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Concerta (methylphenidate) Time released Ritalin - 10 hour long acting tablet.

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Old 11-25-17, 01:38 AM
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108 mg of Concerta. Tolerance is a factor.

Hello I'm ADD-PI and have been dealing with the issues it entails for quite some time.

My brief treatment background:
Started Concerta about three years ago, and the effects were substantially effective. My life changed for the better completely and immediately. Due to my treatment success so far I can't imagine ever being off the medication. Although I was never measured on a specific scale as I hear some people are by their clinicians I would consider my case of ADHD-PI severe in terms of disabling, consequently this is part of my reasoning why I can never imagine myself unmedicated. Unfortunately over the course of three years I have already worked myself up to the 'CADDRA maximum recommended dosage for adults' which is 108 mg of Concerta. (3x36mg/day)

A problem that almost seems unique to me is tolerance (at least my particular degree of tolerance), when I say unique I mean that in my limited time browsing the forum I don't see the issue of tolerance being adequately addressed, and certainly haven't seen solutions to this issue besides the obvious "increase your dose, try something else, learn to cope" suggestions.

Tolerance should be the first thing on a persons mind once they manage to reach their therapeutic dose on the medication. Considering that if you achieved the desired symptom reduction and the benefits outweigh the side effects wouldn't you wonder; how long the benefits that the medication provides will continue to last? At least that is what I ask myself each time I manage a successful day which is almost fully attributed to the effects of the medication when it's working at its best. I wish this problem was more prevalent because maybe otherwise I would stop seeing advertisements from people, or webpages which refers to tolerance being 'a minor problem', or that 'no such tolerance problems even exist.' Maybe this is true for the less severe cases of ADHD, but certainly not in mine. Medication tolerance is my biggest obstacle in the way of performing in my most optimal way. (obviously besides my ADD itself.)

In my experience there is a certain threshold that is dependent on the dosage range which provides the greatest therapeutic benefit. If I don't reach that range than the medication will yet remain effective, however i'll be limited in my capabilities. Therefore at the right dose threshold my capabilities are seemingly 'maximized', or at least I can preform as well as anyone else can at a task, or at tasks, as oppose to lacking in ability when I have not reached the beneficial dose increment. To provide a example if I am on the medication and I have not reached the 'best dosage'; I simply cannot fully control my comprehension (though the medication helps.) of a lecture long enough to recall, remember and enjoy the concepts being discussed because of my lack of attention. When my greatest dose is reached I encounter this problem significantly less where its occurrence is almost rare. Problematically reaching this type of optimal effect from the medication is only reliable for a set time until tolerance builds, thus a dose increase is required.


In conclusion I am writing to ask other users of their input on the subject of medication tolerance, and the possibility of alternative options, followed by a few of my own questions:

-Why the **** **** is there a "maximum" dose in the first place? I've read case studies of doctors prescribing well above the max and seeing the same positive results as it was when a patient had previously achieved their most helpful dose.

-Can we be prescribed medication beyond the maximum dosage? Or is this illegal? Although it is not "recommended", However why aren't there exceptions to this rule (if this is a rule.) especially if tolerability is at a point where the medication almost has no physical effect, even in regards of its side effects.

-Does anyone else experience the same problems with drug tolerance, and have any advice?

Last edited by BookKeeper; 11-25-17 at 02:04 AM.. Reason: under-line a heading, and changing the ******* to ****
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Old 11-25-17, 02:55 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

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Originally Posted by BookKeeper View Post
...I don't see the issue of tolerance being adequately addressed...
Too often because it is overaddressed instead.

Tolerance is unlikely to be a problem with oral psychostimulants taken at clinically-prescribed dosages on a clinically-prescribed regimen.

Even 108mg of methylphenidate. I took that for years (as 2x 54mg)...aside from my anxiety, it worked a treat.


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Old 11-25-17, 04:08 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

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Originally Posted by aeon View Post
Too often because it is overaddressed instead.
I'm not sure what you mean by your remark of it being overaddressed perhaps the problem is discussed quite a bit on the forum, but what I meant by it not being adequately addressed is that I haven't came across any material that provided feedback on how someone went about dealing with this issue had they encountered it whether that be success or failure. I read about people being prescribed beyond the limit to adapt to their tolerance, but those were rare and their, or the article/thread validity is questionable.

I disagree with your view that tolerance is unlikely with any pyschostimulant I don't know the scientific pharmacology behind it, but with these drugs potentially most drugs that are taken prolonged will eventually lead to some form of tolerance. When I say tolerance partaking to this particular post I meant to centre the problem as the deviation from the highest effective dose due to tolerance not that the medication will become completely ineffective, although that could also be a probable occurrence. All of this still applies even if you are taking your medication as prescribed with doctors instructions. As in your case I don't think your beginning dose was prescribed at 108 mg.

