Medication Dosage Questions!!

[lauren15]

I cannot tell you how grateful I am to have this forum!!!

First let me start by saying that I am in recovery and thought long and hard about taking medications for ADHD. I presented my symptoms to my psychiatrist and she offered drugs (Adderall etc. ). At first, I declined. After a month or so, I decided that it may be the way to go. I also want to inform that I have not taken the test for this disorder, due to finances (she had told me it cost around $2,000). I am a struggling actress. You understand!

I was prescribed Adderall (generic, IR) first. I hated this medication, I felt euphoria and then crashed. I also became very very depressed; cried all of the time, I could just stare at a wall all day. She then prescribed me Ritalin which, to my understanding, is less "strong" than Adderall. I do like this medication very much; it is quick, I do not have depression, and I can focus. My issue now is finding my correct dosage and knowing the times between when to take each pill.

I had started out with 5mg/day..complete joke to me. I bumped it to 5 mg 2x/day...still not much. Now I am on 10 mg 2x/day (once when I wake up and again 4 hours later or so). I have been waking up pretty late though since starting this..so I would take my first dose at 11am, then again around 2 or 3. Just now I had taken another 10 mg only 3 hours after my first dose because it was not working.

My questions are:

How much time should be between each dose?
How do I know what dosage is right for me?
What do I do if I wake up earlier on some days?
-Would I need to take more on that day because of the time?

Thank You, I appreciate all of your help!!

[Plognark]

$2000?? That sounds like a load of BS to me, for starters. There's currently no physiological test for ADHD; it's all about childhood history and behavioral observations. There are some brain scans that can give evidence of ADHD type brain function, but they're not accurate or reliable enough for diagnostic purposes.

Knowing what dose is right is tricky... I find that there's sort of a 'sweet spot' where I can concentrate pretty well, but I don't feel like I'm amped up. Honestly, trial and error is your best bet. You'll need to eliminate variables to get a good handle on it; that means no other stimulants at the same time, especially caffeine, and try to keep your sleeping schedule regular. Staying up late and getting up late can throw your whole equilibrium off.

Caffeine isn't bad, but it has a synergy with amphetamine type stims that make it very hard to pin down the proper dosage. For me personally I can only handle tiny amounts now since the combination makes my mood and anxiety erratic.

There are some days when I wake up early, and I try to do stuff that doesn't require much focus until I would normally take my meds.

And, for some advice I can barely keep myself, exercise goes a long way towards evening everything out.

[lauren15]

Yes, $2,000. Supposedly there is a written exam done for ADD/ADHD that goes over a course of 2 days or so. Do I know what I am talking about? Lol.

I have attempted to drink coffee, but I just cannot. Thank you for confirming that! So you recommend to keep taking it around 10:30-11 am? What if I do need to take them before hand...will an issue arise?

I'm not sure what you mean by "exercise goes a long way". Sorry! Physical activity??

[namazu]

For $2000 you probably get neuropsychological/psychoeducational testing. This type of testing is usually required if you're trying to document school-related impairments to get accommodations at a college or university, or for vocational reasons, but it's otherwise *not* absolutely needed to diagnose ADHD.

If there's a strong suspicion that a processing problem, learning disability, or traumatic brain injury may be the source of your ADHD symptoms, then this kind of testing can also be useful. Or if there's some question about your intelligence that really requires testing to find out -- which it doesn't sound like there is in this case.

But most adults with ADHD can be diagnosed without this type of testing.


Also, all that will happen if you take your short-acting medication earlier in the morning is that it will wear off earlier in the day. If that is a problem for you based on your schedule, you can talk to you doctor about trying a long-acting form or adding an extra dose on days you need more coverage.

[shootme]

I'm glad Ritalin works for you, personally i got started on 36 mg concerta, then 54 mg. I couldn't tell when the medicine kicked in or ended. i tried regular Ritalin and it was like 2% better. Then i tried adderall and that worked amazing, gives me wicked mood swings though.

[lauren15]

Oh for sure...adderall was horrible to me!

Namazu, thanks for your reply. My psychiatrist did mention that she cannot do the test, but something with Psycho Education doctor? Regardless, I am glad to know that I do not need to take it. My girlfriend told me she had taken an ADHD test twice already, and once was in rehabilitation for alcoholism. It's very confusing to me whether or not she did; she thinks because I did not take the test then I am not 100% diagnosed.

[silivrentoliel]

There is no test for ADHD. They do have tests for LDs, but there isn't anything that can determine ADHD other than history.

[PoppnNSailinMan]

lauren15 wrote:

My questions are:

How much time should be between each dose?
How do I know what dosage is right for me?
What do I do if I wake up earlier on some days?
-Would I need to take more on that day because of the time?

I started instant release methylphenidate (the generic version of Ritalin) almost three weeks ago, so I had the same questions as you and did some research.

