In my last post on another thread I mentioned:
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I also had the same experience when switching to Concerta. The doc started me at a lower dose. I think the general/most docs concensus is that since Concerta does an instant release of 22% of the dosage, but that can be lower than the current Ritalin IR dosage because Ritalin IR in your system peaks and falls and Concerta is a steadier release.

Personally I think this doesn't work. When we get to a does of Ritalin or its generic that works, its really just working at the top range of that peak, and when you take 2 or 3 IR doses/day you get 2 or 3 1.5 hour productive periods and get a fair amount done. Then your doc switches you to a Concerta dose that is giving your body a steady dosage that is 60 to 75% lower than what you were taking with Ritalin. And half way through the day that Concerta level steadily reduces. One nice result is you don't feel yourself coming off meds and feeling as irritable with Concerta. But the BIG downside is you never reach those good productive levels that you had with the other meds, and too often people think its not working and move to Adderall or Vyvanse (something more suitable to the Hyperactive types), before really knowing how well Concerta could have worked. Part of this problem is that Concerta came out for children origininally, and the Manuf. recommended max dosage level wasn't moved up very much when they started recommending it to adults. IE. the current max still says 72, even though many docs go higher, Ritalin is commonly prescribed at higher comparitive levels, and Canada's Nat. Govt. Insurance pays for dosages up to 108mg. currently. Maybe Shires wants to limit chances of future lawsuits from liver or some other damage, that they may not be responsible for (since many things can cause damages), but attorneys can make a jury believe anything when big buck settlements are involved.

My suggestion to new Concerta ADDers is if the initial dose doesn't work, or seems to work a little but not as good (and Ritalin or generic worked prior to taking Concerta), then request the dosage be bumped to the next highest level (+18mg). (And get a prescript. for the fewest pills taken per day to minimize costs: ie. don't take 36+36+18, take 36+54) and bump it again if needed, at least to equal or be slightly higher than what you had on Ritalin (ie. Concerta dose x 0.22 should equal or little higher than the Ritalin(or generic) that worked).

Some like the up and down cycle of Instant Release (IR) ADD/ADHD meds. Their generic versions are cheaper, and some ADDers don't need all day focus/attention, and some just need to take it when high focus/attention is needed. For inattentive types be careful, esp. students, because personally I've seen when meds are low or not present that even when you think you are really focusing and paying attention your brain isn't receiving everything that those around you are. Strange, but that is how it works, and if it isn't getting to the brain when hearing the lecture, meeting, reading or studying, then it won't be remembered for later use, like tests. That's why grades jump so high for ADDers that get on good meds. The brain that was used to getting by on getting part of the message now gets it all."
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On this post I'd like to ask all Concerta users 4 things so we can all get an idea of what seems to work and what doesn't:

1. What dosage of Concerta are you taking now?
2. Is it working (not at all, a little, somewhat, pretty good, great!) and your welcome to provide more detail?
3. What daily med and dosages have worked in the past?
4. What med and dosages didn't work?
5. Male or Female, age, weight? - just to see if there are any patterns there, ie. heavier people needing larger doses on average or older people needing larger doses, etc.
6. Month/Year you were diagnosed with ADD or ADHD, and how much weight have you lost so far?
7. Currently are you satisfied with your meds or considering some changes?

Myself:
1. 90mg day.
2. Pretty good. Not cleaning and picking up clutter like I did when Ritalin generic initially worked, but able to focus all day. Still evaluating if my brain is getting the entire message of what it hears/reads, and how well its remembered.
3. Ritalin generic 10mg twice day worked for first week, then had to titrate up to 20mg twice a day.
4. Had problems with Ritalin generic 20mg continuing to work, but may have been due to increased temporary stress, very acidic diet speeding absorbtion, and pills being left in hot car for 2 or 3 days. Tried Addreral IR 20mg twice/day, and felt drugged and less focused. Got way behind on work. Went back to try my current higher dose of Concerta.
5. Male, 49, 189 lbs.
6. Diagnosed 11/2008, lost 15 pounds so far.
7. Satisfied, but still evaluating. May try adding a light dose of Wellbutrin not for depression, but to see if it helps since it works in the same areas of brain and I hear it works good for some. Might allow me to lower Concerta dose. Any others taking a med. combination of some type?

