Methylphenidate SR 20mg to Concerta... What strength?

[araisbec]

Hello everybody!

This is my first post on these forums, and I am looking for a little direction. From a very early age (I am presently 21), I have always been a deep thinker, but had a really difficult time with paying attention. Teachers, friends, employers, etc. have all pointed this out to me or my parents at multiple points throughout my life. I have also suffered from minor depression for the last 5 or 6 years which I believe to be a result of my inability to focus in social settings, and on tasks that matter. Recently (as in a week ago), I decided to bring this up with my doctor, and was prescribed Sandoz-Methylphenidate SR 20mg (generic Ritalin SR in Canada).

It has only been about a week of treatment, but I am already convinced that switching to Concerta would be beneficial to me. Although the methylphenidate itself (when at a steady blood plasma level is helping enormously with my symptoms, the issue seems to be that the levels of the drug fluctuate like crazy from the moment I take the pill. The effects seem to last around 4 hours for me, but they tend to peak in the first 45mins to 1hr, and then drop off substancially, hold steady for a bit, and then god knows what. Long story short: The "time release" on this medication is garbage and completely unreliable, which makes assessing therapeutic value quite a cumbersome task...

I have heard from friends, as well as these forums, that Concerta has a much more reliable time release, with a more gradual onset and a gentler tail-end as a result. Since I am taking methylphenidate sr 20mg right now, if I switched, what strength do you think I should start with? I was thinking the 27mg strength sounded ideal...

Also, if you have experience with this switch or the medication in general, feel free to chime in! Thank you!

[known_guy]

Actually, I was wondering the same thing myself.

I recall seeing some chart somewhere, and since I presently take 40mg Ritalin SR daily, I believe a daily dose of 54mg or 72mg of Concerta would be appropriate.

Good luck, let us know how the transition works out!

[Abi]

36 mg's

[araisbec]

Hmm, I was thinking maybe 36mg as well...

I know this is most likely frowned upon, but I had used 36mg concerta from my friend (who had a legitimate prescription) in the past during exam time a few times, and it did seem to work very well, without many side effects. I could concentrate very well, and did not feel like a total robot... but I did notice sweatier palms and feet then I do now, so I guess the side effects were slightly more prominent. The level of improvement I experienced from that concerta though really cemented my beliefs that I have some sort of inattentive disorder.

[araisbec]

Also, known_guy, do you take only 1 pill per day? Right now I am finding 2 20mg SRs barely enough to cover me for the duration of the day...

[Abi]

.....

[araisbec]

Abi, what is the purpose of the "......."?

[known_guy]

I feel you, my psychiatrist mentioned (more than once) that SR is supposed to last 8 hours, but it feels more like 5 hours to me. I take 40mg at 1:30pm - uh, so to answer your question, I take both pills at once.

And whoops, so the 54/72 dose conversion was directed at myself. If I was prescribed 20mg BID I would roughly translate that to 36mg of Concerta as Abi suggested, from what I've read.

[araisbec]

The one thing that really trips me out with the dosing of the methylphenidate SR's is getting the timing right for the second pill. The first one is easy (first thing in the AM), but the second one always kicks my *** lol. I think I'm getting an overlap with the first and second doses, but I swear, I always wait until I am sure that the first has worn off... These Ritalin SR generics are sneaky little ********... :|

Thank you guys, I will bring this up with my Doc. Appreciate the responses. I just hope that my so far awesome medical coverage decides to cover Concerta

[known_guy]

I know, seriously!! I experienced difficulty timing the dosing of my Ritalin SR, back when I was taking two separate (and subsatisfying) 20mg doses... Definitely part of why I chose to complicate things and take an IR additional stimulant dose.

In retrospect though, I don't know why I never tried Ritalin IR and SR together. Maybe that could work? An IR booster taken in the afternoon or something.

[Targaryen]

You could always just get the 18mg Concerta which is the lowest dose to start with. That way you will have some flexibility to find the right Concerta dose.

[BR549]

From the manufacturer's Concerta Prescribing Guide http://www.concerta.net/sites/defaul...t.pdf#zoom=56:


[quote]2.3 Patients Currently Using Methylphenidate
The recommended dose of CONCERTA® for patients who are currently taking
methylphenidate twice daily or three times daily at doses of 10 to 60 mg/day is
provided in Table 2.

Dosing recommendations are based on current dose regimen
and clinical judgment. Conversion dosage should not exceed 72 mg daily.

TABLE 2. Recommended Dose Conversion from Methylphenidate Regimens to
CONCERTA®

Previous Methylphenidate daily dose: CONCERTA® Starting dose
5 mg Methylphenidate twice daily or three times daily: 18 mg every morning
10 mg Methylphenidate twice daily or three times daily: 36 mg every morning
15 mg Methylphenidate twice daily or three times daily: 54 mg every morning
20 mg Methylphenidate twice daily or three times daily: 72 mg every morning

[Legend]

27 mg SR in the morning.

I recommend 2 doses of 5 mg in the second half of the day because the medicine does not last more than 8 hours and because Ritalin leaves the body in hours so might as well as have the coverage and flexibility rather than planning your day around when you wake up and when 8 hours hits.

By the way, the Concerta dosing guidelines are ridiculous. If you took 20 mg SR 6-7 hours apart, the dosing guidelines recommend 72 mg of Concerta, which is wrong for 2 reasons:
1. Concerta only lasts 8-10 hours.
2. Serum levels of methylphenidate will reach 40 mg 6 hours into the release with 72mg, which is overdosing and has serious side effects for someone that cannot tolerate it.

I guess it's because they're trying to market themselves as a 1 pill solution. It's reckless though.