March 6, 2019 at 7:18 pm #110516
Hello! My son 6 year old started 10mg of Methylphenidate approximately 90 days ago and we immediately saw a huge improvement in his behavior at school. His teacher emailed me and said he was finally able to exhibit “full body listening”, and his behavior chart showed that he was doing great. This was a huge relief as I was called into school within a week of his starting first grade because he was so disruptive. He’s a smart funny kid, but he has issues staying still. He was flopping around on the carpet, falling out of his seat, and speaking out of turn. I brought him to his pediatrician to discuss the possibility of him having ADD (my husband also has it and I have no doubt about my son’s diagnosis) and she prescribed 10mg of Methylphenidate and said we could increase it to 20 if we thought he needed it.
Like I said, he’s been doing great on 10mg until about two weeks ago. I noticed he’s been more distractible and he’s been “clipping down (they start at green and then go up or down based on their behavior)” at school for the first time since he started his medication. He’s also been leaving stuff at school and losing something on pretty much a daily basis, but he’s 6 so I guess that’s to be expected. I’m wondering if it’s a sign that we should increase his dosage to 20mg. Is 10mg generally enough for a 50lb 6 year old, or is 20 more appropriate? I’m going to discuss this with his new pediatrician (the old one just retired), but I just wanted to do some crowd sourcing. We’re also on a waiting list for a specialist, but they don’t prescribe, but they will give recommendations.
One more question…the first couple of months he got his medication at cvs and it was a small round white pill, and last month CVS was out of his dose so I went to Walgreens and they gave us capsules. Does this make sense? It’s supposed to be extended release, so the capsules make more sense to me. Can a pill be extended release?
Any advice you can offer would be greatly appreciated! Thanks 🙂
- This topic was modified 2 months, 2 weeks ago by juststartingout.
March 6, 2019 at 7:28 pm #110518
Following; my 54lb 7yo started on 18mg Concerta (methylphenidate extended release) and we upped his dose to 27mg almost 2 months ago. Was doing great until about 3 weeks ago when his teacher started noticing he was beginning to struggle with focusing again, particularly in the mornings, and his impulse control was starting to deteriorate. I’m wondering if we should bump him up again to 36mg or if we should ride it out another month in the off chance that we got a “bad batch”, if you will (as it coincides with his last scrip refill).
March 6, 2019 at 7:34 pm #110519
Impulse control is our biggest struggle as well. He is such a good kid and I hate to see him struggle because I know more than anything he wants to do the right thing, he just has a hard time with self regulation.
March 6, 2019 at 9:07 pm #110521
I truly think that’s the hardest part of dealing with all of this; having to watch as our kids struggle. The best thing you can do is definitely discuss the changes with your pedi at his next med review (which reminds me, I need to schedule that for my boy!). We switched his dose after the 2nd month, after explaining what we and his teachers noticed in his overall behavior. Even though he’s starting to struggle again now, he’s still infinitely better than he was without meds, so that’s a bonus. 😊 Have you thought about trying a different form of methylphenidate instead of doubling his dose? Is there a way to increase his dose by only 5mg instead of 10? Unfortunately trial and error is really the only way we can determine what works, and sometimes there’s a lot of it (and all that comes with it) before we figure it out. Can your son adequately explain how he’s feeling with or without his meds? This information can prove invaluable at a med review. My son is a poor communicator so it’s extremely difficult to get a straight answer out of him when asking him about it, so it’s almost like starting at square one everytime we talk about how things are going w/the doc. One minute the dose is too much and he wants to go back to what we know doesn’t work, then it’s wearing off too fast and he wants a bumper dose for the afternoons (even though his worst times are first thing in the morning), then he wants to try something else…it’s maddening. Haha
March 7, 2019 at 8:51 am #110533
Unfortunately he’s not good at communicating how he’s feeling on the medication. I always just get “I feel fine.” Even though I’ve explained what the medication is for, I don’t think he quite gets it. I made an appointment with his new doctor so hopefully we’ll be able to figure out the best course of action.
March 6, 2019 at 10:50 pm #110524
How well a stimulant works doesn’t really have much to do with age or weight – it’s more about how your individual brain chemistry responds to the meds. A skinny little kid might need the max dose to see improvement in symptoms while a large middle-aged man could be just fine on the minimum dose.
When I started out, I started with with the smallest dose of Concerta and worked up until I got to the point where my symptoms were being managed and I wasn’t experiencing side effects. The small doses would be great for a few days or weeks, but then I’d not get the same benefits from them, and that’s when you know you need to up the dose. Then I went too high, had a horrible month of insomnia and extreme irritability, and went back down again. I got Ritalin as an as-needed afternoon booster for the Concerta, which was helpful, and much more tolerable than taking the higher dose of Concerta.
That said, have you looked at Concerta? At the right dose, I find it more effective and smoother than the IR Ritalin alone, and I’ve been on the same dose for about five years now. Caveat is that you have to get brand name or the good generic (that uses the right release mechanism in the capsule) because the rest of the generics are complete garbage.
March 7, 2019 at 8:54 am #110534
We haven’t tried Concerta. I made an appointment with his new doctor who is much more knowledgeable than his last pediatrician, so I’m hoping she can help us figure it out. He’s still doing better than he was before starting medication, just not as well as he was doing the first couple of months after starting the medication.
