ADHD in Children

[sariel.t]

Hey, 15 year old ADD kid again. Medicine question. I know I should ask my doctor, and yeah, I'm going to. BTW, appointment scheduled next week! W00t. Anywho. Onto questions.

I'm all about being proactive when searching for my meds, and I've been researching different types of stimulants. One of my friends (she's ADHD, I guess us distractable kids just get along better) has been on three different stimulants. She did straight up Ritalin first, but her body kept needing more and more until she maxxed out. Next one she tried was Adderall and it made her SUPER bitchy. Zomg. It sucked. Non-stop PMS of doom, I swear. <shudder> Last one is Concerta. She's been on it for a year now, and at the same dose. And it works awesome like whoa.

Soooooo... now that I'm done with the HUGE background of my girl... (wax loquacious? Me? Whatcha talkin about?) I've been looking at extended release stimulants. Naturally, looking at Concerta since it works great for my friend. I've also heard about Ritalin XR though. I've been on Ritalin, the only problem is fixing my dose level and stuff. So I'm thinking I'll ask my doctor about doing either Ritalin XR (extended release, sposedly should work better??) or Concerta.

Finally, the question: does anyone know if there’s a significant difference in taking Concerta or Ritalin XR? I know they’re both forms of delayed release methylphenidate, but I’ve heard there are significant differences – mainly that Concerta’s better.

Whew! Hopefully someone will read through all this and respond. Thanks!

[Bookworm]

Hi! Let's start with a clarification of the medications you are looking at: There is Ritalin (brand name for methylphenidate) which lasts about 4 hours. There is Ritalin LA, a capsule with "beads" of Ritalin (like the old Contact cold capsules, if you remember them). Half of the beads dissolve immediately, like the "regular" Ritalin pills; half dissolve 4 hours later. Thus, Ritalin LA should last around 8 hours. Ritalin SR (for "slow release," I think) is another 8 hour formulation. It releases only a little medication during the first hour and then gradually releases the rest of the medication throughout the remaining 7 hours. (I believe the release rate is supposed to be steady over that period). There also are two forms of Metadate, a different brand of slow-release methylphenidate/Ritalin, both of which are 8 hour pills.

Concerta is a different form of methylphenidate. It is supposed to last 12 hours, but for many wears off after about 10 hours. About 22% of the medication is released initially, and then the rest at a steady rate throughout the day.

Which medication works best for you depends a lot on your individual schedule. For example, if you take the lowest dose of Concerta, 18 mg, you would get 4 mg of medicine within the first 20-30 minutes after taking it, much like taking a single 5mg Ritalin tablet (but only 4 mg, not 5 mg, so it is a lighter initial dose than the "equivalent" pill!). If you took 20 mg Ritalin LA (closest to Concerta 18mg), you would get 10 mg of medication right away and 10 mg of medication, 4 hours later. Metadate CD, like Ritalin LA, has little beads of medication but a different release rate -- namely, 30% immediately and then 70% in delayed release beads. (I'm sorry, I don't know if the delayed release is steady over the 8 hours or half-and-half, like Ritlin LA).

Thus, those with a heavy a.m. schedule might chose Ritalin LA or Metadate CD over Concerta. On the other hand, someone who experiences rebound might find a smoother, steady dose of medication more to their liking and choose Concerta over Ritalin LA. Someone else might want the longer, all day effects of Concerta, but need a heavier dose in the morning. That individual might benefit from Ritalin LA, Ritalin SR or Metadate and then augment it with a small dose of Ritalin later in the day.

By the way, there might be "Ritalin XR" out there but I'm not familiar with it!

[Boxmaker]

By the way, Concerta pills do not release the full amount of medication. This is due to Concerta's drug delivery system which gradually "squeezes" out the medication at a steady rate. It works in a manner similar to a ketchup bottle where the bottle is "empty" but still has some stuff left at the bottom which doesn't get squeezed out. Thus, if you are looking at Concerta, you might need a bit more than the "equivalent" dose of Ritalin.