|
Post by d on Apr 10, 2006 15:51:22 GMT -5
Mayleng, do you know what the Focalin XR mg equivalent is for Concerta 54 mg?
|
|
|
Post by Mayleng on Apr 10, 2006 16:54:28 GMT -5
If the logic holds true, it would be halved of what the Ritalin LA or Metadate CD equivalent of Concerta is, since Focalin is supposed to be stronger/purer than these meds.
So 54 mgs Concerta would equal approximately 15mgs/20mgs (actually 18mgs but dosage doesn't come in 18mgs) ritalin three times a day. Focalin shortacting would probably be around 7.5mgs/10mgs (halved of ritalin) three times a day. Multiply that by 2 (8 hours for XR) = 15mgs/20mgs of Focalin XR (whichever is closest available dosage).
This is just through pure calculation, how much a child needs of Focalin Xr is up to the child because it is slightly different than the regular Concerta, Ritalin etc.
|
|
|
Post by d on Apr 10, 2006 17:33:22 GMT -5
Thanks.
The ped neuro gave us the Focalin rx in 10's to try out 20 mg the first week or so, then go up to 30 if needed. Of course by the time I get the rx filled tomorrow, she'll have either none or the last school day of it before 1 1/2 weeks vacation so we won't know if it's "school-worthy" for some time. I wanted to check bc she lowballed the Metadate equivalent when we tried that. Maybe the 20 will work here bc it's a different form.
The ped neuro also told me Focalin lasts longer than Concerta. I think she's wrong. I remember reading Concerta was 10-12 hours whereas Focalin is 10? I asked her if she knew how it has been doing (colloquial evidence) for focus and attention, C's major problem areas. She answered with different meds for different heads, no colloquial evidence even after prompting her again.
C has also had it with the ped neuro. Exactly twice in her life C has been forthright with a doc about meds not working. Early fall which I knew before she did and today with "It is really hard to concentrate" - big for her. I see the telltale signs of doodles, poor handwriting, forgeting directions a millisecond after hearing them, hyperactivity and some test/grade variability. C actually tells the doc she needs a dose change or a new medicine (huge for her, I want her to have that type of self-awareness). Ped neuro then tells her she's going to keep her on Concerta 54 mg and she will have to "try harder". She motions that we should do things like close the blinds, eliminate distractions for her. In the car on the way home, C says "I was kinda insulted by that. What do blinds have to do with this if I told her I told her concentrating was hard?"
I am trying to teach my *female* goodlittlegirl ADHDer to know and advocate for herself - so I guess that's what I'm pissed about. I wasn't crazy about this doc before but today she just annoyed the heck out of not just me but C too and could've got in the way of that.
She grew an inch but lost 4 lbs. in 3 mos. (after gaining 20 lbs and many inches in the last year, I am concerned but not alarmed - oh well back to Carnation) so doc didn't want to change from Concerta 54 mg. C's car comment was "If I'm having trouble concentrating and lost weight, uh DUH maybe I need something different."
OK rant over. I definitely have to find a new doc anywhere from immediately to the next 6 mos. depending on how Focalin works. I am scared for parents that don't ask questions or know options. Bonus points if the new doc does not keep us waiting for 1 1/2 hours so I miss younger dd getting off the bus and older's guitar lesson.
|
|
|
Post by Mayleng on Apr 10, 2006 18:20:30 GMT -5
d, 20mgs of focalin xr is the maximum recommended for kids. The Doc should have given you 5mgs to increase every 5mgs, so you could try 10mgs, 15mgs and then 20mgs. It is only supposed to last 8 hours, like ritalin la. Contains 2 types of beads, first type will be absorbed within the 1st hour and 2nd beads will be absorbed 4 hours later. C is right, if she is saying she is not able to focus well on her current med, telling her to try harder is just ridiculous considering we are talking ADHD. It sures sounds like the Doc has no clue what ADHD is really like and yet she is treating it. Makes me sick just thinking about it . Time to find a good Doctor, me thinks! I am, however, very proud that C is so self-aware and can advocate for herself. You have done well there. Let me know how the Focalin XR works out. Even though she is starting Spring Break, it is still a good time to try it, to make sure she does not have any side effects on the Focalin Xr and you can observe her yourself. I am sure she will be able to tell you whether it is helping her focus.
|
|
|
Post by angel on Apr 10, 2006 20:42:30 GMT -5
Hi d,
I just wanted to throw in that FocalinXR seems to take a little while to see results. So you might want to stick out each dose a little longer than you would before you up to the next level. We did jump from 10 to 20 and there was quite a big difference. I agree that adding 5mg would be better to try, but you know how scripts and dr.s go. Maybe they will come out with a 15mg. DD has gained weight and is maintaining on FocalinXR. That has been a plus.
