What's the Problem With Concerta?
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- Опубліковано 16 січ 2023
- The recent shortages of generic versions of Concerta are not directly related to the Adderall shortages that have been a problem for half a year. Concerta is a slow release form of methylphenidate, that uses an osmotic pumping system for very uniform drug delivery. The manufacturer has stopped making the only truly bioequivalent generic Concerta.
For my ADHD friends, put the speed to 1.25 x , thanks me later
Ah... now I know why I get impatient with all his pauses. He's an outstanding writer... as a presenter, not so much 😴💤
I usually don't like sped-up speech, but I'll try it, thx
I watch all videos on 1.25.
@ onlyusernameleft2 I usually don't because it's distracting to me. I have sensory issues which are really peaking at the moment.
More like 2x
even 2x 😂
Thank you for explaining this well! The shortage is really frustrating.
Very interesting view of business aspect and a full explanation of brand name drugs versus generic. Political information is involved as well. Thanks for watching this and sharing!
Having ADHD, i find it necessary to listen however it's very difficult to stay focused on what you are saying. I'll keep trying LOL
Listening to this at 1.75 speed makes it more bearable.
Terrific particularly with teasing apart the small details !
Thanks. Feel free to share with others if you found it useful.
I've been diagnosed with ADHD since childhood and had recently began seeking treatment again after managing without medication for many years. I had been prescribed Foquest which I believe is a matrix bound methylphenidate medication and I had good results with it however after a lot of difficulty with my insurance company I was forced to switch to Concerta or pay the full cost out of pocket. I found this video while researching Concerta and while I found the video very informative and well produced I feel like I have more question than I did when I started this adventure lol.
I hope that as long as you are alive you have questions! They're good things to have.
Thank you
Thank you for the detailed explanation on the concerta generics. It's really unfortunate too.
In the long run, if enough unhappy people speak up, the system might change.
Generic definitely does not work. And there are shortages for, generics as well.
@@gizzelleboccia1806 a number of people do not obtain the full benefits form the generics. And the shortages are likely to last months longer.
@@gizzelleboccia1806the problem is they put lactose on concerta, it’s not even an option for me, and in France only methylphenidate is available so…
So my insurance says I have to try and fail 3 formulary alternatives to Concerta before they will authorize Concerta again. I tried Vyvanse years ago and my dose just kept going up and up, I built a tolerance I guess and it stopped working for me. I'm starting Azstarys today. Hopefully it works for me.
I’ve been diagnosed with ADHD since birth, I’m 17 and up until I was about 12 doctors stuffed my face with ADHD medicine, the last one that they landed on was concerta, and as much as it did make me focus that’s about the only good thing that came from concerta for me, it made me feel like shit and it made me mean and uncontrollable, it made my anger issues spike through the roof and I was just not a good person on concerta
I have several friends who are child psychiatrists who report that for many individuals with ADHD, the very medications that seem to cause lots of side effects and resistance to children and adolescents seem to be much more acceptable to the bodies and minds of those individuals when they are adults. It is not clear if this is primarily physiological or psychological or some developmental forces at play.
@@DrJohnKruseHello Sir I am a medical student with ADHD.I have a theory why this happens...Since methylphenidate is a reuptake inhibitor of norepinephrine and dopamine it lowers serotonin levels in the brain.This lowered serotonin causes crashes,anger,depression,muscle aches etc long term,so I believe adding an ssri to concerta may solve the problem.It did solve mine ,I take escitalopram because of it being the most selective to serotonin and supposedly with less side effects.Of course the ssri can cause apathy and make motivation worse ,so you need to carefully find a balance between the two drugs.For years I had symptoms of high anxiety and panic attacks from concerta suffering needlessly and all that is behind me.
The other thing is a stimulant like legal methamphetamine-Desoxyn which raises serotonin along with dopamine or norepinephrine could be used by itself if the patient doesn't want to take two drugs.I haven't tried it because the drug is illegal here.There is of course stigma and neurodegeneration concerns with this method as well
Yeah i tried concerta triggered Bipolar disorder eposides with anger. After 3 weeks that was at the Lowest dosage 18 mg. I am not trying any other stimulant or non-stimulant drugs my combo of Prozac and Ablify works fine.