Also I am here before you telling you from my own experience taking the medication at a clinically-prescribed dosages on a clinically-prescribed regimen to inform you that tolerance is still a strong factor, though I understand maybe in your experience it might not be as prevalent of a problem.

Thank you for your response. and I apologize if my sentences aren't articulate.

Last edited by BookKeeper; 11-25-17 at 04:31 AM..
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Old 11-25-17, 06:46 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

Tolerance isnt as common as you think it is although it does happen. What are you asking re: tolerance?
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Old 11-25-17, 07:52 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

Yes, tolerance does occur. However, the tolerance is to the "feeling" not to what it is intended for. When you first start taking stimulants you get a honeymoon period where you feel more confident, less anxious, more comfortable in social situations... etc. However, the main purpose of the stimulant is to help you focus and stay on track. Even when all these other effects go away, you should still find that you have a clearer mind and the ability to focus on anything you put your mind to.

So are you sure you're really building a tolerance to the effects the medication is intended for, or are you merely building a tolerance to the "feeling" it gave you?
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Old 11-25-17, 07:56 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

"As in your case I don't think your beginning dose was prescribed at 108 mg."

Interesting assumption, Book Keeper.
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Old 11-25-17, 10:59 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

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Originally Posted by BookKeeper View Post
I disagree with your view that tolerance is unlikely with any pyschostimulant I don't know the scientific pharmacology behind it, but with these drugs potentially most drugs that are taken prolonged will eventually lead to some form of tolerance.
If you don't know the pharmacology behind these meds, on what basis would you disagree? That seems odd to me. Is your position arbitrary?

Your opinion is yours. It is also wrong.

The reason you don't find writings on this is because there isn't any peer-reviewed, clinically-verified data to support the premise.

I've been taking psychostimulants for years at this point, and at levels considered max dose. I've never had any lessening of efficacy whatsoever. They simply work.

To be fair, that's just me, and anecdotes don't prove anything. That said, if there was an issue, we'd hear lots of anecdotes about it.


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Old 11-26-17, 05:31 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

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Originally Posted by aeon View Post
If you don't know the pharmacology behind these meds, on what basis would you disagree? That seems odd to me. Is your position arbitrary?

Your opinion is yours. It is also wrong.

You must find a lot of posts on this forum "odd" because I think the general assumption when people create a thread on this forum is that those people aren't trained experts in the subjects they discuss, or have opinions on. No my position is not "arbitrary." I don't claim to know all the facts, but to the extent of my knowledge and experience so far I can argue that the issue of tolerance is more prevalent of a problem than what you claimed it to be, that is when you stated that tolerance is unlikely when taken properly. You could even hypothesize that the prevalences could be a reason why this problem is "overaddressed".

There is plenty of scientific studies done regarding the issues of tolerance along with plenty of people having this same problem. The problem isn't that there isn't data to support tolerance issues. The problem is that those articles aren't being taken more seriously into consideration to influence broader prescribing policies, or other methods of dealing with tolerance when such problems occur in a patient like myself.

In response to your comment Little Missy I did not mean to come across as being smart when I mentioned that Aeon's dosage likely wasn't started at 108 mg. My intention was to bring attention to the idea that Aeon's dose was titrated up to 108 mg as a result of tolerance developing on the lower doses. If this assumption is correct I am less convinced by your argument Aeon when you advocate that tolerance isn't a problem, or if it isn't the answer still remain indefinite.

In response to Fraser_0762:
Im aware of the "honey-moon feeling" I assure you that I'm not chasing a high sensation from the medication, though I am chasing a certain satisfactory level of symptom relief. I'm not sure how you would describe that without referring to it as a feeling. My core symptom that I want addressed is my ability to have control over my comprehension when someone is speaking. I am open to the idea that you could be right, and that maybe it is a sensation I shouldn't expect out of my treatment.
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Old 11-26-17, 07:26 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

Not many anecdotes, aeon? Only if you ignore the ones that you've been blithely dismissing left and right...

For what it's worth, I have experienced a marked reduction in therapeutic effect after long-term stimulant use, despite taking my medication as prescribed by ADHD specialists who titrated slowly and carefully.

I have never experienced euphoria from ADHD medications, nor have I ever abused any drug.

There was an imaging study showing brain changes consistent with tolerance in medication-naive adults with ADHD prescribed methylphenidate for 1 year.

