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  #1  
Old 06-07-18, 01:46 PM
Welds363 Welds363 is offline
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Over medicating? Or do I really need this much?

Hey guys, I'm 31 years old and my wife and I have been working on getting some treatment for my hyperactive 7 year old son.

I had no idea about ADD until that point and once I began to learn about the conditions it literally began to make my own life make sense to me. So I make myself an appointment and low and behold doc says not a doubt in my mind you're primarily innattentive. So he starts me on metadate ER 20 mg and I'm supposed to check in weekly.

First week does nothing, so he prescribes dexmethylphenidate ER 10 mg. Second week maybe I felt something maybe not, so I tell them, they say double the dose, so 20 mg er. All I could say was jackpot! Worked wonderful! Made me a complete believer. About 5 days in and I started getting quite a bit of side effects, mainly fogginess and some possible depression, not to mention it's not really working as long as it was before, maybe 2 good hours in the morning and a good hour in the afternoon.

So fast forward to now about 5 weeks in and I go to talk to the doctor about the past month and I tell him no more ER for me I would like to have the IR. He tells me that we probably need to raise the dose slightly but they don't make 15 mg IR tablets. He prescribes me 10 mg IR tablets 3 times daily and cut one in half and take it as 15 mg twice daily. Boy was that dose wrong! Way too much, so I've been taking a 10 mg in the morning, followed by 5 mg 2 1/2 hours later followed by a 10 mg 2 1/2 hours later followed by a 5 mg 2 1/2 hours after that. I've noticed taking it like this does get rid of the side effects but I'm not seeing any effectiveness accept for after my 10 mg dosing.

I've looked at the charts and understand how it works and the peaks. I really feel like I need 10 mg 4 times a day and 5 mg in the evening to counteract the sides. I know this seems absolutely crazy and make me feel like a junky honestly but I'm not seeing a great deal of benefit currently. The doctor is willing to prescribe Adderall I just don't know what to do. I've never taken pills or had any addictions in my life, I just know my body, and am trying to be honest. I'm not looking for a rush or anything like that, any advice would be appreciated

Last edited by peripatetic; 06-07-18 at 02:40 PM.. Reason: added paragraph breaks to ease reading. no other edits
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  #2  
Old 06-07-18, 05:08 PM
Welds363 Welds363 is offline
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Re: Over medicating? Or do I really need this much?

I am sorry for the very long post, I guess maybe a better question would be since more than 10 mg seems to be too much, is it really possible for the medicine to be metabolizing so quickly to wear off? I've never been heavily overweight but keep a few pounds to spare and have never considered myself to have a high metabolism. Like I said in the above post, the doctor is willing to let me try other avenues if I feel I need to, I just don't have much experience and would hate to start from square one.
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  #3  
Old 06-07-18, 06:25 PM
CharlesH CharlesH is offline
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Re: Over medicating? Or do I really need this much?

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Originally Posted by Welds363 View Post
I've looked at the charts and understand how it works and the peaks. I really feel like I need 10 mg 4 times a day and 5 mg in the evening to counteract the sides. I know this seems absolutely crazy and make me feel like a junky honestly but I'm not seeing a great deal of benefit currently.
d-MPH has a fast elimination time, so it'd make sense that you'd have to constantly re-dose. And 45 mg/day seems on the high end, but not extreme by any measure.

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Originally Posted by Welds363 View Post
The doctor is willing to prescribe Adderall I just don't know what to do.
Adderall is from amphetamine class of stimulants. Some people do better on amphetamine, and others do better on methylphenidate. It might be worth trying out. Stimulants have their effects right away, so you might be able to tell right away which one is better for you.

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I've never taken pills or had any addictions in my life, I just know my body, and am trying to be honest. I'm not looking for a rush or anything like that, any advice would be appreciated
Addiction occurs when people try increasing the dose the maintain euphoria. That's not what you're doing.
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Old 06-07-18, 06:43 PM
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Re: Over medicating? Or do I really need this much?

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Originally Posted by Welds363 View Post
I've looked at the charts and understand how it works and the peaks. I really feel like I need 10 mg 4 times a day and 5 mg in the evening to counteract the sides. I know this seems absolutely crazy and make me feel like a junky honestly but I'm not seeing a great deal of benefit currently.
That doesn't seem unreasonable.

The maximum manufacturer-recommended daily dose (not a hard and fast rule, but what's been tested for FDA approval) is 60mg, and you'd be well under that at 45mg total/day.

(Inconvenient, yes, in terms of having to remember 5 doses a day...but not unreasonable if you have strategies for remembering to take it.)

Quote:
Originally Posted by Welds363
The doctor is willing to prescribe Adderall I just don't know what to do. I've never taken pills or had any addictions in my life, I just know my body, and am trying to be honest. I'm not looking for a rush or anything like that, any advice would be appreciated
If you're seeing benefit in terms of reduction of ADHD symptoms, and you're not chasing a euphoric high or constantly increasing your dose, and you're working closely with your doctor to manage your symptoms, then it doesn't seem like a problem.