Also here in Europe there is shortage in Mylan's methylphenidate.
Thanks for the update. In our global economy lots of our supply chains area intertwined.
Do you think that tid Ritalin IR is preferable/more effective than those generic extended release methylphenidate forms? Great content as always. Thanks.
The advantage of three IR doses a day would be that you could optimize a daily schedule for yourself, and that you could also change this daily schedule for a particularly demanding or easy day. The disadvantage, particularly for those with ADHD, is having to remember three times as many doses during the day, with the potential for forgetting or delaying each one, even if alarms have been set. I have a few adults who like the IR flexibility, and probably more who would rather find one pill that works for them. I also have a fair number of people who take an IR in conjunction with the extended release, either to get a more rapid onset of action in the morning, or to augment at another time of day.
I take a stack of L theanine 200mg, L tyrosine 500mg, NAC 1000mg, Ginko 160mg, Tumeric 1,500mg in the morning with a cup of coffee once a day. I also take a vitamin/ mineral packet and later on Vegetable Protein and Creatine Monohydrate shake for extended focus.
I'm glad that you found a combination of things that work for you.
At 28:48 you mention that amphetamine based products have more really serious side effect risks. Can you mention what those are in comparison to methylphenidate?
Dr, thanks for your video, it is very informative as I was looking online to research the difference in bioequivalent and brand name. I am about to start my 3rd month of methylphenidate - the psychiatrist wrote ‘any brand’ 18mg for 2 weeks then increase to 36mg, my first month was Matoride, then the pharmacy were out of stock so I had to ask GP to rewrite script for concerta which they had in stock.. the last month has been fine, to be honest I haven’t noticed any significant side effects on either brand, I feel concerta doesnt. Make me crash as much.. but. I don’t know if that’s because my body has got more used to it.
Today when I spoke with pharmacy they offered Matoride as it is back in stock and I said I’d just stick with Concerta (and also saves me having to contact GP to rewrite script)
My question is , in your opinion do you think its better to take the brand name when available? It’s thrown a spanner in the works! And its something I will discuss with my psychiatrist when I have my 6 month review in July. Many thanks
Unfortunately, I don't have a generic answer. I've worked with some individuals who thrived on any formulation of Concerta, and didn't notice any differences. And others have been sensitive to the differences. If cost is not an issue, then you are at least getting consistency if you stick with the brand name.
I took 27mg concerta, it worked perfect for me, i got lots of work done, no crash, however, 10 hours after taking it i went for an intense gym session, i noticed i could not lift as heavy weights, and some chest discomfort, not sore, no fast heartbeat just discomfort, should I be concerned?
Without knowing your health history and family history it's not appropriate for me to give specific advice, but it would be quite unusual for Concerta at this dose to provoke a brand new cardiac problem. But hearts are clearly very important, so I would discuss it with your prescriber, and consider having a more thorough cardiac evaluation if more alarming details come up.
Yes
Day 3 without my medication and my spine feels like it's breaking in half, or maybe it's my old age. Whatever it is I'm not moving from this spot until my medicine is back in stock.
I'm sorry to hear that shortages are still having terrible negative effects on people. I hope that you're able to resume soon.
I'm taking vyvanese and its very beneficial as far as making me think well, stabalizing my mood and making me go out there and do things without fretting, however, sometimes it gives me anxiety. I am wondering if the dose is to low (I am naturally anxious) or if I should switch to Concerta.
Without a thorough examination I can't make specific recommendations. My approach is usually to try to optimize someone's current medication, which often means trying higher or lower doses to see if they are more effective or cause fewer side effects. Vyvanse capsules can be opened to get a lower dose.
I was on 54mg of the concerta that uses osmosis to slowly release. Prescribed June 2022 I was going through alot of issues. And stupidly dropped concerta, without tapering.
The withdrawal lasted for 3 months. Don't know exactly how but my guess is it messed with my d2 dopamine thingy and gave me symptoms of schizophrenia. Not saying I know its just what I currently have in my head lol.
