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Too Small a Dose? Make Your ADD Meds Last Longer
"My son takes 10 mg. of Focalin three times a day, but metabolizes it quickly, so he's not covered all day. The doctor won’t up the dose as he’s already over the FDA limit of 20 mg. Help!"
The FDA's recommended daily limit refers to the maximum dose of medication in the body at one time, not to the total taken in a day. Your son is taking 10 mg. at a time, not 30 mg. a day. Also, FDA guidelines are just that — guidelines, not absolute limits.
When my patients metabolize a stimulant quickly, I first try to supplement it with a non-stimulant. I might prescribe one of the tricyclic antidepressants, such as imipramine or nortriptyline (these slow down the rate at which the neurotransmitter norepinephrine is absorbed).
Next, I would keep careful records and “fill the gaps.” If a four-hour tablet lasts three hours, your son might need one of these tablets every three hours. I would keep observing each unit of the day, and try to have an adequate dose in place for each.
Note: These are only suggestions. I’m not recommending a specific treatment plan for your son. That should be determined only by his physician.
Larry Silver, M.D., is clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. and director of training in child and adolescent psychiatry at Georgetown University School of Medicine. He is a former acting director and deputy director of the National Institute of Mental Health, as well as the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities.