I was prescribed with 90mg concerta. I found out that 90mg concerta is the equivilant of 20mg Ritalin x 3 times a day.

(22% immidiate release and the rest supports the dose through out the day).

My TOVA test was performed under 27.5 mg ritalin, and I did excellent! (way above the normal charts).

Taking 54mg concerta and 90mg concerta proved to be ineffective when it comes to Attention and concentration (however it deals with the hyperactive).

I took 108mg concerta (18mg extra) and still - the change is not that significant. I still can't concentrate well enough.

I compare this to Ritalin 27.5 and to my latest finding - Ritalin LA. I was prescribed with 80mg. It works really well! I'm concentrated and attentive. I'm not implusive or hyperactive. The only downside here is that I get "butterflies" feeling (like being anxious) through out the day.


Questions:
1. Do I need higher dosing of concerta? 108mg = 24mg ritalin, and I did TOVA with 27.5mg.
2. Am I wrong about the concerta calculation? could it be that I need 72mg? --> How come people are ONLY prescribed with 36 and 54mg while I got 90mg? (I weigh 90kg).
3. Whats the Ritalin LA dosing procedure? does it work like Concerta (22%) or does it release 40mg twice a day? (which means, I get 40mg instead of 27.5)


Thanks!

1.) When you say the 27.5 mg ritalin was effective, do you mean a total of 27.5 for the day? If that lower level of ritalin worked, then I don't think upping the concerta past 90 is likely to work. Why not go back to the short-term ritalin?

2.) Your calculation of the conversation equation between concerta and ritalin is correct by my research .... and you have to ask your doctor why he gave you 90 mg when most people have lower doses. (I'm on 54 right now. And I don't think it's working all that well.)

3.) I think ritalin l.a. releases in two dosages spread four hours apart. And unlike Concerta, the conversion formula is 1 to 1 (as in take the same dose as if you were taking multiple doses of the short-term ritalin.)

4.) Sounds like the 27.5 mg ritalin worked well. Why not stick with that? That's where I'm a little confused. Some people do better with the instant release than they do with concerta even though it's the same drug ...

5.) Or ... why not stick with the Ritalin L.A. at 80mg? You say that really works. There's a good chance your anxiousness will decline over time as your body gets used to it. But if it's really working, then it's working! .... Sounds like Ritalin works for you and Concerta doesn't. That's good information to know. You can proceed on that basis. There are subtle things (some unknown) that make one formulation of the same drug more or less effective for one person than for another. I think you can trust what you're reporting here.

good luck.

Thank you.

However I still had high hopes for concerta, as its supposed to last for 10-12 hours! Thats really important my course of life.

The reasons I didn't try Ritalin 27.5 anymore is because I get a nasty rebound effect, and it only has an effective time of 2.5 hours (out of the total 4!). My doctor said I can take it up to twice a day. This means I get it at hour 0, and at hour 2.5 I already have to take the next dose ... another 2.5 hours, I get an effective time of less than 5-6 hours.

The reason I asked about Ritalin LA is because she gave me 80mg. You says its 1 to 1, meaning its the equivilant of 40mg ritalin twice a day! How come she prescribed it to me if Ritalin was given twice a day, 27.5mg?

I can't contact her anymore. She was part of the instutite that examined me. I gotta find a new doctor now as I'm supposed to be under psychiatric observation.

I can't understand the dosing issue. If concerta 90mg = 20mg ritalin .. why was I given it? and how come people who get 20-25 mg ritalin, are presribed with concerta 36-54 (which are 10-15mg) ??

I took 108mg today. Totally ineffective. I was inattentive and unconcentrated as ever. Couldn't study at all. I worry that ritalin LA worked well because I was WAY overdosed (almost by 1.7!).

Apparently there is a lot of confusion out there in the matter of finding the equivalent dosage of ritalin ir vs. concerta.

Here's a link I was using for the conversion.
http://www.addadhdblog.com/concerta-getting-the-right-dose/

So your doc prescribing 90 concerta seems to be accurate for a dosage of 27.5 ritalin taken bid (twice a day).