According to Jefferson B. Prince et al., “Pharmacotherapy of ADHD in Adults,” in Russell A. Barkley, Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (Guilford Press, 2006), p. 716:

“There are few data available to guide the dosing parameters of stimulants. FDA guidelines for dosing reflect general cautiousness and should not be the only guide for clinical practice. For instance, absolute dose limits (in milligrams) do not adequately consider a patient’s height or weight, or use in refractory cases or with adults. The dose should be individually titrated based on therapeutic efficacy and side effects. Treatment may be started with either short-acting or extended-delivery preparations at the lowest possible dose (Greenhill, Pliszka, et al., 2002). The stimulants have an immediate onset of action and may last from three to 12 hours, based on the formulation of the agent (immediate- or extended-release). Initiation of treatment with once-daily dosing in the morning is advisable until an acceptable response is noted. Treatment with immediate release preparations generally starts at 5 mg of MPH [i.e. methylphenidate or Ritalin] or amphetamine once daily, and is titrated upward every 3-5 days until an effect is noted or adverse effects emerge. Repeat dosing through the day is dependent on duration of effectiveness, wearing off rate, and side effects. Typically the half-life of the short acting stimulants necessitates at least twice daily dosing, with the addition of similar or reduced afternoon doses dependent on breakthrough symptoms. In a typical adult, dosing of immediate-release MPH is generally up to 30 mg three to four times daily; dosing of amphetamine is 15-20 mg three to four times a day. Currently, most adults with ADHD who are with a stimulant are prescribed extended delivery preparations, such as MAS XR [i.e. extended release mixed amphetamine salts such as Adderall XR], OROS MPH [i.e. oral-osmotic-release methylphenidate such as Concerta], or one of the beaded MPH preparations. Despite the increasing use of stimulants for adults with ADHD, up to 50% may not respond, may have untoward side effects, or may manifest comorbidity that stimulants may exacerbate or be ineffective in treating.”

Although written with children in mind, I found an article on a PBS website by Dr. Lawrence Diller called "The What, When, and How of Taking Ritalin" to have a useful description of the titration process (which is slightly different than the one described above by Prince et al.):

"when starting Ritalin, a typical dosing schedule would be to take one 5 mg tablet for the first three days, then take two together on days four through six. Every fourth day a pill is added, up to a total of 20 mg per dose--unless the patient experiences significant and persistent negative side effects, in which case no higher dose is attempted. Curiously, this 5 mg to 20 mg range applies to three-year-olds weighing only forty pounds as well as to full-grown men weighing six times that amount...The purpose of this trial-and-error process, or titration, is twofold: to find the lowest dose at which the best response is achieved, and to minimize side effects. For most children, one 5 mg tablet is not enough to produce any observable change in behavior or performance. Incrementally increasing the dose allows the family to determine the dosage that produces the optimal response. If 10 mg of Ritalin works better than 5 mg and as well as 15 mg, then the child should take only 10 mg."

http://www.pbs.org/wgbh/pages/frontl...gs/diller.html

The book Answers to Distraction by Edward Hallowell and John Ratey gives the following useful information on how to tell when you've reached the right dose: "Often my adult patients have a difficult time defining the exact effect the medication has on them. To help in this evaluation many patients use a journal, a part of a page of their organizer, or develop their own symptom checklist and rate the medication's effect." So I've been keeping a daily journal on my computer to keep track of the side effects of my generic Ritalin whenever I up the dose and to note what improvements in my ADHD symptoms my partner and I or our friends have noticed. That will help me determine when I've reached the right dose or if any improvements are taking place. It helps to get someone else to help keep track of improvements since the person with ADHD might not always notice these even though they are taking place.

I started taking my Ritalin only once a day at first so that I could tell how long it took until it wore off, and I found that it takes about four hours in my case. So I take a new dose about every four hours. But how often you need to take Ritalin will depend to some extent on your own metabolism and how soon it wears off in you own case. From what I've read, instant release Ritalin can wear off in a couple of hours in some people and last for four or five hours or more in others.

[PoppnNSailinMan]

shootme wrote:

I'm glad Ritalin works for you, personally i got started on 36 mg concerta, then 54 mg. I couldn't tell when the medicine kicked in or ended. i tried regular Ritalin and it was like 2% better. Then i tried adderall and that worked amazing

Instant release Ritalin seems to be working for me, but I can't help wondering if I should at least try Adderall to see if it might work even better?

[Twiggy]

I had the same reaction to Adderall IR and got switched back to Ritalin IR.

I usually take 10mg-20mg per dose and it works great for about 2.5 hours and then I have to take it again or else I'm back to being ADHD.

Right now just stick to what your doctor prescribed. Taking more than prescribed will only make your prescription run out fast. Talk to your doctor about the medication problem.