calls and finally gets the doc to call you.

The squeaky wheel gets the grease. ;) So go on and squeak a little...good luck!

Everytime I call the doctors office to get a refill, the nurse will say, please have the pharmacy call and we will evaluate and refill. I explain to her that I am requesting Concerta and she will say have the pharmacy call. I continue to explain that this is a schedule II, you can't refill. You get my drift, the recepection / nurse that answers the phone just wants the phone to stop ringing.


My recommendation, make an appointment to see the doctor for a prescription review or whatever they call it. At that point you get to be face to face with the doctor. That is my method. As crazy feet pointed out, squeeky wheel gets the grease, I just squeek in the office.

Crazy feet,

Are you still taking Concerta? Was there a noticeable difference once you reached 81 mg vs. the lower doses?

Crazy feet,

Are you still taking Concerta? Was there a noticeable difference once you reached 81 mg vs. the lower doses?No I am not, but not because it was not effective. I did notice at 81 mgs that I finally had a totally clear head :) and it lasted as long as I could ever get Concerta to work (about 8 hours as opposed to maybe 6 at lower doses). I always did have to add booster doses of IR Ritalin in the evenings to avoid rebounding at inopportune times though. I have a very rapid metabolism for all medications and I have an extremely long day during the school year (5:30 AM until at least 9 PM, most of that time spent with a very hyper toddler and my older kids have ADHD too) :rolleyes: so its very important that I have a clear head for as long as possible.

I have recently begin taking Adderal XR due to bipolar complications with methylphenidate but that certainly does not mean that Concerta did not work for my ADHD :) HTH and good luck to you! Concerta is a great medication, my child takes it and has no side effects whatsoever.

I was doing a little more digging at medscape (interesting place for research on any medical related, including ADD) and found this blurb in an interview with a doc that specialized in ADD treatment.......

With stimulants, the higher the dose, the better the desired effect and the greater the likelihood of side effects. So, one should be aggressive with the dosing but very sensitive to side effects. Affective and mood blunting can occur with higher doses of stimulants, and dry mouth can sometimes be uncomfortable. These are dose-related side effects that might limit one's ability to dose higher, but generally one would want to dose as high as possible with tolerable side effects.

It's important to mention some numbers because clinicians may think they're dosing high when they're really not. In an open-label continuation study of MAS XR in adults,<SUP>[5]</SUP> 41% were on 60 mg per day and around 39% were on 40 mg per day. In a randomized, controlled trial of adults treated with OROS methylphenidate, the average dose was 81 mg with standard deviation of 32 mg.<SUP>[6]</SUP> Without this frame of reference, clinicians may be nervous about going over 54 or 72 mg of OROS methylphenidate.

I think since Concerta really isn't officially approved for adults means its mostly being under-dosed.

J

JR1973-

Good find on that MedScape article: Getting It Right With the Adult ADHD Patient (http://www.medscape.com/viewarticle/546188): An Expert Interview With Kenneth Steinhoff, MD.

You have to register to view this article (FREE). MedScape.com (and WebMD.com) are great resources in general.

I especially like Dr Steinhoff's emphasis on not looking at the amount of the dose but rather if the dose is effective.

Yeah, I agree with careful monitoring of dosage. Some people are very sensitive to stimulants, and some are not. I personally am not! I've self-medicated with caffeine for years, at allll waking hours. Looking back, the huge drive to put caffeine in my body definitely says something. Even with the 54 mg Concerta, I need my constant coffee/diet soda to concentrate and make it through my day effectively, and it's still very difficult to do so. I like Concerta much better than caffeine, it feels cleaner and smoother, I'm just at a low dose for my body, I believe.