What to Know About Concerta (Methylphenidate HCl)

Concerta is a central nervous system stimulant used to treat symptoms of attention deficit hyperactivity disorder (ADHD). The main ingredient in Concerta is methylphenidate, which is better known by the brand name Ritalin.

Methylphenidate works to treat ADHD by inhibiting the reuptake of the neurotransmitters dopamine and norepinephrine. This increases neurotransmitter levels boosting activity in the prefrontal cortex, the brain area responsible for thinking, thought analysis, and regulating behavior.

Concerta is a controlled-release tablet that provides a steady dose of methylphenidate throughout the day.

Uses

Concerta was approved by the U.S. Food & Drug Administration (FDA) in 2000 as the first once-a-day medicine for the treatment of ADHD. It is approved for use in children over the age of 6 and adults under the age of 65.

In its traditional form, methylphenidate is shown to be effective in controlling ADHD symptoms, such as difficulty sitting still, trouble paying attention, and taking a long time to complete tasks. Research shows methylphenidate also improves teacher-reported instances of fidgeting, interrupting, and finger tapping, and increases on-task behavior, compliance, and academic performance in hyperactive children.

The downside of methylphenidate is that it is short-acting, meaning it wears off quickly and requires multiple doses a day. In children, for example, this means needing to take the medication in the morning, again around lunchtime, and sometimes another dose after school.

Concerta, on the other hand, requires just one dose a day and lasts for 10 to 12 hours.

Before Taking

Available by prescription, Concerta is a first-line treatment for ADHD. Some patients may use other medications before being prescribed Concerta, although healthcare providers can prescribe it as the first medication you try.

In children, Concerta is sometimes prescribed by a pediatrician, though many patients are first seen by a psychiatrist or neuro-developmental pediatrician to confirm a diagnosis of ADHD. As part of the evaluation, your child's school may be asked to fill out a questionnaire assessing the student's behavior prior to treatment. Another assessment questionnaire may be required after the child has been on medication for a while to determine if it is effective at the current dose.

In adults with ADHD, Concerta is often prescribed by a psychiatrist or neurologist, although some primary care healthcare providers may be comfortable prescribing ADHD medication with a documented diagnosis from a clinical psychologist, psychiatrist, neurologist, or clinical social worker.

Precautions and Contraindications

Do not take Concerta if you have a sensitivity to or have had an allergic reaction to methylphenidate.

Central nervous system stimulants like Concerta should not be used in people with structural cardiac abnormalities or other serious heart problems, as serious cardiovascular events and sudden death have been reported. All patients should be monitored for changes in heart rate and blood pressure. It is also contraindicated for people with glaucoma.

The use of stimulants may cause adverse psychiatric symptoms including psychotic or manic symptoms in people with or without a prior history of psychiatric illness. Patients should be evaluated for bipolar disorder prior to being diagnosed with a stimulant. 

Patients with high levels of anxiety, tension, and agitation should use Concerta with caution since the drug may aggravate these symptoms. People with a history of drug dependence or alcoholism should use caution when taking Concerta as psychological dependence can occur.

Concerta should also be used with caution in people with a family history or diagnosis of tics or Tourette’s syndrome.

Dosage

Concerta is available in 18-milligram (mg), 27-mg, 36-mg, and 54-mg tablets. The maximum dose is 72 mg, and older teens and adults may be prescribed two 36-mg tablets a day.

When switching from a short-acting version of methylphenidate, such as Ritalin, to Concerta, the starting dose is typically closest to the total daily dose. For example, a patient who takes 5 mg of methylphenidate three times a day would likely be started on the 18 mg dose of Concerta.

How to Take and Store

Concerta should be taken in the morning with or without food. Do not break, crush, or chew the tablet, as it is coated for extended-release.

Concerta is a controlled substance and should be stored at room temperature, securely our of reach of children. Stimulants, like Concerta, are tightly regulated in many states. You may require a new prescription from your healthcare provider for each refill, and you may be asked for photo identification upon pick up at the pharmacy.

Side Effects

The most commonly reported side effects of Concerta are:

• Headache (14%)
• Upper respiratory infection (8%)
• Abdominal pain (7%)
• Vomiting (4%)
• Loss of appetite (4%)
• Insomnia (4%)
• Increased cough (4%)
• Pharyngitis (4%)
• Sinusitis (3%)
• Dizziness (2%)

Stimulants like Concerta may reduce appetite and slow growth. Children taking stimulants like Concerta should be monitored for appropriate growth in height and weight. 

Warnings and Interactions

Concerta should not be taken along with MAO inhibitors (drugs used to treat depression and anxiety); patients should wait at least two weeks after stopping an MAOI (under a healthcare provider's advisement) before taking Concerta.

If you or your child is having significant side effects from Concerta, a lower dosage or a switch to a different medicine might be needed. But it's important to consult your healthcare provider before making any adjustments.