View Full Version : Cutting open the Conerta pill (for a good reason), but for digestion?


alexander123
12-20-09, 08:35 PM
Hello, I have recently tried different types of methylphenidate meds and have so faR DISCOVERED for myself THAT Concerta and Ritalin LA are the two most effective meds, (a) as concerta provides constant supply of mph, Ritalin LA because theiy use polymer covering for phase two release and that seems to actually dellay for three hours. Anyhow, Concerta is the smoothest, even if the intial rise of plasma levels is a bit slow. and in my case lasts six hours max.

sooo, as I am doomed to high dosages anyhow, I have at one stage decided to to cut open one 36mg Concerta capsule, as I need 40mg in the morning anyhow. U se scissors to cut it in hald lengthwise. shortly afterwards I will take the undamaged capusles with slow release.

BUT, every time I have done that I get serious constipation. my theory is, that the "gooey" stuff that is inside the capusles for the osmotic effect, is perhaps not the best substance to travel through your intestines., perhaps it kind of glues the **** together, excuse my french?

anyone have infos or experience on this< b

formax
12-21-09, 04:49 AM
Euhm, how is this for a theory?

Cutting open pills is wrong! Cutting open XR pills is even more wrong! You release all the substance into your stomach in 1 hit.

Normally the medication is released over a period of 8, 10 or 12 hours, and here you are taking 8 hours worth of 'meds' in one shot.

Your stomach ain't up for that, it's too much in too little time, especially when you take it early in the morning on an empty stomach. This way you're not only messing up the positive effects, you're messing up yourself. You'll feel like on cocaine the first few hours and have a horrible crash later on.

Even when your condition requires a high dosage it does not, in any way, justify cutting open pills!

I would suggest to stop doing it right now and instead have a chat with your doctor/psychiatrist about this issue. The reason you're doing it may be valid ( need a higher dosage, effects may wear of, not the right med for you,... ) but you're only damaging yourself by abusing the medication you're taken.

alexander123
12-21-09, 07:19 AM
Euhm, how is this for a theory?

Cutting open pills is wrong! Cutting open XR pills is even more wrong! You release all the substance into your stomach in 1 hit.

Normally the medication is released over a period of 8, 10 or 12 hours, and here you are taking 8 hours worth of 'meds' in one shot.

Your stomach ain't up for that, it's too much in too little time, especially when you take it early in the morning on an empty stomach. This way you're not only messing up the positive effects, you're messing up yourself. You'll feel like on cocaine the first few hours and have a horrible crash later on.

Even when your condition requires a high dosage it does not, in any way, justify cutting open pills!

I would suggest to stop doing it right now and instead have a chat with your doctor/psychiatrist about this issue. The reason you're doing it may be valid ( need a higher dosage, effects may wear of, not the right med for you,... ) but you're only damaging yourself by abusing the medication you're taken.

I think you missed the essence of my post. You're right of course that I should consult with my doctor and I have an appointment already. And I am alltoo familiar with what you write. That I need a relative high dosage (who knows why, metabolism or restricted ability of my body to take up the substance), my doctor knows.

The "theory" is that Concerta has a very slow onset (as opposed to immediate release or Ritalin LA (50% immediate release). This is why many "Concerta-patients" (and some other LA/XR takers as well) take, in accordance with "doctors orders", the concerta PLUS some dosage of an immediate release in the morning.

As I have discussed this with my doctor before as an option but will only see him in the new year, I creatively helped myself by cutting open the concerta. Concerta does not contain extended release coating but immeidately release substance (which is released through a tiny capsule hole by osmosis). so theoretically I am creating an immediate release dosage.

BUT, there is other stuff in the capsule that I fear when release into the digestive system, causes constipation, which is why I fear it's not a good idea . I was asking for comment on this particular issue only, not for moral evaluation and/or an explanation on how extended/delayed release medication works (I am familiar with it).

Wintermute
12-21-09, 07:44 AM
What dosage of concerta are you taking?

It's really not a good idea to tamper with your meds, especially with a med like Concerta which is marketed as a nearly tamper proof med...Please please please don't do anything that may make it more difficult for ADHD people to obtain the medicine they (we) need.

trishcan
12-21-09, 08:10 AM
Concerta is not recommended for people with digestive problems, so it could be that you had some unknown pre-existing issue that is complicating things. Otherwise, Concerta is typically well tolerated as far as digestion goes, save for an occasional upset stomach.

Cutting the pills won't necessarily eliminate digestive issues, and could present a whole host of other problems, since it prevents properly delivery of the drug. I'm sure you're aware of that. You might find taking a lower dose is more effective than tampering with the medication until you can speak to your doctor.

It sounds like an IR med could help with the dosing issue, but if the problem is less of a dosing issue and more of a digestive concern, then you ought to consider a different delivery system (multiple dosing of IR, etc).

jrob
12-21-09, 01:59 PM
Anyhow, Concerta is the smoothest, even if the intial rise of plasma levels is a bit slow. and in my case lasts six hours max You're obviously metabolizing the medication at a rate faster than released; which you realize. You missed the fact, however, that everyone else does too; that's the whole point of concerta. By breaking the cap, plasma level peaks at a higher point than your doctor intended. You may get stern replies from forum members because of this; just giving you a heads up.

