Concerta Tolerance Question

[OnePrimeMover]

I have heard much about the tolerance issues associated with Adderall, and comparatively little about tolerance to Concerta. Is tolerance less of a concern with Concerta? Any information of your own experiences with tolerance and Concerta, however anecdotal, would be greatly appreciated.

A second question: Is cross-tolerance an issue when switching between Adderall and Concerta? Are they pretty much linearly related, or can you reduce tolerance issues by regularly switching between the two (say, every three months or so)?

[ADDinOC]

I'm confused. I thought Concerta was Methylphenidate, and Adderall was Dextroamphetamine. Aren't those completely different stimulants?

[OnePrimeMover]

Aren't those completely different stimulants?

Yes. My second question was, does tolerance to one stimulant reflect in any way as tolerance on the other? That they are different chemicals doesn't rule out this possibility: They may affect the brain in similar ways, and the brain's development of tolerance to one may be felt as cross-tolerance in the other.

Regardless of the similarities or differences between the drugs, I was also asking about Concerta tolerance in general. Is it an issue? If so, how drastic is tolerance with Concerta in general? Does it compare to tolerance with Adderall, which I have heard can have quite an effect after a few months of use?

[Daven]

No, you can easily develop it for both.

And no, they are indeed diffrent compounds, having diffrent methods of action. If you switch to adderall from concerta, you are having the full effects of adderall, and vice versa. They effect diffrent responders. About the same as taking an advil and then having a caffine pill.

[Chadwick]

I'm reasonably sure that cross-tolerance develops. I've seen many studies indicating such on pubmed. Think about it. One way or another, they both increase dopamine, one by releasing more dopamine and mildly inhibiting re-uptake (amphetamine). The other, by aggressively inhibiting re-uptake (methylphenidate) of dopamine. In both cases, you have dopamine receptors getting more dopamine than they're used to. The body responds by reducing the sensitivity of the dopamine receptors, which is called down-regulation.

Regarding tolerance to stimulants in general, it's a problem for some people and not a problem for others. I don't believe we're sure why. I think if tolerance is a reality, then it can be minimized by minimally taking the drug, i.e. taking it 6 days a week instead of 7. Skipping the evening dose and just being content with 8 hours of coverage/day instead of 12-14, etc.

[Daven]

Its due to prossessing that tolerance develops. The drugs were designed to be compleatly out of the system by 8-12 hours. That inst the case most of the time.

Now the cross tolerance issue has been well documented. There is no such tolerance. Drinking milk also effects the dopamine in the brain, as does carb heavy food. As does droves of other factors. Now if you alwase get sleepy after eating a big meal, does that mean in a few months it wont effect you any more?

Actualy, ive known of a few people who develop a tolerance to stimulants quite quickly (usualy a month or so) that have adderall one month, then ritalin the other. Worked quite well for them. But it doesnt sound like somthing I would want to go threw.

[Daven]

Actualy I think I should say that technically you are correct, almost anything that stimulates the dopamine in the brain will cause that to some degree, but the methods of action, as diffrent as they are, make the effect almost unknown, or compleatly in some cases. As does quite a few other products. But its so small, that there could never be the chance for you developing a tollerance to the other medication.

[Gregster]

I know that some people do switch meds in order to get around the tolerance problem that can develope in some people. Not everyone has issues with tolerance, but it does seem to occur - I've read about it and heard anicdotal evidence from people here.

[Chadwick]

Cross tolerance is not something to discount so readily. See these studies:

http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=6791199

http://www.ncbi.nlm.nih.gov/entrez/q...st_uids=978464

If anyone has access to this study, please share its conclusion!

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11773663

And this study too might require special access privileges:

http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=7301057

[Daven]

From a paper by Dr. Mary Ann Block

In humans, chronic administration of Ritalin produced tolerance and showed cross-tolerance with cocaine and amphetamines.

And if you look at the study you posted,

Administration of d-amphetamine (2.5 mg/kg) or methylphenidate (20 mg/kg) decreased milk consumption in rats.

Thats quite a bit of product.

