When medication wears off

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    • #103042

      Anyone have experience or insight with what appears for our daughter to be her daily dose wearing off. She takes her medication at ~7:30am. Starting around 4pm we notice her worsen (self control, emotions, etc). This continues for the next few hours until bed. Now making sure she has eaten enough helps, but it doesn’t seem to be enough. Sound familiar? Anyone had prescribed a larger dose or even a second daily dose?

    • #103045

      I’m not sure how old your daughter is but my 17 year old son went through the same exact experience. One of his symptoms (of ADHD) is overeating/binge eating. When he started his medication, all symptoms disappeared..a miracle as he’d suffered for years. The medication (30mg Elvance)would wear off at about 2-3 PM as his first dose was taken at 730am-8. Sure enough, he’d start craving food/binge eating & severely biting his lip again (I take 50mg in the morning and the same would happened to me). My son revisited our ADHD specialist Dr. Humphries at the Harley Group in London and he prescribed a second 30m dose at 1PM. It worked! He’d tire at about 10-1030PM and sleep until 730AM. I was given a smaller dose at 1PM and experienced the same outcome. A second dose works, but don’t have your daughter take her medication too late. ..she’ll have trouble sleeping! I’m sorry your daughter is struggling..I hope you know I care & you’re not alone.❤️🌸

    • #103051

      Good point that I left out some info. My daughter is 9 and has been on methylphenidate for about 3 yrs. I think it’s 30mg.

    • #103223
      Penny Williams

      It’s called rebound and is very common. Here are some strategies that can help:

      When Meds Go Bad: After-School Rebound Strategies

      When to Give Kids Another Dose

      ADDitude Community Moderator, Parenting ADHD Trainer & Author, Mom to teen w/ ADHD, LDs, and autism

    • #103587

      My son is also on Methylphenidate 20mg, he has been on the same dose for about 3 years. When we started 4th grade, this year, we couldn’t get through homework in the evening. So, now we take a smaller, 5mg, “boost” ever afternoon. It has changed our evenings dramatically for the better. But, as someone posted earlier make sure not to take it too late in the day or bedtime goes out the window! We adjusted the afternoon timing A few times before we found what worked for us.

    • #103596

      I’m an ADD patient and dad. Try a time release (XR), increase, or a different med altogether. After 2 other meds I found Adderall, then an XR, on down to a dosage increase to finally nail it for me. We did similarly the same with my daughter who was around 10 at the time. She’s now 13 and doing a lot better. But we also found out she’s on the mild spectrum of Autism as well. So whole new ball game for me, my wife, and baby girl. I hope this helps. 😉

    • #103599

      As an adult, Concerta lasts 8 hours for me. Methylphenidate instant release lasts 2 1/2 – 3 hours. I’ve found a benefit from taking second smaller concerta dose, but timing is important. Have tried instant release in afternoon, but that seems to overshoot and then wear off quick. I’m experimenting with combining Concerta and Aptensio. Aptensio works much quicker than Concerta, so it’s a lot easier to notice the effect. Concerta takes about three hours to work for me, but it’s steady for several hours. Dosing is constant battle between doctor, insurance, and pharmacy. FDA guidelines should take into account how long patient needs the actual effect of the medication. As a parents of ADHD kids who also has ADHD, I need 16 hours. ADHD is worse as an adult parent, so absolutely do not skip having your child learn behavioral modifications along with medication. Can I drive while listening to music, having a stirring conversation with my wife, while my kids are arguing in the back seat, and not miss the turn. Absolutely not, but while medicated I can calmly say, one second I need to pay attention to where I’m going. Usually I wouldn’t distract myself by answering a forum, but I’m having a bathroom remodeling. Today is demolition day. So while I am medicated, I can’t focus with the banging so my ADHD sends me to instant gratification of screens.

    • #103608

      My Son is on Methylphenidate ER 54mg. He takes it at 6 am and it wears off late in the afternoon. His doctor prescribed a 10mg “booster’ to get him through homework and dinner time, but won’t be in his system at bedtime. It works wonders just to take the edge off and help him focus.

    • #103614

      I have had similar issues with my 10 year old daughter. She is on adderall xr. Adding another short acting dose in the afternoon was not an option due to appetite suppression and difficulty falling asleep. We added intuniv which helped smooth the transitions with med wear off in the evening. Not perfect but definitely better. We had to play with dose timing and the first few weeks she was a bit drowsy (started on 1mg and worked up to 2mg). She takes it in the AM with her adderall. My goal had not been to add another medication but daily meltdowns were becoming so problematic. I also noticed that when her classroom changed the snack time to the afternoon she was much less irritable. Best of luck to you!