The constipation you mention is an autonomic effect of methylphenidate itself.

In a fight-or-flight response, the same effects occur in an acute reaction to high stress. If you know you're going to be In a fight, your body knows this too; adrenaline begins to flow. The heart beats faster and blood is diverted to muscles from, of all places, the gastrointestinal tract. It serves a dual purpose: In addition to the extra blood for muscles, any urge to defecate will vanish; natural selection tends to favor those who don't crap themselves in a lion chase.

"But it only happens when I cut it open." Because it's more methylphenidate than you're supposed to have at once. As far as your theory goes, if concerta was made out of that weird orange flavored fiber drink and golf ball sized, I'd say you were right; but the reality is that the 'gooey stuff' is digested every time you take concerta; not just when you cut it open.

jrob
12-21-09, 02:20 PM
Ok, now that i think of it, your theory actually wasn't too bad. Absorbtion of water by cellulose binder is actually the mechanism of release for Methylin ER. Still the volume of stuff in the pill is too low to make significant change.

I wanted to note that, although it does seem like poor judgment, a significant number of patients actually can't digest certain time release formulations. When I was initially diagnosed my doctor mentioned this in explaining why she prescribes IR before any XR; can add a confounding variable to the mix, making it difficult to determining the best course of action.

Even considering all that, I'm sure all would advise that you not continue opening concerta caps. You most likely have the best of intent, and are obviously being careful in your trial by noting new side effects and looking for outside input. Still, as a rule of thumb, if you don't intend to tell your doctor about any/all changes you made or things you tried, then you shouldn't do them.

formax
12-22-09, 05:30 AM
I think you missed the essence of my post.

I understand some people have trouble with the extended release mechanism as far as digestion goes. And I did not miss the essence of your post, I was just worried by your question. By suspecting the release mechanism instead of the (to) high dose of methylphenidate causing the constipation problems had me worrying.

That I need a relative high dosage (who knows why, metabolism or restricted ability of my body to take up the substance), my doctor knows.

I'm taking 108mg a day so I understand your search towards a better solution.


As I have discussed this with my doctor before as an option but will only see him in the new year, I creatively helped myself by cutting open the concerta.

I highly doubt a(ny) doctor would give his/her consent for a patient to cut open an extended release pill.


so theoretically I am creating an immediate release dosage.

Indeed you are, only the dosage is too high, (probably) causing your problems.


BUT, there is other stuff in the capsule that I fear when release into the digestive system, causes constipation, which is why I fear it's not a good idea .

Well I understand your concern but when you fear something you might want to check out what that other 'stuff' actually is.

From the Concerta XL Prolonged Release leaflet:

What CONCERTA XL Prolonged Release Tablets contains:

The active substance is methylphenidate hydrochloride. Each prolonged
release tablet contains xx mg of methylphenidate hydrochloride.

The other ingredients are:

butylhydroxytoluene (E321), cellulose acetate, hypromellose (E464),
phosphoric acid concentrated, poloxamer 188, polyethylene oxides 200K
and 7000K, povidone K29-32, sodium chloride, stearic acid, succinic
acid, iron oxide black (E172), iron oxide yellow (E172) and iron oxide
red (E172).

Film coat: iron oxide black (E172), hypromellose (E464), lactose
monohydrate, titanium dioxide (E171), and triacetin.

Clear coat: carnauba wax, hypromellose (E646) and macrogol 400.

Printing Ink: iron oxide black (E172), hypromellose (E464), and
propylene glycol

So you might want to check if you have any digestion or constipation problems linked to this 'stuff'


I was asking for comment on this particular issue only, not for moral evaluation and/or an explanation on how extended/delayed release medication works (I am familiar with it).

I didn't mean to give a moral evaluation, however I feel it's my duty to point you to the facts. Especially since you say you 'know' how extended/prolonged release work but you do not know what the 'goey stuff' inside might be and what effect it may/may not have on your digestion track. I'm sorry if I don't offer you the answer you were looking for, but these are facts. And some one should point them out to you.

alexander123
12-22-09, 06:18 AM
@most that replied:

ok ok, I get your concerns, but dont overreact! ;) I was not planning to keep on cutting open Concerta pills and I dont think half of the world if gonna copy my act resulting in you not getting your Concerta, I was just creatively trying something out for a few days (and not anymore ( any more) )so I can report to my doctor if Concerta plus immediate release in the morning works for me. I am still convinced that when cut open, it is like an IR (which by the way, as a monotherapy I do not react to well, too many ups and downs).

and by the way, from what I know, when taken normally, the "gooey stuff" inside the pill is NOT released. I am aware that MPH as such by itself can cause digestive problems, it does not in my case though. only happened during my "experiment".

if anyone is interested: cut open a concerta pill lengthwise (preferably twice, i.e. theoretically 4 pieces, though it will break "unevenly" and put it in a glass of water and check on it in an hour or two. if you have solid pieces still, take the brown substance (that is the non-MPH stuff). otherwise, be amazed at how "gooey stuff" floats in the glass. definitely touch it with finger or spoon, you can probably pull it into very long strains. and then imagine that in your big intestine... I dont think that's a good idea at all and in fact, I think it could possibly be dangerous resp. health-hazardous.