But under normal usage, there is no known cross-tollerance issues. Perscribing two diffrent substances is pretty common. Its not what most Dr.'s prefer to do, but its done none the less when it is needed.

[Chadwick]

Daven, you as well as I know, "no known issues" doesn't mean no issues. It simply means we cannot conclude either way. Regarding your quote by Ann Block, this seems to support a theory that you might be trying to debunk. Chronic does not necessarily mean high. Chronic simply means every day. I take amphetamine, chronically.

[Daven]

Originally Posted by Chadwick

Daven, you as well as I know, "no known issues" doesn't mean no issues. It simply means we cannot conclude either way. Regarding your quote by Ann Block, this seems to support a theory that you might be trying to debunk. Chronic does not necessarily mean high. Chronic simply means every day. I take amphetamine, chronically.

"All case studies, the average dose of the common mixed salt amphetamine was 200mg over the average of five months."

My point in that was yes it is posible, as I stated earlier, but under normal sercumstances, it will never happen. Tolerances are very fickle. Under general cercumstances, an tollerance to adderall can be gone in as little as 3 weeks. But some abusers report never being able to recover. Same goes with alcohol.

yes you are correct,

Lack of evidence does not mean lack of condition. But all the personal stories, and those made by psychologist, and the evidence thus far points to there being no such thing as a cross tollerance in normal cases.

But then again, right now Its generaly up to the persons oppinion, there doesnt seem to be a definitive answer given yet, so this is a case where we just have to agree to disagre.

[sixmurphys]

I cannot express how happy I am to have found this forum and this thread. I have been searching and searching for information about "tolerance" and have finally found something! Both my daughter's pediatrician and neurologist feel that tolerance does not take place. They say it is a matter of finding the proper dosage. I disagree.

I have four children. Two with ADHD, one with ADD/inattentive type, and another with Autism. The one experiencing a problem with tolerance is my 8-year old daughter with ADHD. She has been on Concerta for the past year and a half and is now up to 54 mg. and now it is no longer working. She is very small (47 lbs. 48" tall) and I worry about her being on this high of a dose of medication. I would say her medication works at about 65-70 % effectiveness, but enough of a decline to be getting calls from school.

She has an appointment with her neuro next month and I'm so afraid he's going to increase her dose to 72 mg. Maybe I can show him this information and he will consider alternating medications for her.

I would appreciate any further discussion, as well as opinions on her dosage compared to her body size. I am worried about long term risks (heart, etc.)

Thank you.

Kim

[jonquiljo]

Originally Posted by Daven

Now the cross tolerance issue has been well documented. There is no such tolerance.

I want to bump this thread as I have been trying to get an answer to the question whether Ritalin holidays on Adderall will work??? Given my scientific knowledge, I suspect it would work well - however there are people who emphatically say that you will develop cross tolerances from one to another. But that doesn't make sense as they (Ritalin and Adderall) both act on different receptors, etc. We won't even get into the differences in metabolic tolerance.

Can you take a "holiday" from Adderall with Ritalin and vice-versa??

The answer to this would help LOTS of people on this board. Tolerance is an enemy of effective medication. Those of us adults with ADD don't easily have the option of "not being able to get it together" a couple days a week, etc.

Now Dr.'s don't readily prescribe both meds to patients most likely due to concerns of liability - they don't want to risk a patient taking both at once. Dr.'s are very much about liability - athough a few are enlighened healers - just a few. I wouldn't expect a reliable answer from a Dr. But then I have become very cynical of medicine over the years - with good reason.

Any ideas - anyone?

[scuro]

Originally Posted by Daven

From a paper by Dr. Mary Ann Block

You guys kill me. Dr. Block? Dr. Block who wrote the book No More ADHD and now has her new home program called, "breaking free from ADHD".
http://blockcenter.com/#events
Tell me there is no bias there. Too funny.

Kids who take Ritalin, they don't seem to develop tolerance as you folks describe it. I work with kids who have been on it for years. I have never heard one student say, my ritalin doesn't work anymore. Come on this board and it seems that every second post is on this subject.