Here is a link from the ritalin la manufacturer. It notes the 1 to 1 dosage correspondence to regular ritalin.... 5 mg taken twice a day of regular ritalin is equal to 10 mg taken once a day of ritalin la.

http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_la.pdf

Obviously we can't always trust a pharmaceutical company, but they clearly say ritalin la has less highs and lows than regular ritalin taken in 2 doses four hours a part. So it makes sense that you like ritalin la better if your problem had to do with rebound, etc.

But you're right: your doctor did go up on the ritalin l.a. Maybe he wanted to increase the effectiveness time (not sure this works) or perhaps he was planning to add a third pill for you ... he may have simply miscalculated, thinking ritalin la had to be higher as the concerta does has to be higher to achieve same effect as the ritalin ir.

Good luck in finding a new doc.

I didn't quit get you.

You say the doc was accurate giving me 90mg concerta for 27.5 mg ritalin?

It can't be. I'll copy from the site you gave me:

"90 mg Concerta = 20 mg 3 times per day"



27.5 mg and 20mg ritalin still work for 4 hours. Its the effectiveness thats matter according to dosage, not the time period. Ritalin LA works for 8 hours because it releases the drug twice (once and twice after 4 hours).

90 mg concerta is the equivilant of 20mg 3 times a day, given at 3 different time intervals. you can't add 27.5 and 27.5 (twice a day) and say its comparable to 20 + 20 + 20. The dosing is given at 2 (or 3) intervals, and it doesn't prolong the dosage time, just how effective it gets DURING that period.

I guess she was mistaken by that.

You're right: 90mg concerta = 20mg x3 of regular ritalin (according to this source, which I hope is correct.) You were taking 27.5 x 2 = 55. So I guess I was rounding off.

The 55 mg of ritalin is pretty close to 60 right? So I think your doc is in the right ballpark. There can't always be an exact match apparently. But he's definitely not far off.

But you know what: I would love to double-check this conversion. I know certain sites can be wrong and yet they hang there on the yet and acquire credibility. So this is all according to this one site. But I think it's a good site.

You're right: 90mg concerta = 20mg x3 of regular ritalin (according to this source, which I hope is correct.) You were taking 27.5 x 2 = 55. So I guess I was rounding off.

The 55 mg of ritalin is pretty close to 60 right? So I think your doc is in the right ballpark. There can't always be an exact match apparently. But he's definitely not far off.

But you know what: I would love to double-check this conversion. I know certain sites can be wrong and yet they hang there on the yet and acquire credibility. So this is all according to this one site. But I think it's a good site.


What I'm saying is that 2x27.5mg ritalin are NOT 3x20 by definition.

Single Ritalin dose works for 4 hours. Be it 10mg, 20mg or 40 mg. If I get 3 dosage of ritalin, it means I get 3 periods of 4 hours each. If I get 2 dosage of ritalin, it means I get 2 periods of 4 hours each.

90mg = 3x20mg meaning, the equivilant of 3 dosages of 20mg (concerta = 12 hours, ritalin = 4 hours, 3 dosages = 3x4 = 12 = concerta).

I was given 27.5 ONLY twice (and not three times). meaning I got 55mg for a period of 2 doses = 8 hours! and not 55mg for a period of 3 doses (12 hours!).

What I'm saying is, I'm getting 27.5mg for 4 hours, and another 27.5 for ANOTHER 4 hours - and thats it.

While concerta calculation forces you to divide the doses into 3 times a day. IT means that if I wanna calculate how much concerta I want, I gotta check 27.5x3 (rather than just 2!), and find the equivilant ritalin dose (almost 120mg).

You check your dose per 4 hours period, and not per whole session. If 27.5 was the effective amount of 4 hours, it means it should STAY the effective amount for any period.

Wow, either you explained that a lot better this time or I got a lot smarter this time or both. NOW I get you.

I see exactly what you're saying ...But I think there is another way to look at this ... I think you have to look at this two ways.