Id like to learn more about this because concerta was incredibly useful to mend some of my taxing issues.
I don't have a good explanation for your response. That's certainly a longer withdrawal than the majority of people experience after stopping methylphenidate products. Also, it wasn't quite clear from your comment what symptoms of schizophrenia you experienced, and whether that seemed to be a response to the Concerta or also part of the withdrawal. The older antipsychotics were all dopamine blocking agents, so it would be unusual for withdrawal from Ritalin to mimic schizophrenia.
@@DrJohnKruse thanks for the answer. I did experience pretty troubling reactions towards everyday things. For example music would sound oddly sharp and violent, a chair would grab my attention keeping me in a loop of confusion and horror, peoples expressions and intent seem evil and twisted. Occasionally heard voices and saw disturbing hallucinations.
Simply everything was constantly out to hurt me, well thats what my brain felt which i made fun of.
Not trying to be mean towards concerta, i actually plan on taking it on a lower dosage. The side affects I had were what I described but turned down a notch. Withdrawal amplified them, alot.
Another thing i think anxiety wouldve been a better description than schizophrenia, or not im seriously unsure.
@@vexamili it sounds wise to proceed very cautiously.
I have a lot of issues in the uk getting a doctor to prescribe concerta. They diagnosed me with non organic psychosis and now they dont want to prescribe me Concerta
Have you had much experience prescribing Rubifen? This is the methylphenidate formula I have been prescribed. Different delivery mechanism.
So far I think it’s been okay and net positive results. But I am quite keen to try something else before I settle. We don’t have vyvanse funded where I live, but that seems to be quite a well tolerated option
As far as I can tell, Rubifen isn't available in the US, and I haven't been able to determine what methylphenidate product it might be most similar to. I'm glad that it's providing at least some help.
Should i ever combine any energy drinks with concerta? I know y shouldn't combine high caffeine content with stimulants, especially concerta. Could the acidic conditions severe interfere with Concerta.
The bigger issue than the acidity (which may have minor effects on absorption rates) is that the energy drinks will contain caffeine and often other stimulants, so it makes it more likely that with Concerta you will feel too jacked up, irritable, agitated, and jittery, will have more trouble sleeping, and may have increased blood pressure and heart rate. If the doses are too big, there could be more serious side effects.
I was on Concerta 27+18 and hated the side effects, then i got a generic, it was dreadfull. Asked doc for vyvanse, she gave me wellbutrin (!?) and i stopped taking them because it was making me agressive. Been without treatment for 2 years now........
I hope that you can get back into treatment with someone that works well with you, because many of the symptoms of ADHD can be substantially improved with treatment.
Hey Dr! Thank you for this video. Do you have any literature I can cite to my dr on generic vs brand ?
I've been slowly trying to add references to the information for the older videos on this channel, but have not gone back that far yet. Gina Pera's ADHD blog is a wealth of information on Concerta brand name and generic differences. adhdrollercoaster.org/
Hi, thank you, you piqued my interest. And you have a soothing voice!
I am a 54 yo woman. I have known my entire life that i am unique. 15 years ago i sought help and was given wellbutrin, after 3 weeks of no sleep, stomach ache, and having zero feelings about anything, like a zombie. I quit. I had asked about adhd. But being a woman with no obvious symptoms they didnt beleive me. Vit. D helped. Then since about a year ago I have been seeking help. I have two brothers, my son and my granddaughter that have adhd. It has felt like a long battle. I have medicaid and live in the US. I feel so disheartened about our mental and/or health care system. I still don't think i actually have a diagnosis. Luckily they have I have allowed me to try Concerta 18mg, it helped a bit, but caused gastrointestinal back up/ narrowing, when i was able to use the bathroom, it was pencil sized. Then i tried Vyvanse st 30mg it was okay for a couple nk weeks then tried 40mg then it stopped working and my adhd symptoms are worse than ever. Iam thinking the dose was tok high... So i have stopped taking that and now I might be trying another drug. Wish me luck.
I feel like maybe these fancy timed released options are not fot me.