ARG on the dr!!
angel
|
|
|
Post by notab on Apr 10, 2006 21:30:06 GMT -5
d, I would have had to work hard to restrain my mouth with that dr. The lack of knowledge about the meds and even more irritatingly talking to your daughter that way Angel, It seems like that was the case with my ds, although since he is on Strattera to it was hard to tell. Where did you read that? I had someone from my son's school tell me that, but I didn't trust the source enough to buy it wholeheartedly
|
|
|
Post by d on Apr 11, 2006 8:30:56 GMT -5
Thanks all for the tips and support. Yup, it is time for a new doc.
I think I'll start out with 10 for a few days, then go up to 20 so I can see differences for myself. If necessary, 30 sometime after school starts. We'll see how it goes. Now that I know it make take a few days longer to see effects, I should take advantage of this 11 day school vacation to see the differences in doses.
And the more I think about this doc, the more it is not right. Everything I've read says why bother medicating if not at optimal dose. We did use a sub-optimal Concerta dose once for several months bc of weight gain (and her teacher that year was awesome redirecting her) and we used to give her 1/2 doses on weekends but that was done purposely. If 5 mg Focalin is minor but could make a major difference, why didn't she give me the 5 mg rx so we could see?
Also, as for the duration this doc keeps making comments that the effects of Metadate and Focalin should last as long as the Concerta due to residual effects. I pressed her to give me a short-acting Ritalin booster which C never wanted to take when we tried Metadate. What a twit this doc is, bc softball season is starting and she has finals in all subjects for the first time this year. I can see her spacing out on the field so will encourage her to use that short-acting on nights she needs it.
I used our car talk to tell C why it is important to keep her wits about her with doctors when she is an adult, and I won't be with her so that she can get decent care.
Mayleng, the 20 max Focalin might be similar to many docs not wanting to go past 54 on Concerta although the 72 is necessary for some kids. Argh, it would be a shame if we found that 15 or 25 vs 30 Focalin was her optimal dose but this doc didn't guide us there.
|
|
|
Post by Mayleng on Apr 11, 2006 10:26:40 GMT -5
d, Just remember that 5mgs of Focalin(short acting) is equal to 10mgs of Ritalin (short acting), the XR and LA are the same. Focalin dosage should be half of the regular Methlyphenidate. So if you increase by 10mgs Focalin Xr, you are in effect increasing by 20mgs ritalin LA or Metadate CD at a time. So if you bring her up to 30mgs of Focalin XR (the max is 20mgs as recommended by the manufacturers) it would equal 60mgs of Metadate CD or ritalin LA (approved dosage for kids on these 2 meds are 40mgs) or 90mgs Concerta (FDA approved for kids is 72mgs maximum). There is no reason why you cannot give 5mgs, 10mgs, 15mgs, 20mgs Focalin XR. More expensive because you will need two scripts. But you are at least not making such a big jump in dosage. Focalin does not last as long as Concerta - 8 hours is what is in their site's info. With any meds it really depends on how fast the kid metabolizes them. www.focalinxr.com/index.jspPage down to the prescribing info part. According to this article, a 15mg one should be coming up in the Fall. pediatrics.about.com/od/adhd/a/05_focalin_xr.htm
|
|
|
Post by d on Apr 11, 2006 11:40:41 GMT -5
d, Just remember that 5mgs of Focalin(short acting) is equal to 10mgs of Ritalin (short acting), the XR and LA are the same. Focalin dosage should be half of the regular Methlyphenidate. Argh, the math is giving me a headache and I used to work with #'s for a living!!! The short to long acting conversions are killing me. Please bear with my denseness and confirm my math: I'll see when she takes it but if the Concerta 54/equiv of 18 mg short-acting wasn't working since Focalin XR 10 mgs is the equivalent of short-acting 20 mg that may be enough, right??? Between the difference in the med form and the 2 mg boost, she might be ok/optimal on Focalin 10 or maybe bump up to 15 mg (vs Focalin 20 or 30)? Am I right? This is where I get confused and the math doesn't make sense to me. Focalin XR 20 would be the equiv of 40 short-acting or Concerta 60 mg? (The 40 equivalent sound ridiculously high and unsafe but Concerta 60 vs 54 is not much of a difference. ?) Focalin XR 30 would be the equivalent of 60 short-acting or Concerta 90 mg - in either situation way too high. I didn't see the short-acting equiv's on the Focalin website and the Novartis hotline didn't know.
|
|
|
Post by Mayleng on Apr 11, 2006 14:18:50 GMT -5
Go to the Prescribing Information on that link I gave you. Go to page 20 under:
Patients currently Using Methylphenidate:
For Patients currently using Methylphenidate, the recommended starting dose of Focalin XR is half the total daily dose of racemic Methylphenidate (meaning regular Methylphenidate ie. ritalin). .......... The maximum recommended dose is 20mg/day for Pediatric and adult patients.