But in general, there's a lack of good data on tolerance. (This provides no basis for the premise that it occurs frequently, but it also provides no basis for the premise that tolerance doesn't occur or is rare at therapeutic doses.)

Last edited by namazu; 11-26-17 at 07:36 AM..
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Old 11-26-17, 07:31 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

There's a lack of data on tolerance, because the pharmaceutical industry will not spend money on research that would ultimately rubbish their own products.
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Old 11-26-17, 08:09 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

I think tolerance can happen I just dont know if the average person can notice it.What I mean is the feelings associated with medication can sometimes be confused with tolerance when really its just the body betting used to he medication.How many times have people said the medicine doesnt feel the same way bit did in the beginning> I dont think all of those people are experiencing tolerance,
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Old 11-26-17, 08:20 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

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Originally Posted by sarahsweets View Post
I think tolerance can happen I just dont know if the average person can notice it.What I mean is the feelings associated with medication can sometimes be confused with tolerance when really its just the body betting used to he medication.How many times have people said the medicine doesnt feel the same way bit did in the beginning> I dont think all of those people are experiencing tolerance,
That's certainly true. However, I think a lot of people with ADHD rely on the feeling that stimulants give them because they require that extra motivational impact to drive them through tasks. So I can certainly see where the OP is coming from and why other people experience problems with this as well.

I think for some people, taking stimulants every single day of their lives just isn't necessary like it is for others and they should save them for times when they really need that additional boost to carry them through a difficult task.
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Old 11-26-17, 08:21 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

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Originally Posted by sarahsweets View Post
I think tolerance can happen I just dont know if the average person can notice it.What I mean is the feelings associated with medication can sometimes be confused with tolerance when really its just the body betting used to he medication.How many times have people said the medicine doesnt feel the same way bit did in the beginning> I dont think all of those people are experiencing tolerance,
Probably not all of them are experiencing tolerance to the therapeutic effects of the medication. There are plenty of other things that can happen in a person's life or body that can result in worsening of ADHD symptoms, independent of the medication.

But plenty of people have come to the forum to note that their ADHD symptoms are no longer controlled as well as they used to be by the medication, without another obvious explanation. In such cases, tolerance may be a plausible explanation -- or at least one that doesn't warrant dismissal out of hand.

Count yourself lucky that you continue to find your medication beneficial after all these years!
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Old 11-26-17, 08:30 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

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Probably not all of them are experiencing tolerance to the therapeutic effects of the medication. There are plenty of other things that can happen in a person's life or body that can result in worsening of ADHD symptoms, independent of the medication.

But plenty of people have come to the forum to note that their ADHD symptoms are no longer controlled as well as they used to be by the medication, without another obvious explanation. In such cases, tolerance may be a plausible explanation -- or at least one that doesn't warrant dismissal out of hand.

Count yourself lucky that you continue to find your medication beneficial after all these years!
Well I used to be the person who didnt believe in tolerance but Ive since changed my mind based on needing dose changes over time. I still think i am a poor self evaluator about whether its tolerance or just me expecting perfection and that my feelings of the meds get in the way of what it actually happening with them but thats why I have a doctor that manages this for me.
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Old 11-26-17, 10:32 AM
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Re: 108 mg of Concerta. Tolerance is a factor.

Quote:
Originally Posted by BookKeeper View Post
No my position is not "arbitrary." I don't claim to know all the facts, but to the extent of my knowledge and experience so far I can argue that the issue of tolerance is more prevalent of a problem than what you claimed...
You can argue what you like, I have no problem with that. The reason I wondered why you were arguing at all is because you said that you did not know the science.

Quote:
Originally Posted by BookKeeper View Post
There is plenty of scientific studies done regarding the issues of tolerance along with plenty of people having this same problem. The problem isn't that there isn't data to support tolerance issues. The problem is that those articles aren't being taken more seriously into consideration to influence broader prescribing policies, or other methods of dealing with tolerance when such problems occur in a patient like myself.
Please provide links to these studies.

Quote:
Originally Posted by BookKeeper View Post
In response to your comment Little Missy I did not mean to come across as being smart when I mentioned that Aeon's dosage likely wasn't started at 108 mg. My intention was to bring attention to the idea that Aeon's dose was titrated up to 108 mg as a result of tolerance developing on the lower doses.
It wasn't.

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If this assumption is correct I am less convinced by your argument Aeon when you advocate that tolerance isn't a problem, or if it isn't the answer still remain indefinite.
It's incorrect, and it's telling that you would assume such a thing in the absence of evidence.


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