1.) These meds do NOT work for exactly 4 hours or 10 hours or 12 hours. Those are approximations, averages, and we as individuals are not averages. For you a short term ritalin may work for 4 hours; for me it might work for 5 hours or 2 hours or not at all ... So I think you're being too literal here. This even varies day to day, dosage to dosage, with each individual. Pill 1 may work for 2 hours and pill 2 for 4 hours. Or pill 1 could work for 5 hours and pill 2 for 5 hours. This unpredictability in the length of time of effectiveness is one of the central problems in medication management.

2.) Same thing with concerta .... the manufacturer says 10-12 hours a day. But you can just read on this board and see that many people don't experience the medication working that long .... Some people might get 8 or 7. Some get 12. Some seem to get nothing!

3.) Now stay with me--I'll get back to your point in a second--from the point of view of the total amount of medication you ingest each day--which is what the FDA looks at for safety--the issue isn't "how long is the effect lasting." The issue is "how much of this drug do you ingest each day?" That's what the safety guidelines are based on, as I understand things.

4.) Therefore it doesn't matter IN THIS WAY OF THINKING whether you take ritalin 2 times a day or 3 times a day. To get the total dosage you multiple dosage by number of times taken. Period. The concerta equivalence is based on how much total dose you take in one day.

5.) So by definition of amount of drug ingested in a day, 27.5 X 2 IS pretty much the same as 3 X 20.

6.) Now you are speaking another concurrent truth, which is you are asking about length of coverage. I understand this and it makes full sense. But just for the record, when the FDA monitors drugs, it's not looking at that; It's looking, as I understand it, at the amount of drug you ingest a day in your system.

7.) What I understand you to be saying is that ideally you would have been on regular Ritalin three times a day at 27.5. That is your ideal dose and schedule is what I hear you saying (even though you only got it twice).

8.) So if this is what you're saying then yes, if we were to imagine that you would have gotten an extra dose of the 27.5 ritalin, then you end up with a total of 82.5 mg of ritalin a day, which would convert to yes, to about the 108mg of concerta.

9.) So yes you are right, but ... again I think you are misreading things to assume that the equivalent dosage is always going to achieve the equivalent effect. Our bodies interact and respond different to all these different drug formulations in very different and unique ways. Already 108 is high for concerta ... the fda has apparently recently given initial approval to concerta as drug for adult adhd ... and they top off at 72 mg a day. So 90 and 108 are higher than the FDA regulations that are apparently coming out.

10.) Now some docs apparently are quite comfortable going beyond the FDA recommendations, as they think companies play it super safe just to ensure easy approval ... So you're wondering if you need 126mg of Concerta? ....Because the 108 didn't really work ...That's getting way past the pending FDA guidelines.

11.) This is a decision only you can make ... I wonder if you could just stick with the Ritalin la and maybe add a booster at the end of day .... and maybe your booster wouldnt be ritalin ... maybe it would be adderall .....

12.) I'm still not clear: is the Ritalin la not lasting long enough? .... Because if 108 Concerta isn't working, then I myself would NOT go up, especially if I felt good effects from the Ritalin la.

13.) How many days did you try the 108 of Concerta? ... Maybe give it several days to make sure ... .... but it sounds like Ritalin LA is your way to go ... let's just hope the side effects decline, which they probably will .... and you can add a booster to that if you need it ....

Anyway, this has really pushed my brain to THINK! ... I've learned a lot discussing this with you. I really hope this helps in some way. It sounds like you are really really close to hitting the sweet spot of things.

Thanks, I got what you wanted to say. You were look at it from the FDA point of view as to how much the body can take.

I was looking at it as how much is effective. What I came to learn that casual Ritalin works for 4 hours (effective time varies, but the drug sticks to your blood stream for 4 hours). If you wanna calculate how much effect it has on you, you gotta remember that after 4 hours the drug vanquishes, and it doesn't matter what the dose was. If I tke 27.5mg or 20mg, after 4 hours it wouldn't matter. If 27.5mg was my effective TOVA test dosage, I should be constantly dosed with 27.5mg. If I wanna switch to 12 hours Concerta, I gotta calculate through that dose.