Hi. I know this won't agree with your premise, but I hope it helps...

My teen daughter began taking Concerta 18 mg. She was fine in the early morning and early afternoon, but by around 3 pm she was a loud, jittery, obnoxious mess. After a week of that, she went up to 36 mg and it was nightmare. So she came back down to 18 mg and back to the same old: morning and early afternoon okay, but by 3pm, bad bad bad. So--

We figured out that the Concerta delivery stages--20% in the first 4 hours, 20% in the second 4 hours, and a huge surge of 60% in the 3rd stage--would not work for my daughter. The final surge was too much.

What we have found DOES work is the big dose (Focalin 7.5 mg) in the early am, a 2nd dose of 5 mg around noon, and a 3rd dose of 2.5 mg pm. This means she is tapering down throughout the day, while Concerta is designed to increase the dosage at the end of the day. (That final surge also caused insomnia with our daughter).

I appreciate all replies and info. That is interesting. I read that the way Concerta is made, they surround 78% of it in a shell that your system can't break down while in you, but they then put a small hole in the shell with a laser to allow a slow release. They then surround that shell with the remaining 22%, allowing that to immediately release first when swallowed. So, after that initial release your stomach acid can only get through that little hole and release the rest slowly and you safely will 'pass' the empty shell out of your system when you go the bathroom.

I'm not sure why your daughter would have that reaction late in the day... If she is ADHD, then those Concerta results could be it wearing off too soon causing her to act loud, jittery and obnoxious (was she taking it early, like 5am or 6am?), but the 36mg was just too much of an increase, which also caused the insomnia.

She may have had better results with a 27mg dose, which is available, or an 18mg dose of Concerta followed by a small dose of Ritalin or other med at 2pm. If the Focalin is working that's what counts, and I'm glad to hear you have her meds figured out. If the ever needs a change of meds as she ages you might want to try a 27mg dose of Concerta. You could just try it for 3-5 days, and wouldn't it be nice to take just one pill per day.

1. What dosage of Concerta are you taking now?
2. Is it working (not at all, a little, somewhat, pretty good, great!) and your welcome to provide more detail?
3. What daily med and dosages have worked in the past?
4. What med and dosages didn't work?
5. Male or Female, age, weight? - just to see if there are any patterns there, ie. heavier people needing larger doses on average or older people needing larger doses, etc.
6. Month/Year you were diagnosed with ADD or ADHD, and how much weight have you lost so far?
7. Currently are you satisfied with your meds or considering some changes?

1. 36mg once a day

2. Works for impulsivity, hyperness but not for concentration, focus or distractability.

3/4. Worked up to Ritalin 40mg a day for 2 weeks, concentration effects lasted only a week (maybe placebo effect?) Most side effects went away, except for the rebound depression and was getting very dangerous so changed to Concerta. Started with Concerta 18mg for a few days and psychiatrist told me to bump it up to 36mg as I was not getting much benefit.

5. Female, 23 yo about 55kg.

6. Diagnosed with childhood ADHD when I was 10, rediagnosed April this year at 23yo. Haven't lost much weight as I have been eating on a schedule for a few years.

7. I'm happier with Concerta than Ritalin as I don't get the rebound stuff happening and I think it really works. Currently starting a combination of Concerta with Dexamphetamine IR.

Is Concerta too often prescribed to low at first?

Yes and thankfully, it is. I'm a firm believer in the titration process (more information can be read here (http://www.addforums.com/forums/showthread.php?t=34796)) and I would rather build to my preferred dose than suffer intolerable side-effects.