and by the way, why I tried this: I live in a country where diagnostic and treatment of ADULT AD(H)D is far behind, say America for example, so (a) one cant go to a child psychiatrist and (b) adult psychiatrist mostly dont know anything about it do not / will not treat it, so you have to go to that ONE specialist in your nearby area where you dont get much time and (c) they often (from my experience) are not highly knowledgable in different MPH-meds-mechanisms.

anyhow, I'm done explaining myself. I should not have posted that kind of question.

alexander123
12-22-09, 06:40 AM
Ok, now that i think of it, your theory actually wasn't too bad.

thank you! (and, see my other post, it was only for a few days...)


I wanted to note that, although it does seem like poor judgment, a significant number of patients actually can't digest certain time release formulations. When I was initially diagnosed my doctor mentioned this in explaining why she prescribes IR before any XR; can add a confounding variable to the mix, making it difficult to determining the best course of action.

what do you mean by "cant digest"... that the MPH is not released?

From my own experience, I found that I digest time-release formulation faster than manufacturers infos. one formulation with wax-coating that depended on stomach pH and on food just didnt do it at all, worked 3 hours and must have released substance too fast , Ritalin LA worked better but still released 2nd phase earlier than 4 hours (is independent of food intake though and apparently the polymercoating is permeated by water).

Concerta, from what I know, does not depend on stomach acids, food, digestion etc. and works by good ol osmosis, i.e. some "water-sucking stuff" is inside, it expands and thus pushes the MPH out. What I am wondering about though, is this:

a) if you have a fast-moving digestion, perhaps the pills move too fast into the big intestine, where, if I remember correctly from school biology, the body doesnt take up substances (anymore)? or does it?

b) perhaps substance release (speed, amount) depends on ones fluid intake? high fluid, fast release, low fluid, slow release?

anyhow,

Wintermute
12-22-09, 05:34 PM
I'm still wondering what your dosage is? And how much do you take *daily* when you cut the pills into pieces? I think you missed my question earlier.

Vickie
12-22-09, 06:53 PM
Keep in mind that the stims act as a diuretic and as the kidneys dump more fluid (as urine), you may be getting a bit dehydrated and increasing the potential for constipation (with or without the stuff that causes the extended release in the OROS capsules).

alexander123
12-22-09, 07:09 PM
I'm still wondering what your dosage is? And how much do you take *daily* when you cut the pills into pieces? I think you missed my question earlier.

as I posted, I only did that (cut open a pill) for a few days and not so anymore, so I dont understand your second question. as for your first question, my daily dosage is currently roundabout 120mg. as the issue is closed, why does that still interest you?

jrob
12-23-09, 03:48 AM
thank you! (and, see my other post, it was only for a few days...)



what do you mean by "cant digest"... that the MPH is not released?

Yeah, by can't digest, i simply meant that the polymers, waxes, or whatever else is holding the med, fails to break down for whatever reason. An example would be the wax-coated pills that didn't work well for you.

a) if you have a fast-moving digestion, perhaps the pills move too fast into the big intestine, where, if I remember correctly from school biology, the body doesnt take up substances (anymore)? or does it?

b) perhaps substance release (speed, amount) depends on ones fluid intake? high fluid, fast release, low fluid, slow release?

Concerta's release mechanism is basically what you describe. It's primarily mechanical rather than relying only on dissolving stuff. The inner contents expand with water absorption. In the bottom of the concerta cap, there is a hole (i've never seen concerta so i don't know if it's visible.) As the substance expands, it pushes itself out through the hole. It then is broken down and the methylphenidate enters the system. The shell of the capsule is excreted relatively unchanged. In other words, it works like you thought, but the 'gooy stuff' does come out of the cap.

I think a little less than 1/4th of the dose is actually on the outside of the capsule, intended to be 'instant'. As far as the substance release goes, concerta remains rather constant when compared to other flavors of MPH, at least from what I've read. I imagine it could be effected by the rate it moves through the body. The large intestines are basically the body's last chance to get water out of the undigestable remains of food so it ends up being too dry for any normal drug absorption. Most oral drugs are absorbed in the small intestines. In other words, theoretically if the concerta made it to the large intestines before it had fully released, that'd probably be the end of absorption.

I don't, however, think that it could be related to fluid intake. It's just speculation, but I imagine that if something is preventing the function of Concerta's time release, it's not lack of fluid.

Anyway, if you don't think the concerta is working as well as it should, it's probably easier to switch meds rather than slow down your digestion. If you found Ritalin LA to be good but too quick, then Metadate CD should be considered. It is a bead based, bi-phasic release, similar to ritalin LA but intended to be longer-lasting.

Four
12-28-09, 12:48 PM
If you cut it in half and peel off the IR coating, you could just take the methylphenidate without taking the "expander" part. If you still have digestion issues then it's not because of the "expander".

Am I not understanding your question?