When i looked up how the Concerta pill works, i was amazed. I dissolved one in water and thought no wonder it blocked me up. 😅
There is all this gooey slime and the pill is still whole.
Thanks for reading and letting me voice some of my frustration. 🖖
Gonna pick up my Brand Concerta today i have only tried Generics cause i was under the impression it was all the SAME since under my prescription it says if brand is not available same or equivalent will be provided so why would i as a patient doubt i thought hey why not go with the cheaper same thing right?
Well i first i tried Xiromed ER (36mg) oval shaped rather thin did not have the laser drilled hole i thought this worked great
Then i got a renewal and i got Sandoz 36mg oval shaped rather thick shell it did have that laser drilled hole in it
And i felt that the effects where not as smooth it did not last as long therapeutic effects where diminished and i crashed at the end of the day.
Then titration process started as me and my Dr discussed my process so now on 54mg Sandoz and sure it sorta improved worked great the first 2 days, and at day 3 around 4hr mark i felt terrible just lethargic blurry vision of sorts and spaced out/ not happy yet not feeling depressed slightly agitated.
So i dont know what that was about if it released everything to fast or what but gonna give Brand Concerta a test tomorrow.
its so frustrating when i thought everything was worked out i get the Honeymoon period wears off as to be expected and it did and worked fine for a while.
Iam rather newly diagnosed as an adult so still figuring things out only 2-2.5month on medication.
In addition to the honeymoon period (and I have a video on that) most people have significant day to day variation in their ADHD symptoms, in part related to how well they slept the night before, but other factors, mostly unknown, are certainly in play. So it may take more than a day or two to sort out what works well for you.
@@DrJohnKruse
Hello Doc!
It's been a wild ride these couple of months was under a titration process (Now on 54mg+18mg taking the 18mg 3hrs after i take the 54mg) got on Concerta (Brand) and i will say it does have a smooth release profile and it's pretty consistent day to day in it's delivery of the medication.
I had to change to generic again now to Actavis but under recent circumstances had to switch to STADA which is much like Xiromed so that has worked out pretty good when it comes to duration and symptom ease.
Reason i had to change from Concerta (Brand) is i got stomach issues major IBS i am not sure if it's the medication itself or the actually capsule causing it.
Cause i still have IBS issues with (Generic) but not as profound and harsh as when i was on Brand Concerta.
Is it common to have IBS issues when on Methylphenidate?
i have no know stomach ulcers i have tried taking Digestive enzymes / lactose intolerance pills ( i have no known lactose intolerance but then again i don't consume any dairy product due to skin breakout)
I have a meeting soon again and we might discuss changing medication would Elvanse/Vyvanse (Lisdexamfetamine) be a fair candidate to consider as a replacement / trial?
Some moments had to re-watch., currently on concerta 18 mg - and it's literally does nothing for me, some nausea sensations within first 2 hours and then - nothing... why? I am a student and I can't focus on anything 😭
It's possible that Concerta won't work for you - it doesn't help everyone with ADHD. But it could also be that the dose is too low. Stimulants usually produce results within hours, so if someone doesn't have benefits or troubling side effects, most doctors would increase the dose after a few days. (Many people have lots of day to day variation in their unmedicated ADHD symptom severity.)
@@DrJohnKrusethank you so much for the answer, I have an appointment with my doctor in 2 weeks will discuss it as well. Because in my case I didn't get any bad side effects, (pharmacist literally scarred me with "be prepared you might sweat, heart palpitations, dizziness, anxiety..." I was postponing starting this medication for a week, and when started was again surprised- no side effects , no focus improvements like I took a vitamin or something, was trying to do my assignment and again distractions , re-reading everything, then social media ... something else ... and it's been a hours ... nothing is done, but time spent ... like always..... hopefully my doctor will find some solution for me... at the same time even before starting medication, I could sit and paint for hours and will not even notice the time... if start at 7 pm, I can paint till morning ... but school, appointments, exam dates - it's not sticking to my brain., I constantly loosing things, forgetting names... may be it's not ADHD but dementia or something. My whole life I was hearing "you have so much potential, just try better"... if only people knew how much "trying better" I did... successfully graduated from college and was literally crying when got that diploma because so many sleepless nights were spent to memorize stuff... and not to fall behind... I didn't had diagnosis yet, and not continued university studies and I feel so stupid for not being able to listen , for zoning out.. not being able to do things like everyone else . Sorry for the long message.
