March 12, 2018 at 3:34 pm #78809dug89Participant
So, my doctor increased my dosage of Concerta XL from 18mg to 36mg. When I took two 18mg capsules, I noticed the drug working, but when I took a single 36mg, it didn’t give the same effect as the two 18mg capsules. What could be causing this? Any thoughts?
March 12, 2018 at 10:26 pm #78843kevinelsonbemisParticipant
I have adult ADD, been trying meds for 23 years now, I am 48. One time I compared the release amount of the 36 and 18 because I thought the 36 was not working. Concerta brand 18mg releases more medication at the beginning than a 36mg concerta. You can actually feel the difference because of the initial dump. The 36mg tends to release longer with less dump at the beginning. Also brand is much better than generic, there is a correct measured clinical dose. Generics sometimes have more or less clinical dose due to parameters/tolerences of production.
March 13, 2018 at 5:37 pm #78919ADDdocParticipant
It’s important to know whether you are comparing the brand name product to the brand name product of each strength, rather than brand of one strength to generic of the other, and also, if using generics, comparing generic to generic of the same generic manufacturer! Concerta® (brand) is one of the rare medications where the FDA issued a warning a few years ago (but did not order a recall) that the generic “Concerta” of 2 of the 3 generic manufacturers did NOT meet the bioequivalency specifications of the brand name!! Even insurance companies agreed to cover the brand, in light of this, rather than have to deal with complaints of ineffective or inconsistent clinical effectiveness from differences among the generic products.
The immediate release portion of Concerta has been stated to be 22% of the total dose, and is in the “overcoat” of the tablet, the surface.
One possible consideration to explain your differences in effectiveness of the 2 18mg tablets vs. the 1 36mg tablet, “might” be that the surface area of 2 tablets is greater than the surface area of one tablet, thus, the amount of immediate release coated surface area exposed to immediate dissolving in the stomach “might” be why it is dissolved sooner, and thus absorbed more quickly than the same total amount of immediate release medication on the surface of the single 36mg tablet. Just a thought ;—)
Your question seems to be addressed by the manufacturer (of the brand name product) in the second paragraph below, where they describe the equivalence of 2 27mg tablets and 3 18mg tablets.
“5.2. Pharmacokinetic properties Absorption
Methylphenidate is readily absorbed. Following oral administration of CONCERTA to adults, the drug overcoat dissolves and plasma methylphenidate concentrations increase rapidly reaching an initial maximum at about 1 to 2 hours. The methylphenidate contained in two internal drug layers is gradually released over the next few hours. Peak plasma concentrations are achieved at about 6 to 8 hours after which plasma levels of methylphenidate gradually decrease. CONCERTA once daily minimises the fluctuations between peak and trough concentrations associated with immediate-release methylphenidate three times daily. The extent of absorption of CONCERTA once daily is generally comparable to conventional immediate release preparations given three times daily.
“Pharmacokinetic equivalence has been demonstrated for two 27-mg CONCERTA tablets with three 18-mg CONCERTA tablets. The mean values of the treatment ratio (2 x 27 mg fasted/3 x 18 mg fasted) of the log- transformed pharmacokinetic values for Cmax, Tmax and AUCinf were 101.1%, 104.3% and 100.3% respectively. The 90% CIs for the treatment ratios were within the pre-specified 80% – 125% range.”
Some people feel the immediate release portion of the tablet is insufficient to give an initial, immediate, adequate clinical response. This is sometimes treated by taking a small dose of an immediate release methylphenidate tablet (Ritalin or generic) with the Concerta, which gives a stronger immediate effect, beginning 20-30 minutes after administration, while the extended release Concerta is ‘catching up.”
Hope this is helpful.
March 24, 2018 at 10:17 pm #79902NumbAllDayParticipant
Haha yes my roommate has to do 18 and 18 because 36 at once didn’t work well for him. It’s just the way you feel the concentration curves in your body from going from low concentrations of the med to higher. If you go higher all at once, you won’t have that second bounce-up so-to-speak, so many people feel that is less effective because it’s just one giant hike up versus two moderately leveled ones. Same for all medicines when you do micromanaging.
June 4, 2019 at 10:13 pm #117995MalemidthirtiesParticipant
I’ve been taking concerta for about 3months, I’m 32. It has made an amazing difference in my life. I am so much more effective at work, and when it’s family time I am focused on my kids. My overall anxiety is way lower because I’m slowing down, completing tasks to completion, and better prepared. I was taking 2 x 18mg which seemed ok. I was switched to 1 x 36mg and noticed a significant drop off in effectiveness. I called the pharmacist and they said same brand, and they weren’t sure why there was any difference. I felt a little dumb because there was really no reason I could think of why it would be less effective. They said since 2x 18 is the same as 1x 36, they would just give me 2x 18 again without needing to see my doctor. Thankful for this thread to know it’s not just in my head.
June 7, 2019 at 10:52 am #118073Dr. EricParticipant
Are you basing this on how you feel or by productivity, lack of problems, etc?
I ask this because Concerta’s big benefit over other types of methylphenidate is the time-release.
It has a much slower rise and fall.
You are definitely less likely to feel anything as it comes and goes.
I personally, hated the crash that came with my non-Concerta methylphenidate wearing off.
I don’t feel my Concerta, but I still get the same benefit in productivity.
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