March 7, 2019 at 6:36 am #110529
Ok, so, I don’t know what would be the best dose for your son, that should be a conversation you have with his specialist, and you should not, EVER decide that on your own, even if your doctor says it’s ok.
Pills cannot be extended release. Capsules are extended release. Here in Norway, I was started on instant release capsules for lower doses, then once we increased my dose past a certain threshold, I’ve switched over to extended release capsules. We’re gradually heading towards the ideal dose for my height and body weight, which is about 60-70mg. Instead of taking one pill every 4 hours, I’m taking one pill per day. The medication keeps working throughout the day. However, for some people, extended release is simply not suitable. It’s more convenient taking just one pill per day that lasts the entire day, but that doesn’t always gel with the way your body works.
By any chance, did your son’s issues coincide almost perfectly with the day he took the capsules for the first time, or only a couple of days after he took the capsules? Because if so, that’s a sign that the delivery mechanism (extended release) is not suitable for him at the dose he’s on.
You should never accept substituted medications if you’ve been on a specific medication for an extended period of time. While generics and capsule versions use the same active ingredient (methyphenidate), the delivery mechanism is different. It can be metabolised faster or slower in your son’s body, and the effect he gets from his medication will change, as you’ve noted. To put it a different way, my SO is on birth control. One month, the pharmacy gave her a ‘bioequivalent’ medication (same active ingredient, different brand), and she broke out, her mood was all over the place, and so on, and so. That is because, while the active ingredient remained the same, the way her body processed it was fundamentally different. It’s not usually a problem for things like antibiotics or sleep aids, anything that you’re only on for a short time, but if it’s a long term medication, changing brands can have negative effects. Not harmful ones, necessarily, just that the medication might not be as effective, or might show more side effects. This possibility is exacerbated if you switch from an instant release pill to an extended release capsule, and is manifesting in your son’s difficulties managing his symptoms.
I’d recommend either having the prescription refilled now (explain the situation to your doctor), return the capsules, and get the medication your son is used to being on, or continue with the capsules until they run out, and then refill the prescription, MAKING SURE you get the old ones. Don’t increase the dose without consulting your specialist, and DO NOT give your son two of the capsules to increase the dose. XR capsules are dispensed containing the appropriate dosage, you’re not meant to take multiple of them.
Hope this helps.
- This reply was modified 2 months, 2 weeks ago by Spaceboy 99. Reason: Edited for clarity
March 7, 2019 at 9:03 am #110535
I wouldn’t say his change in behavior perfectly coincided with the change to capsules, but definitely within a few weeks. He actually is getting a refill today, and I will go back to the old pharmacy and get the tablet form. It would be nice if that solves the issue and no increase is necessary. I’m reading that generally the tablet form is dispensed twice a day, whereas he only takes one dose in the morning, so maybe a smaller afternoon dose might be necessary. I’m definitely not making any decisions on my own, don’t worry, I’m just gathering information so I know what questions to ask the doctor when we go in for his appointment. Ideally I’d like him to stay on the lower dose, but if it’s not working then an increase might be necessary.
- This reply was modified 2 months, 2 weeks ago by juststartingout.
March 7, 2019 at 9:09 am #110537
You’re right- instant release pills usually are given twice daily, but some people find that they only need the medication for part of the day, or that taking an additional dose later interferes with their sleep, etc. etc.
If you want him to have the same effect throughout the day, he’d need to take an additional pill at the same dosage, or a smaller dose in the afternoon, which wouldn’t give the SAME effect, but it would give more effect than unmedicated afternoons, if you understand me.
To be honest, higher dosages are only harmful if it’s more than he actually NEEDS. He’s not going to turn into a junkie or anything just because he’s on a higher dose, AS LONG AS it is the dose he requires, and not just extra medicine for the sake of it.
The reason pills are normally given multiple times a day is to maintain whats called ‘Bioavailability’. If you take one 10mg pill in the morning, and one in the afternoon, your body always has 10mg available throughout the day, even though the daily dose is 20mg. One 10mg capsule would, by this logic, have 5mg bioavailability throughout the day. The fact that your son responds well to 10mg of bioavailability suggests that it’s a good dose for him, and you can give him that dose AGAIN later in the day. It won’t increase his tolerance to the medication, because you’re giving the second one when the first one runs out. Make sense?
March 11, 2019 at 10:50 am #110743
ADHD medication is not dosed by age or weight. How an individual dose on a particular dose depends on metabolism, genetics, and neurotransmitter needs. A 300-lb man could need less than your 6-year-old. This primer covers all aspects of ADHD medication:
ADDitude Community Moderator, Parenting ADHD Trainer & Author, Mom to teen w/ ADHD, LDs, and autism
March 11, 2019 at 5:29 pm #110836
Thank you everyone for your insight. We met with his pediatrician and we decided to increase his dosage to 20mg. He’s been on the new dosage for a couple of days and I see a great improvement already. We played a board game this weekend and I was really impressed with his focus and attention to detail. Today was his first day back to school and he clipped all the way up to the highest color (based on overall behavior and performance through the school day). Basically, so far so good!
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