FDA approval - I got that point as well. 20mgX3 = 60mg which somesort of a daily limit.

Will not go beyond concerta 108, I'd have to see a psychiatrist first. I tried 90mg twice and 108mg once, none worked. I just believe the OROS process of Concerta isn't working as it should in me.

Ritalin LA I believe works. But I'm affraid I'm overdosed. 40mg per pill and 2 pills taken togather (80mg). Its almost twice as causal Ritalin dose! freaks me. Effective time is 8 hours and I'd have to complete that with casual Ritalin. Israeli equivilant of FDA forbids that. I can't purchase 2 different methylphenidate drugs. I can get Ritalin LA, or I can get Ritalin. can't get both at the same time ;)

In the u.s. the recommended max for ritalin la is 60 mg per day, but I've got a book here by university of pennsylvania doctors who are adhd specialists and they say ritalin la can be given once or twice a day at up to 40mg ...

Is the recommended dose the same in israel? ... Some docs do give the patients above the recommended max, as long as the side effects don't get out of control.

I wouldn't worry about being on 80mg a day ... that's me ... just make sure you get to the doctor regularly and keep your blood pressure/heart rate monitored for a while ...

But good luck ... again, you're so close! .... I love it when the medicine (any of them) really works for people. So I am happy that you're having some success even as I feel sad that the concerta isn't working.

Lets hold our horses. I'm affriad I'm not too close at all. Concerta was supposed to be my saviour, as it lasts for 12 hours. It doesn't. All its good for is the extra 3 calories it gives me (as I'm dropping food level lately).

Ritalin LA I believe works, but I can't know for sure. I took it only 3-4 times. I will try again next week when my Concerta stock "ends" (as I'm "supposed" to take it daily, and I bought 10 doses, meaning, I gotta wait atleast 10 days before getting a new prescription).

I'm waiting for the psych ofcourse.

The limit enforced here regarding methylphenidate is 60mg a day, and you can get a permit of buying more if your psych gives you a recommandation letter you send to the Health Ministery.

As stupid as it gets, it can get even more stupid. 60mg of Ritalin IS CERTAINLY NOT 60mg of concerta. However, you can't purchase 90mg concerta as it goes above the government limit of 60mg methylphenidate. Someone isn't doing their homework ;)

Hopefuly this dreadful world would modernize itself as it understands ADHD more, and hopefuly more drugs and other treatments would be available soon.

Thanks for your help and concern! It got me studying more and investigating info I needed. Hope this clears soon and I'll end this post with concrete answers. :cool:

This entry is entirely too long for an online discussion forum. Online entries have to be much much shorter or else no one will read through them. (And no, I did not read it all--I never read posts this long.)

In any event, this entry deserves its own thread. It doesn't seem appropriate to attach this to a thread where someone is asking specific questions. Why don't you start your own entry? I'd shorten it if I were you, but you might then get some good responses. Otherwise, you are "hijacking" a thread.

If you ask me its not even a legitimate thread. Its an advertisement for this guy, and his methods.

To me it looks like a copy paste and not a research made for this specific question. I won't be surprised if I see this same answer in different threads / forums.

I just wanted to add something I believe will help you figure this problem out. I have dealt with different pain medicine for 30 years because I have chronic pain from having had bone cancer. The answer is really simple: DRUG MANUFACTURERS DO NOT TELL THE TRUTH ABOUT HOW LONG THEIR DIFFERENT DRUGS WORK. The problem you are having is not you it is the BS the manufacturer of that drug advertized. Just about all of them tell fibs about how long their drugs last. Here is one example. OxyConinXR 80mg. supposedly to last all day,12 hours. In the real world they last 4-6.5 hours! One more AdderalXR25mg. is supposed to last "all day" Well that is great IF you have 7 hour days. Otherwise I need 50mg. of AdderallXR and 500mg. of oxycodone a day--4 X 80mg. plus 6X 30mg. for breakthrough pain. How that helps. And don't forget about your body building up tolerance to drugs over time.

Maurice, wouldn't the drug companies make more money if they told people to take medication more often? Sell fewer pills and make less profit?