    • #103616

      Exactly the same. My 12 year old son has taken Methylphenidate as Concerta 54mg XR for a couple of years. He was having a terrible crash around 5. He was emotional, irritable, angry, and very negative for about an hour, then it transitioned in to his non-medicated “slap happy” hyperactive, impulsive behavior for the rest of the night. And getting him to bed was a long, exhausting process. Our Dr. prescribed a booster of 5mg short acting Ritalin at 4:30 and it has worked wonders for the crash. It wears off about an hour before bed, but we no longer have that hour of misery after the Concerta wears off. We recently added Intuniv 1mg XR in the afternoon and it has helped control the excess impulsivity before and after his other medications are in effect since it is a 24 hour medication.

    • #103623

      Same here with my 7 yo son. The doctor told us to stick with it for a couple of weeks and see if he normalizes, which he did. So if it’s new, give it a week or so. If not, try an xr with an afternoon dose. Last, you might need to change the meds – each one works differently on each person. Good luck!

    • #103631

      Our son had been getting Methylphenidate (Quillivant) in the mornings, and we had a similar cliff effect. We have been giving our son a booster that would take us from the end of school until about 7:00pm. Worked wonders for his behavior and ability to do homework, etc. He had been on Quillivant, then Quillichew. Just started him on a longer lasting 36mg of Concerta, which seems to be a good, single 12 hour dose. So preferable to the four a day he had been getting. He is 8yo and about 50lbs.

    • #103594

      My kiddo is 5 yo and has that same issue. Our Dr. put my kiddo on Tenex during the day in addition to his regular ADHD meds. It helps at school, so we thought we’d add a second dose at night. So far still rebounding, but will report back.

      Good luck!

    • #103604

      I’m a college student and I had the same experience. I talked to my psychiatrist and she said there’s a new form of Adderall that’s an extended extended release, and there’s a discount card to make it cost only $3. The only downside is that because it’s brand new, there’s only name brand so insurance won’t cover, and it’s h*ll and a half to get my meds filled on time because the pharmacy won’t accept refills until 2 days before or the day of last dose. Hopefully an off-brand will become available soon, because this med has been really helping me stay on top of my game until I wind down to go to bed at night.

      I would talk to your psychiatrist or med prescriber about options. I was also offered a “booster” which is like a very small immediate release that you take right before the extended release wears off. It doesn’t work for everyone (I would often forget to take it and suffer the consequences) but there are other options out there. It’s really tough, especially for school age children and college students, when it comes to finding med combos that work for us. Just keep your child in on the conversation, because being able to identify when your own meds are wearing off can be a huge help. Then you can start to use “Wise Mind” (https://www.dbtselfhelp.com/html/wise_mind.html) to identify what are good actions, instead of letting your ADHD run rampant.

      Hope this was helpful!! Good luck! 🙂

    • #103691

      Our psychiatrist prescribed deplin(L-Methylfolate) for this issue. We tried after school boosters but it was just more medication in my mind, and didn’t seem to work(maybe we will need them as he gets older-has a job, HS level homework…). I read about it and was giving him 1-2mg per day but it did nothing for him. Found out from our psych that bc of his specific chemistry, he needed more. My 2 younger children, also ADHD(yeah! Full house!), take Pure brand Folate 500, and it’s probably all they need. How much you need, or whether it would work, depends on your brains ability to process ….folate? Ummm. I’m probably butchering that, I’m not a chemist or a doctor. I’m sure someone else reading this can clarify my misinformation. But what I can say is it worked for us. So does taking Vayarin. That’s our magic mix, and so far so good. Good luck to you!

    • #103697

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    • #103705

      Hi, my 11 yr old tried methylphenidate at the end of last school year and we started it again this year. She had 10mg in the AM and we even added a 5mg booster in the afternoon. The meds helped tremendously, but the same thing happen in the evenings. She would become hateful and have multiple breakdowns, even her counselor told us she is not the same person she was before. My husband read an article about magnesium helping with adhd, we asked her doctor about the correct doseage. He told us there are studies that show it helped. We took her off the meds and started the magnesium twice a day, she has shown the same results with it as the meds. She is concentrating in school, and getting her homework finished without a fight. We have down days, everyone does. We can also tel when she has skipped a few days of taking the magnesium. She tends to hide her vitamins when she doesn’t want to take them. That’s what helped us, I hope you find a solution, we only want the best quailty of life we can give them and sometimes it’s seems to be a long road to get there.

    • #103719

      Wear-off irritability, and wearing off sooner than typical are both often signs that you need to go up a notch or 2 on the dose. Try that. My experience is that doing that is successful 9/10 of the time.

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