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Concerta

A once a day stimulant for kids with ADHD.

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Updated July 16, 2014

Methylphenidate, more popularly known by the brand name Ritalin, is a stimulant that has long been used to treat kids with attention deficit hyperactivity disorder. And although it usually worked great at controlling ADHD symptoms, one big downside was that it wore off quickly, so kids often had to take two to three pills a day.

This frequent dosing meant that children had to take a pill in the morning, another one around lunch time at school, and sometimes another one after school.

In addition to being inconvenient, kids usually didn't like being separated from their classmates and lining up at the nurses office for their pills.

Over the past few years, the move to once a day stimulants to treat ADHD was welcomed by kids, parents and I'm sure school nurses too. Now kids only had to take one pill in the morning and it lasted for 10-12 hours.

Approved by the FDA in 2000, Concerta was the first real once a day medicine for ADHD and it quickly became popular. Like Ritalin, its main ingredient is methylphenidate, but it is packaged in a special, controlled release tablet that provides your child with the medication throughout the day.

Concerta Dosing

Switching to Concerta from regular Ritalin is easy. You usually just take your total daily dose of Ritalin and change to the Concerta pill that is closest to that dose. So if your child is taking 5mg of Ritalin three times a day, for a total daily dose of 15mg, you would probably change to the 18mg Concerta tablet.

Concerta is also available in a 27mg, 36mg, and 54mg tablets, providing flexible dosing options. There are also reports that a 72mg tablet will be approved soon, making it easier to prescribe higher doses.

Although Pediatricians often start with low doses when starting a stimulant, keep in mind that in a recent study1 95% of kids were either on the 36mg or 54mg strength tablets, so don't give up on Concerta if the lower dosages don't seem to be working.

Switching from Adderall or Adderall XR is also easy. You usually just double your total daily dose of Adderall.

Concerta Side Effects

According to Concerta's product information packet, the most common side effects of Concerta are headache (14%), upper respiratory tract infection (8%), abdominal pain (7%), vomiting (4%), loss of appetite (4%), insomnia (4%), increased cough (4%), pharyngitis (4%), sinusitis (3%), and dizziness (2%).

If your child is having significant side effects, a lower dosage or a switch to a different medicine might be needed.

Other Long Acting Forms of Methylphenidate

There are other long acting forms of methylphenidate, like Ritalin LA and Metadate CD, so why choose Concerta?

For one thing, although they are all made of methylphenidate, they do have differences in their delivery systems.

Concerta's delivery system provides a child with an initial dose of about 22% and then the rest of the medicine later in the day. So if your child is taking Concerta 18mg, he will get only 4mg on medicine in the morning, and will start off with a little lower dose if he was previously on 5mg three times a day of regular Ritalin.

Ritalin LA uses a method similar to Adderall XR, so you get half the dose first thing in the morning after taking it and the other half later in the day. That means that if your child is taking Ritalin LA 20mg, he will get a 10mg dose in the morning. That's a big difference from the 4mg dose he would get if he was taking Concerta 18mg.

So if your child is mainly having problems in the morning when taking Concerta, changing to Ritalin LA might be a better option than increasing the dose of Concerta. It is available in a 20, 30, and 40mg capsule.

Metadate CD is similar to Concerta in that you get an initial lower dose. Metadate CD is made up of immediate release beads that give 30% of the dose right away and then the other 70% of the dose is continuously released from extended release beads. A downside is that it is only available in one 20mg strength, so your child has to take more than one capsule to get a higher dose.

Concerta can't be chewed or crushed and must be swallowed whole, so it can be a problem for kids who can't swallow pills. Both Ritalin LA and Metadate CD can be opened and sprinkled on food, like applesauce, if your child can't swallow pills.

What You Need to Know

Concerta is not for everyone, especially kids with anxiety, tics, or Tourette's syndrome, but it may be a good option for other kids with ADHD.

References:
1ADHD treatment with once-daily OROS methylphenidate: interim 12-month results from a long-term open-label study. Wilens T - J Am Acad Child Adolesc Psychiatry - 01-APR-2003; 42(4): 424-33

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