Have you run your dosing idea past your doctor yet?
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Old 06-07-18, 06:57 PM
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Re: Over medicating? Or do I really need this much?

No, I haven't discussed the thought of 4x10mg and 1x5mg since we just decided the end of last week to start 3x10mg a day. He specifically told me that there is no right answer that he can give and that as long as I'm checking in and keeping them updated to split it up however I find it effective. I will say it is very inconvenient trying to split it up at the right time, but we have scheduled breaks and lunches at work so I've pretty much just been taking a whole or a half dose every break. I used to get pretty bad hyperfocus on certain things that I was interested in working on but on the other hand some projects were so unbearably boring that I didn't know how I was gonna make it through the day. More than once I have just dropped what I was doing and just left work because I couldn't stand one more minute, this seems to really level the playing field between wanting to do and being forced to do. As troublesome as taking 5 doses a day would be that's what gets me wondering what if an amphetamine class may suite me better and hopefully get by with just twice a day.
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Old 06-07-18, 07:08 PM
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Re: Over medicating? Or do I really need this much?

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Originally Posted by Welds363 View Post
No, I haven't discussed the thought of 4x10mg and 1x5mg since we just decided the end of last week to start 3x10mg a day. He specifically told me that there is no right answer that he can give and that as long as I'm checking in and keeping them updated to split it up however I find it effective. I will say it is very inconvenient trying to split it up at the right time, but we have scheduled breaks and lunches at work so I've pretty much just been taking a whole or a half dose every break. I used to get pretty bad hyperfocus on certain things that I was interested in working on but on the other hand some projects were so unbearably boring that I didn't know how I was gonna make it through the day. More than once I have just dropped what I was doing and just left work because I couldn't stand one more minute, this seems to really level the playing field between wanting to do and being forced to do. As troublesome as taking 5 doses a day would be that's what gets me wondering what if an amphetamine class may suite me better and hopefully get by with just twice a day.
Yes, it may also be worth trying something from the amphetamine family if you've never tried it. It may work better or last longer; it may not. If it helps, that would give you some long-acting options to try that you haven't tried already.

People vary enough that there's really not a reliable way to predict who will respond best to which medication.

If an amphetamine helps, and doesn't cause bothersome side effects, great! If not, maybe the methylphenidate 10mg, 4x/day + 5mg 1x/day could work.

The important thing is that you're working with your doctor to figure this out -- and that your doctor seems reasonably knowledgable and willing to help you find the most helpful treatment.

Best wishes!
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Old 06-08-18, 04:32 AM
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Re: Over medicating? Or do I really need this much?

Personally I would give amphetamines a try.
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Old 06-08-18, 08:02 AM
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Re: Over medicating? Or do I really need this much?

I plan on going back to school for a couple of classes soon which is why I originally wanted to talk to the doctor. Concentrating on bookwork has always been a down fall of mine, like reading a whole page and zero comprehension or retention.

While I try and get this dosage right it's really just to be ready for school. I like to try to keep in the back of my mind that I made it a pretty successful 30 years without medicine. When and if I can get dosage figured out I believe that I'll end up scaling back to only during school, studying, and anytime I need to make it over a hump or rough patch at work.
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Old 06-11-18, 11:41 AM
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Re: Over medicating? Or do I really need this much?

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Originally Posted by namazu View Post
That doesn't seem unreasonable.

The maximum manufacturer-recommended daily dose (not a hard and fast rule, but what's been tested for FDA approval) is 60mg, and you'd be well under that at 45mg total/day.

---SNIPPAGE---
My understanding of the OP is that he is taking Focalin (generic or otherwise). IIRC Focalin is only reviewed for 20mg/d. I always thought that was strange since MPH is reviewed for the 60 mg/d of which the dex isomer would be 30mg/d.

Of course if I misunderstood any/all, I would appreciate the clarification. -LN
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Old 06-11-18, 12:43 PM
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Re: Over medicating? Or do I really need this much?

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IIRC Focalin is only reviewed for 20mg/d. I always thought that was strange since MPH is reviewed for the 60 mg/d of which the dex isomer would be 30mg/d.
All that means is that the pharma company that submitted Focalin for original FDA approval did not submit data to support usage of 30mg/day. Why? Who knows.
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Old 06-11-18, 01:13 PM
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Re: Over medicating? Or do I really need this much?

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My understanding of the OP is that he is taking Focalin (generic or otherwise). IIRC Focalin is only reviewed for 20mg/d.
Ah, good catch! (I misread the post and thought that the OP was taking IR methylphenidate/Ritalin, rather than dexmethylphenidate/Focalin.) Thanks.

You are correct that the manufacturer's recommended daily maximum dose of IR dexmethylphenidate/Focalin is 20mg -- which, as CharlesH pointed out, means that the manufacturer did not submit data supporting higher daily doses for evaluation by the FDA.
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