So this is how they calculate:
Because concerta last 12 hours, you divide by 3 = 4 hours Ritalin LA, Metadate CD lasts 8 hours, you divide by 2 = 4 hours Regular shortacting ritalin and focalin lasts = 4 hours
See the common denominator here - 4 hours.
Soooooooo you need to find the common denominator for each long acting med and see how much is released if it was a short acting equivalent (which only lasts 4 hours) and then multiply it by whether it is an 8 hour med (multiply by 2) or a 12 hour med (multiply by 3).
In the case of focalin and focalin xr equivalent you need to divide your current methylphenidate, which is concerta by 3, because it lasts 12 hours. Then divide that by 2 because focalin is stronger and multiply by 2 for focalin xr because it lasts 8 hours. Have I confused you. I know I could just not tell you to divide by 2 and then multiply by 2 again as they negate each other but that is how the logic works.
Here:
C is currently on 54 mgs concerta:
Divide 54mgs by 3 = 18mgs regular ritalin (which lasts 4 hours).
18mgs divided by 2 = 9mgs of regular focalin (because focalin is stronger and lasts 4 hours).
9mgs x 2 = 18mgs of Focalin XR (because it lasts 8 hours) - beads are released every 4 hours. The closest mgs would be 20mgs of Focalin XR.
So depending on how C reacts to Focalin XR she might only need 15mgs to 20mgs of Focalin XR.
If you were to give her 20mgs of focalin XR, it will equate to:
20mgs x 2 = 40mgs of Ritalin LA or Metadate CD (8 hours)
20mgs x 3 = 60mgs of Concerta (12 hours).
If you give her 30mgs of Focalin Xr.
30mgs x 2 = 60mgs Ritalin LA or Metadate CD (8 hours)
30mgs x 3 = 90mgs of Concerta (12 hours).
So the big jump is because you are increasing regular methylphenidate by 20mgs for every 10mgs of Focalin XR. So it is better to increase by 5mgs of Focalin/Focalin XR than 10mgs at a time.
I hope it is clearer now.
|
|
|
Post by Mayleng on Apr 11, 2006 14:29:08 GMT -5
d, I gotta go meet my banker now. I will check back later to see if you have any more questions.
|
|
|
Post by d on Apr 11, 2006 14:34:44 GMT -5
Thanks for taking the time to write that and humoring me. The 8 vs 12 hour calculation was tripping me up. The upstairs lightbulbs are slowly turning on.
And this ped neuro should be *fired* especially now after I understand this better. How flipping dangerous to rx Focalin XR 30 mg plus not giving us the option to tweak in 5 mg increments! I already picked up the rx. I'm surprised the ins co didn't redflag it.
My ped (who also has an ADHDer) is going to hear about this when I see him in the next few months, if not earlier. Lots of peds refer kids to this ped neuro. He will want to hear it.
|
|
|
Post by Mayleng on Apr 11, 2006 17:48:40 GMT -5
Unfortunately, the Doctors only hear with their drug rep tells them. Most don't bother to read the prescribing information provided. I had to educate our Ped on Strattera when we first tried it. The Norvatis hotline themself could not answer your questions, what does that tell you. All that info was on their site under Prescribing information. We all need to find out info about the meds ourselves and not trust that the doctors know. It is sad and dangerous.
|
|
|
Post by justfunnin on Sept 26, 2007 22:23:58 GMT -5
Hi, I am new but just wanted to comment that my 10yo son is on 108mg concerta am (above recommend g/lines, but unsafe on lower doeses) Especially if it is bad enough that your daughter noticed she needed something else the dr was very apathetic to ignore that... how is the focalin working for you? I am looking for something else that might work better for my son so i am seeking opinions of anyone switching from concerta to something else, strattera was a no go!
|
|
|
Post by Mayleng on Sept 27, 2007 6:45:39 GMT -5
justfunnin, have you tried Metadate Cd? Concerta did nothing for my son, but Metadate Cd has been working great for the last 3 years. He has no side effects from it. We have tried alot of meds including Strattera (except Focalin & Daytrana) and Metadate CD has been the best for him.
Metadate CD only last 8 hours though, but since your child sounds like he needs a longer acting meds, he can take a second dose of Metadate Cd when he comes home and that would cover him into the evening.
Just a thought.
|
|