Concerta Use and Side Effects in Children With ADHD

A young girl doing homework in the living room

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Methylphenidate, more popularly known by the brand name Ritalin, is a stimulant that has long been used to treat kids with attention deficit hyperactivity disorder. And although it usually worked great at controlling ADHD symptoms, one big downside was that it wore off quickly, so kids often had to take two to three pills a day.

This frequent dosing meant that children had to take a pill in the morning, another one around lunchtime at school, and sometimes another one after school.

In addition to being inconvenient, kids usually didn't like being separated from their classmates and lining up at the nurse's office for their pills.

The move to once a day stimulants to treat ADHD has been welcomed by kids, parents, and school nurses alike. Now kids only had to take one pill in the morning and it lasts for 10 to 12 hours.

Use of Concerta for ADHD

Approved by the FDA in 2000, Concerta was the first real once a day medicine for ADHD and it quickly became popular. Like Ritalin, its main ingredient is methylphenidate, but it is packaged in a special, controlled-release tablet that provides your child with the medication throughout the day.

Switching to Concerta from regular Ritalin is easy. You usually just take your total daily dose of Ritalin and change to the Concerta pill that is closest to that dose. So if your child is taking 5mg of Ritalin three times a day, for a total daily dose of 15mg, you would probably change to the 18mg Concerta tablet.

Concerta is also available in a 27mg, 36mg, and 54mg tablets, providing flexible dosing options. And although an even larger tablet isn't available, older teens can be prescribed two 36mg tablets to reach the maximum dose of 72mg.

Although pediatricians often start with low doses when starting a stimulant, keep in mind that in a recent study 95% of kids were either on the 36mg or 54mg strength tablets, so don't give up on Concerta if the lower dosages don't seem to be working.

Switching from Adderall or Adderall XR is also easy. You usually just double your total daily dose of Adderall.

Concerta Side Effects in Children

According to Concerta's product information packet, the most common 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%), and dizziness (2%).

If your child is having significant side effects, a lower dosage or a switch to a different medicine might be needed.

And although the FDA "did not find an association between use of ADHD medications and cardiovascular events," such as stroke, heart attack, and sudden cardiac death, they do recommend that "patients treated with ADHD medications should be periodically monitored for changes in heart rate or blood pressure."

Other Long-Acting Forms of Methylphenidate

There are other long-acting forms of methylphenidate, like Daytrana, Metadate CD, Ritalin LA, and Quillivant XR, so why choose Concerta?

For one thing, although they are all made of methylphenidate, they do have differences in their delivery systems.

Concerta's delivery system provides a child with an initial dose of about 22% and then the rest of the medicine later in the day. So if your child is taking Concerta 18mg, he will get only 4mg of medicine in the morning and will start off with a little lower dose if he was previously on 5mg three times a day of regular Ritalin.

Ritalin LA uses a method similar to Adderall XR, so you get half the dose first thing in the morning after taking it and the other half later in the day. That means that if your child is taking Ritalin LA 20mg, he will get a 10mg dose in the morning. That's a big difference from the 4mg dose he would get if he was taking Concerta 18mg.

So if your child is mainly having problems in the morning when taking Concerta, changing to Ritalin LA might be a better option than increasing the dose of Concerta. It is available in a 20, 30, and 40mg capsule.

Metadate CD is similar to Concerta in that you get an initial lower dose. Metadate CD is made up of immediate-release beads that give 30% of the dose right away and then the other 70% of the dose is continuously released from extended-release beads. A downside is that it is only available in one 20mg strength, so your child has to take more than one capsule to get a higher dose.

What to Know About Concerta

In addition to these tips, other things to know about Concerta include that:

  • Concerta can't be chewed or crushed and must be swallowed whole, so it can be a problem for kids who can't swallow pills. Both Ritalin LA and Metadate CD can be opened and sprinkled on food, like applesauce, if your child can't swallow pills. Quillivant XR is a liquid version of methylphenidate and Daytrana is a patch, so kids who can't swallow pills now have many options.
  • Concerta is a federally controlled substance.
  • Generic Concerta (Methylphenidate ER) became available in December 2012. Unfortunately, two forms of the generic did not seem to be therapeutically equivalent (they had a different extended-release mechanism than real Concerta) and were soon taken off the market.

Concerta is not for everyone, especially kids with anxiety, tics, or Tourette's syndrome, glaucoma, or an allergy to Concerta, but it may be a good option for most kids with ADHD.

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Article Sources

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  1. Questions and Answers Regarding Methylphenidate Hydrochloride Extended Release Tablets (generic Concerta). Center for Drug Evaluation and Research, U.S. Food and Drug Administration.

  2. CONCERTA® (methylphenidate HCl) Extended-release Tablets. U.S. Food and Drug Administration.

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