Best alternatives to Concerta? And another question too.

[wolfshades]

Hi everyone.

I’ve been on Concerta 54 mg and my tolerance has been slowly building – which I *hate*. This med is pretty awesome and has produced some spectacular results for me. My doc has increased it by prescribing an additional 18 mg. I was pretty sure he told me to take it in the afternoon but the label reads that I should take it in the morning. Given the time release quality of it, I’m completely unsure so I’ve taken it in the afternoon. Frankly I’m not sure if it’s working. I’m not noticing any kind of dramatic differences in the afternoon, but by the end of the workday I’m back to (my) “normal”: flighty as all get out, and beginning to look for those shiny bouncing balls in my mind. : ) So that’s the first question: when taking a 54 mg capsule, is it better to take the 18 mg with it?

Next question: I’ve seen a few people mention that taking a “drug holiday” on the weekend will lessen the toleration affect. Is this true? And now that I seem to have tolerated the heck out of this particular dose is it too late to try the drug holiday thing? (I’m guessing the answer is yes)

Final question: for those who’ve had to change meds because they tolerated Concerta too much, what have you gone to? I’m guessing Adderal or Ritalin might be the next best bet, if only because (if I understand correctly) you only take it when you need it, so your tendency to grow into tolerance might be less.

My nightmare is: eventually I’ll tolerate the heck out of everything and will be back to where I was before I began this regime.

P.S. Straterra was a horror for me, and I’ll never go back to that (not a tolerance problem – it produced some spectacularly unwelcome side effects).

Thanks in advance for any thoughts you might have on this!

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[g.laiya]

i think we all have that fear that we’ll find something that really helps us (and we tolerate it well), only to be let down later as it loses effectiveness.

i also have read about some people taking med holidays to avoid developing a tolerance to stimulant meds.but when i mentioned to my psych that i may do that – just take it on days i’m scheduled to work and times i need to tackle big/difficult projects at home – he said he didn’t think it was a good idea – at least not yet. he said i should wait until i’ve had a chance to learn new/better ways of functioning, develop good habits and such – and let them take root – and then i can play around with taking meds prn if i want. he said this will likely take at least a few years. not sure if that’s for most people or my particular set of circumstances though.

right now i’m taking the adderall xr in the morning, daily, and also have the short-acting version to use in the afternoon as needed for better coverage into the evening. this would probably be a good med to consider if you need to switch from concerta. but i’m pretty sure with any of the stimulant meds we have the same issue – risk of developing tolerance.

also my guess would be that you’re supposed to take the 54mg plus the 18mg together in the morning….or maybe he wanted you to experiment and see what helps you more, taking together or separately. best to just call your dr’s office to clarify instructions.

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[Tiddler]

Hi

I got some good advice at a conference on autism. Temple Grandin said that there were excellent results when people REDUCED their medication when they felt it wasn’t working. The temptation is to go up and up but sometimes the opposite can help and that’s what happened with her (though naturally it was a different drug.)

I felt that my concerta wasn’t working and I upped the dose. I didn’t like the side effects. When I dropped back down, I found I was MUCH more productive, calmer, focused and happier.

I thought it wasn’t working because I wasn’t getting that clarity and head space that came when I first took it, but what was there instead was an ability to clear some of the unwanted crap out of my head and enough control over what I was doing to actually get on with stuff.

Just me but more productively busy.

Less like I don’t have ADHD and more like I’m learning how to live with it.

Something to think about maybe?

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[Tiddler]

I should add though that I don’t get any benefit after about 6 hours and I would like to ‘top up’ once I get to speak to a psych finally – but I get more done in those 6 hours than I did in a week before I started taking it.

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[kc5jck]

Tiddler – The counter-intuative effect of reducing dosage may be similar to people gaining weight when they eat less because the body’s metabolism overcompensates and, burning fewer calories, begins to store more fat.

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[wolfshades]

Interesting comments, everyone. It appears I’m way more of a newbie at this than I thought. Never considered that a lesser dose might actually help – although……I would have thought my doc would have suggested that. (I’m aware that medicine is often a case of trial-by-error, so I’m not blaming him).

The other side of the coin though is this: after it wears off – my creative side actually gets a bit busier. Last night when my mind was doing its whirling-dirvish thing – as it is wont to do – I churned out a blog and actually got a lot of hits on it.

I suppose the bottom line is that I want the meds to work for me when I’m doing my humdrum job, and I don’t want them or need them when I’m doing something creative. Which might make Adderal the better choice.

And I honestly have NO idea whether any of that makes sense. : )

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[kc5jck]

http://www.youtube.com/watch?v=w2AI8r4q8V8

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[nellie]

Wolfshades,

I’ve been taking 30mg of Vyvanse for a little over a year. I did try the holiday from medication for three weeks. When I started taking it again I definitely noticed a difference. To be honest often I feel I have a tolerance and it’s not working but if I don’t take it I am not as alert and there just isn’t the same motivation as while taking it

Compared to all of the other meds I find Vyvanse much more subtle – as if it’s just quietly working in the background

I just started reading More Attention Less Deficit by Ari Tuckman ( which is available from Amazon via a link from the shop here).. In the section about medication he mentions that dosage effect is based on weight., the higher your weight the higher your required dose. So if there is a significant weight gain the dosage may not work as well. He says other reasons for a seeming loss of effectiveness is increased responsibility and therefor greater requirement of attention, or possibly stress or sleep deprivation. According to what he writes there is no tolerance development at normal dosages.

I

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[Anonymous]

I build up a tolerance to adhd meds fairly quickly . I have taken most of them out there (building from low to the highest dose). I have to change them about every year. I like concerta the best, because it is not speedy and its smooth. Vyvanse is a little speedier, but no where near adderall (the one that is not time release). Right now I am taking 40mg of amphetamine salts (generic slow release adderall). It isnt as bad as I had first thought. I hope I can take this one for a long time. This is the only one that is free, with my insurance plan (thank goodness).

Vyvanse and Concerta are really expensive.

But I was told that the copywrite (or what ever it is called) for concerta expired in May. I am hoping that a generic will come out fairly soon.

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[Anonymous]

@WShades

I am on 74mg of Concerta XL and have recently returned from a three week holiday in France. Whilst there I managed to lose my last three days worth of medication so had to go without until I got back to the UK.

My point was/is, I noticed that before (like you) I suspected that my tolerance to the drug was increasing and that they perhaps were not working as well as they used to.

On returning back to the UK, I took a 36mg dose( 1/2) and the effect was immediate! The next day I returned to full dose and again it was like someone had turned on the lights.

I am not saying to drop your medication for a few days, that is your call. But I hope you can find some of what I am writing of some use to you…

WOFH

Pete xx

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[nellie]

hey everyone

just found this really interesting video on Dr Kenny’s blog . There are actually four videos as part of a webinar but the second one deals with medication. Near the end of it he talks about tolerance. It’s done with a sort of powerpoint format so you can drag the player to the part that interests you.

http://www.addadhdblog.com/adhd-medication-free-webinar-training/#7bc39

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[munchkin]

54 was making me a zombie in the afternoon, so I switched to 36 and it was overall a much better balance for my day.

Then I ended up taking short acting because of appetite issues, so I take the equivalent of about 36mg – just in shorter acting tablets…

I did believe that I needed more and was surprised that less was actually better. There is a “right” amount – too high or too low, and I don’t get a good effect.

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