In Turkey, last week I had encountered fake concertas ! 54 mgs, 2 boxes both same... No effect almost, not even side effects, and there is nothing I can do about it with officials... There is NOTHING online about it...
I'm sorry to hear about it. Maybe you are the first to report it.
@@kontes9833 hangisi daha iyi ? Bana 'gerçek' concerta 54mg 1 günde tam geliyordu
How did you know it’s not the original? I’m on 27mg and I’m going through the same thing
How could u tell?
@@1gamz I memorized the effect and side effect, I have a big time attention deficit disorder so the difference is as big as being asleep and being woken up
I was taking Vyvanse and got switched to Foquest (Canadian Concerta brand) due to the side effects. While Vyvanse wasn't perfect, Foquest made me feel like a robot. No emotions at all. It felt terrible after a while.
It's possible it was a dosage (too much) issue, and not just that it is a different substance - Vyvanse is dextroamphetamine while Concerta is methylphenidate.
I took the generic concerta.. it made me have crazy sweats and I was edgy.
Then I switched to the name brand and it didn't do anything.. I was taking 36 on it and it was like I wasn't on anything...
I'm now starting on Vyvanse! Hope it is better!
Best wishes you find something that works for you.
update?
Good info just really hard to follow
Hard to follow conceptually, or hard to follow because of the quality of the sound or distractions in the video?
Am on Xaggatin, makes me drowsy. Every few hours. Then am up and alert but i feel its not making me focus
It sounds important to discuss this with your doctor, there may be timing or other adjustments that can help.
Concerta makes me sleepy and I don’t know why.
Should I use it before bed?
For some people with ADHD a low dose of stimulant in the evening can help them fall asleep, but most of it is gone by morning, so it is usually not helping with next day focus.
Im from latin america, and could tell the difference between the alza delivery and other way more normal looking pills. Do you know why alza osmosis is so hard to replicate?
Most slow release drugs the mechanism for gradual delivery is a coating on the outside, or the matrix the drug is mixed into, that dissolves slowly after in enters the gastrointestinal system. Some of the fancier variations on this have layers that are affected strongly by the acidity of their environment. The Alza osmotic delivery system consists of the drug in a tiny permeable sack, and a quantity of a specific salt, both encased in a rigid but permeable shell. By the power of osmosis, the salt draws in water from the body at a very steady rate, and the influx of water compresses the drug sack, because the outer rigid shell doesn't change size. The compression of the drug sack pumps the drug out at a very steady rate. Apparently the tricky step is getting the size of the pores right. Wellbutrin XL is one of the other medications using this osmotic technology, and for more than a decade after they came out with a 150 mg and a 300 mg osmotic pill, they were unable to engineer a 450 mg pill, even after contracting it out to other companies.
Importantly, these osmotic drugs should NOT be cut in half. Cutting the outer shell destroys the slow release mechanism, and the drug is not evenly distributed across the two halves of the pill.
Hello I started taking Concerta 18 mg but I am starting to notice my sleep instead of 10 hrs I get 5 to 6 hrs. Is this normal? Should I be concerned. For me lack of sleep may cause depression and mania.
It would concern me. Sufficient and regular sleep is important for mood and ADHD. Insomnia is a known possible side effect with Concerta or any stimulant.
It also saids Never drink any alcohol with concerta. How dangerous is this I am making wine. Prob will not drink any since it 10 to 15% ethanol.
Wow! Even at x2 speed it's too slow. I can't listen even though l really want to 😢
The problem with Concerta is, that it doesn`t work. Because it has to harsh fluctuations in impact during its duration of effectivness. Just look at its dose response curve and you shall see the problem.
Ive been waiting to talk about why it was discontinued and how it caused mental damage to juveniles.
