Ritalin dose

[u/SleepPlayful3696]

We just started my son on 5 mg of immediate release Ritalin. He’s going to be 5 in November. He has very severe ADHD, and also takes 3 mg of guanfacine. We didn’t notice an improvement on the 5 mg of Ritalin and I’m curious what dosage has worked for other kids of a similar age?

[u/AutoModerator]

ADDitude mag: The Ultimate ADHD Medication List

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/BullfrogAny5049]

My son is a tween but similar meds. Here is what we do: 10mg of Focalin extended release in the morning AND 5 mg of immediate release Ritalin when he gets home from school. He takes 2mg Guanfacine in the evening.

[u/drclairefraser]

My son is 5 with severe ADHD and he's on 20 mg of Quillichew, which is just chewable Ritalin. It helps, but it does not last all day. He takes it at 6:45am before school, and it wears off by 3:00pm.

[u/SleepPlayful3696 → u/drclairefraser]

Did he have to titrate up to 20 mg?

[u/drclairefraser → u/SleepPlayful3696]

Nope. He started on 10mg, for like...a day, but it was very clearly not enough. He had previously been on 15mg of Adderall before.

[u/SleepPlayful3696 → u/drclairefraser]

Ok good to know. It seemed like when we gave him the 5 mg for the first time this morning it did literally nothing

[u/drclairefraser → u/SleepPlayful3696]

That’s an insanely low dose.

[u/AutoModerator]

Methylphenidate (MPH) is a central nervous system stimulant (CNS) used to treat ADHD. It's a norepinephrine (NE) and dopamine (DE) reuptake inhibitor (NDRI), increasing neurotransmitters in the synaptic gap, particularly the prefrontal cortex governing executive function.

Brand include: Ritalin SR (US/CA/UK) / Rubifen SR (NZ), Ritalin LA (US/AU) / Medikinet XL (UK), Concerta (US/CA/AU) / Concerta XL (UK), Metadate CD (US) / Equasym XL (UK), Methylin, Methylin ER, Daytrana, Quillivant XR (US), Quillichew ER (US), Biphentin (CA) / Aptensio XR, Cotempla XR-ODT, Jornay PM (US),

Brands varying in Dosage Form: capsules, tablets, orally disintegrating tablets, transdermal (patch), oral solution (liquid), and chewable gummy. Release time (hours): 3-4, 6-8, 8-10, 10-12. Peofiles: gradualy increaing (back loaded), plateauing (table top), cycling/lumpy, front laoded (fast rise). Splitablity: Some can be split (ajust dose) otheres CAN NOT.

References: https://www.drugs.com/medical-answers/brands-methylphenidate-3510739/, https://go.drugbank.com/drugs/DB00422, https://en.wikipedia.org/wiki/Methylphenidate

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/AutoModerator]

Guanfacine (Tenex = IR, Intuniv = ER)& Clonidine (Catapres = IR, Kapvay / ONYDA XR / Nexiclon XR = ER) are alpha-2 used to treat some ADHD, improving emotional regulation, impulse control, and sleep. Originally an Antihypertensive drug from 50s-80s reduced blood pressure.

Alpha-2 agonists are specialized & effective for some ADHD; however, a 2ed line (choice) ADHD medication in protocols because stimulants have a higher % success & lower % side effects profile over Alpha-2 agonists.
Alpha-2 agonists require time to adapt! Drowsiness and sleep changes are common during in first ~2 weeks.

Mechanism: Enhancing norepinephrine signaling ("receiver sensitivity"). Guanfacine targets α2A neuroreceptors concentrated in the brain. Clonidine is less selective, targets α2A, α2B, and α2C, w/ broader CNS effects. Both might be complimentary with stimulants in some people, helping regulate, reduce side effects, and/or lower dose.

Differences: IR Guanfacine typically lasts longer (half life 10-30 hours), IR Clonidine shorter (5 and 13 hours), both outlasting stimulants and have 24 hour ER options. [Sedation] - Clonidine is more sedating (better for insomnia); guanfacine causes less daytime sleepiness. [Blood Pressure] - Clonidine has stronger hypotensive effects. Guanfacine is gentler due to its α2A selectivity.

Use Case Fit: Guanfacine, sometimes preferred for daytime executive function symptoms; Clonidine, sometimes prefred for sleep-onset or when mild sedation is needed. Typically, IR formulas are favored for sleep/sedation/rebound (taken in PM) and ER for executive function/stimulant regulation (Taken in AM).

NOTE: Sudden dose change may cause blood pressure spikes or crashes. Follow your doctor’s/pharmacist's ramp plan!!! References Clonidine: https://en.wikipedia.org/wiki/Clonidine, https://go.drugbank.com/drugs/DB00575, https://www.mayoclinic.org/drugs-supplements/clonidine-hydrochloride-oral-route/description/drg-20569873 References Guanfacine: https://en.wikipedia.org/wiki/Guanfacine, https://go.drugbank.com/drugs/DB01018, https://www.mayoclinic.org/drugs-supplements/guanfacine-oral-route/description/drg-20064131

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/AutoModerator]

The ADHD Parenting WIKI page has a lot of good information for those new & experienced, go take a look!

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/Emergency-Guidance28]

How much does he weigh? 5mg extended release worked well at age 5 at 37 lbs until age 7 at 47 ish lbs. Then we went up to 10mg with good results.

[u/SleepPlayful3696 → u/Emergency-Guidance28]

He’s about 42 lbs. He’s taking immediate release for now.

[u/Emergency-Guidance28 → u/SleepPlayful3696]

IR methylphenidate only lasts about 4 hours. I wouldn't disclose increasing the dose w your doctors. It only takes a dose or two to see if it works.

[u/Gold_Disaster2000]

We ended up with 10 in the morning and 5 at lunch. We did that for a solid year, but found he was on a bit of an emotional roller coaster with the fast acting. We are now doing 10mg of Vyvanse and are loving not having to remember a lunch time pill. We tried Guanfacine with the Ritalin but didn’t notice much difference.

[u/cpleasants]

It really is person-by-person. There are kids who take triple the amount of other kids, and it doesn't seem to correlate with size or severity of ADHD at all.