My doctor is pretty conservative. Instead of 1 week titrations, he does 4 week ones. When I started, I went from 20 mg of Adderall XR, and that wasn't a fun transition. But ultimately it worked out. It's much better than some of the other doctors starting people out on 54mg which is simply insane.

1. What dosage of Concerta are you taking now?
45mg (18+27)

2. Is it working (not at all, a little, somewhat, pretty good, great!) and your welcome to provide more detail?
I'd give it a 9/10

3. What daily med and dosages have worked in the past?
Age 10-18:
Ritalin SR 20mg in the morning, 5 mg Ritalin IR at 4pm. Worked very well, but gradually lost effectiveness around 18. I continued to take it until age 22. I know now that I simply needed a higher dose, after studying the correlation of body weight and effectiveness.
9/10
Age 18-20:
8/10
Age 20-22:
7/10

Age 23 (for 1 month):
Strattera, titrated up to ~40 mg or whatever the dose is. Helped with some things, but lots of sides.
Overall 4/10

Age 23-24:
Adderall XR 5->10->15->20mg.
7/10. Insane dry mouth side effect, sleeping issues.

Age 24-25 (present)
Concerta 18->27->36->45.
9.5/10. Same as Ritalin, but dose is adjusted, and there's a lot less ups and downs.

4. What med and dosages didn't work?
See above. Straterra mostly. All of the others worked, even at lower doses. But at lower doses the treatment seemed partial. Lots of gray area as I titrated up.

5. Male or Female, age, weight? - just to see if there are any patterns there, ie. heavier people needing larger doses on average or older people needing larger doses, etc.
You don't need to ask here. There's empirical data showing older/heavier people need more. It's noted in Concerta's prescribing info.
Male, 25, 165 lbs. I'm gradually working down to 150 lbs through exercise. I had an insane appetite while switching from Adderall XR 20 mg to Concerta 18 mg, and I had a knee injury making it difficult to exercise. I haven't had difficulty keeping weight due to Ritalin since age 13 or so.

6. Month/Year you were diagnosed with ADD or ADHD, and how much weight have you lost so far?
Around 1994-1995. My doctor, teacher, and mother (nurse) worked all together on it. My mom tried it as a last resort after tutoring and special education, etc. Within 2-3 years of starting treatment, I was in the top 10% of my class. Today, I'm a computer engineer and I graduated in the top of my class.

I lost 10-15 lbs at age 11-12, and my doctor was concerned. But the thing was I was a bit overweight. And I lost it intentionally. I walked 4-5 miles a day for a month.

7. Currently are you satisfied with your meds or considering some changes?
Completely satisfied. Maybe in several years when treatment gets better, I may try something else. But Ritalin has a huge track record medically and in my experience.

1. 18mg
2. I don't think it's working at all, but my mom thinks it may be working a little bit.
3. This is my first ADD medication. I was just diagnosed over a month ago, so this is the first one I'm trying.
4. Haven't tried any.
5. Female, 16, 150 pounds.
6. July 30th, 2009. I haven't lost any weight so far, but I've only taken it four days in a row once, so my appetite goes back to normal the next day and I make up for what I didn't eat ^_^'
7. I would really, really like some changes. I need to go up, but my doctor isn't in the office until the day school starts, so hopefully I'll be able to get a higher dosage before school starts getting tough.

My 11 year old granddaughter has been taking Concerta for about 4 months, and we are all pleased with the results.

She is 5'3" and weighs about 140 pounds. So far no weight loss but she's still growing, probably more than an inch over the summer.

She started on 18mg for one month. We could see good results at that level and no side effects. Seems to be falling asleep better.

Then she went up to 36 mg for the next month. Still working well and no side effects.

Now she's taking 54 mg - school just started last week so we don't know how well that is going to go. She just started middle school so it will be tougher than last year. But I can tell you that we had a much better summer than we had last year. :)