(Even heard how there was a controversy and regarding depression and suicidal behavior was the reasons behind its discontinuation)
I feel i was deeply affected, i feel i should get a psyche evaluation to see get a proof of depression and anxiety that may have been caused by the drug, then consult my former pediatrician about the damage caused...
I'm sorry that you had a bad experience.
I'm not aware of any controversy about Concerta and depression / suicidal behavior. If that were the reason, you would think that they would have removed brand name Concerta and the branded generic version, but they didn't touch the brand name Concerta. To me that strongly suggests that it was purely a business decision, and they are making more money by just selling the brand name, even if they lost out on the volume of patients treated.
People with ADHD are far more likely than those in the general population to have depression and anxiety issues, even without any medications in the picture. Many people find methylphenidate to actually alleviate depressive symptoms.
The wine is for my Mother it helps her sleep.
What is your take on vyvance
My talk on this channel on Vyvanse has been one of my most popular. ua-cam.com/video/Vr545dDEs4c/v-deo.html In summary, many of my patients have felt that it worked better for them than any other stimulant. But everyone's brain is different.
Hello doctor I have a problem I have a very high level of ADHD, I started taking 36mg because 18mg was not working at all. I prefer to take 36mg for a month but there were days it seems to be not working and it is very difficult to understand, one day there is a cocentration the next day the medicine is not working at all? I tried 72 mg and it didn't seem to work at all. And if I am not on medication, I am very hyperactive, I talk a lot, as I talk to people I change topics very quickly, I don't finish one story. What is the problem?
Many people with ADHD notice a lot of day to day variation in their symptoms. How well they slept the night before can be an important contributing factor, but not the only one. Concerta should be pretty consistent in terms of your blood levels each day that you take the same dose, so the bigger variable is where your brain is at each day. I hope that you and your doctor can find a plan that works for you.
@@DrJohnKrusethis is a helpful comment for those of us adjusting ourselves and our doses. It takes some getting used to shifting from ritalin-style to concerta-style medication, I'm five days into the latter, having a so-so experience with it, but my doctor also says it simply works differently and there will be a reaction and some adjusting. It seems logical to observe other factors in daily rythm as part of it.
Please remember you are addressing mostly adhd audience here. I had to really resist on skipping to the next video.... get to the point?? Almost 10 min on how osmosis works. It's a pill witha small hole that slowly releases the dosage throughout the day and a constant rate....there
I actually start with the point, in the take home message. I've found over time that many people appreciate understanding things, rather than just memorizing isolated facts. But I'm aware that I speak slowly and methodically and that won't appeal to everyone. As others have pointed out, listening at a faster speed may make for a better experience for you.
@@DrJohnKruse Thank you for your reply. May I suggest more visual stimulation for our ADHD watchers, drawings, pictures, etc. I maybe wrong but we like facts and creative ways to carry through your take home message. Do you have a video on how concerta/ritalin affects the GABA/Glutame system? I am currently weening off Alzam with my unformed GP precribed me as a chronics medication instead of the maximum of 1 month to avoid dependence, to address an withdrawl from an addiction I had. Now 3 years down the line I realized how devestating benzos are taken over such a long period. Trying my best with diet and lifestyle changes to get that balance back. I managed to go from 6MG to currently 1mg pd, with the guidance of an experienced medical proffesional, taking off .5mg every 2 weeks which seems like a harsh taper but so far the withdrawl effects are worth the elimination of this toxic drug. Thank you.
Never take this drug ever!! There is a severe withdrawal.
how long you took it and what was the dosage? Thank you
@ernestalab6592 4 years stopped for pregnancy. Back on for 2 years. Spent another year trying to come off but relapsed 3 times. Its been a whole journey full of depression and fatigue
The way you speak and the framework of your thoughts is finely tuned to make watching this video intolerable for people who struggle with attention.
Thanks for sharing your individual response. It doesn't seem to match that of many others. Feel free to adjust the speed if it works better for you.
Doctor does Concerta cause Erectile dysfunction
Anything is possible, but more commonly (and still pretty uncommon at that) drugs that promote norepinephrine can result in priapism - or erections that last longer/harder than usual or desired.