Getting the max out of medication

[Onthemove1971]

While speaking to our son's child psychiatric about using his medication better ( not just increasing) she recommended we wait until he walks out the door for school to give it to him. She also educated me that his " time release" medication will release a certain amount through out the day. So she wanted me to give him a short acting with it so there is a boost to it for academic classes in the morning. It means less in the PM for sports and homework.

We will try all of this and see what happens.

Does anyone else know how to get the best out of the medications? I realize not everyone can wait in the morning and that am is a struggle. But I have rewards in place to manage the morning.

Thanks!

[Hidden]

Wow, it's like you read my mind! We are having to get a new pediatric psychiatrist for my daughter because our other one went to only two days a week. I can't wait to talk to her because I think my daughter's concerta is wearing off too early and I don't want to increase it I just want to help it work a little better. She had mania too from bi-polar and that tends to kick in too without her concerta. I think I can manage the mornings and I'm hopeful that she can concentrate a little more in the afternoons? I'm interested to see what others have to say. This has been on my mind for awhile!

[Hidden in reply to Hidden]

Oh and we tried the short acting and she had a real crash after the first four hours....I'll be interested to see what happens for you guys.

[Onthemove1971 in reply to Hidden]

So great we can do this together. Our child psychiatrist also said if we contuine to just give the Ritalin alone he is only getting a small amount of it 3x a day. Which is great, but we need to give a short acting on top to help with that so he is really getting more. Today was not a good day becuase he had a test and we had to write a study sheet. Anyway, my plan is the long acting (normally 6:30-2:30- but a small amount) with a smaller amount of short acting.

I can not stress enough how getting a psychiatrist to work with you is. We are very lucky. Also having all the hard academics in the am when they are getting the most of of it. Or you dose at school with a nurse. If I get there I will tell our son if he has any F's he will have to take medication at school.

Hope this helps. I will let you know how things go.

[Hidden in reply to Onthemove1971]

I completely agree regarding the child psychiatrist. I'll be very interested to hear how it goes!

[katcald]

On school days, I give my son a short acting dose an hour before he has to get up and let him go back to sleep. Then I give him his extended release pill right before school. He gets another short acting dose in the afternoon

[Onthemove1971 in reply to katcald]

Wow, this is exactly what she talked about. The only thing is that she told us that he will get the best out of the medication 20-30 min after it is taken. For us he is riding the bus so that is wasted time for the medication (compared to having max for the academic time)

I am curious does anyone have their child go to the nurse right when they get to school? I am no MD but isn't that a better solution that it wearing off in the middle of the day?

I am going to try his long acting and 10mg of his short ( he usually takes 20 in the PM) and see what that does for us.

If this works I feel like this is such a new revelation for us.

[Hidden in reply to Onthemove1971]

Huh. I can't understand why I didn't think of something like this! I have to take my daughter to school early because I have to get to work. So maybe if I could give her a short acting and then right before classes the nurse can give her the long acting....only concern for my daughter is that she has to take her Abilify at night. Not sure if the Ability will work if the Concerta is still in her system.....Appointment next week, I'm definitely asking about this. THANK YOU!

[Onthemove1971 in reply to Hidden]

Yes!!! Yes!!! You got it...

[Pennywink]

Great question! I’m curious about others responses. 😊

We’re in the middle of our second month in a stimulant, and my son is only in first grade - so far less demanding of a school year. So I don’t have a ton of input right now.

Our prescribing physician mentioned he prefers Metadate CD over Concerta (both extended release methylphenidate, but with different release mechanisms), as he feels Concerta’s release mechanism tends to leave kids struggling in the mornings at school. So perhaps that varies depending on the medication.

[Onthemove1971 in reply to Pennywink]

Thank you for this feedback! We can learn from each other.

[ASMomma00]

My daughter takes a 6-hour dose of medication at 7am, right before we walk out the door. School starts at 7:20. She then takes a second dose in school at 12:45pm, which gets her through the rest of the school day and any after school activities but wears off well before bed time. It’s worked pretty well for her.

[Testarossa1975]

In second grade, my son was taking 20 mg quillivant (methylphenidate). He was struggling to get started in the morning. The psychiatrist added a 5mg immediate release generic methylphenidate tablet. This really helped. Towards the end of fourth grade, we weren’t able to get quillivant so we switched to generic Ritalin la. He still took the 5mg tablet. We didn’t any obvious changes then. Fifth grade became more of a struggle to get work done. After having a couple of meetings and email conversations with his teacher, we finally determined that he wsn’t making good progress in the morning. The problem was not that he was not on task, but he was working to slowly.

It turns out the quillivant had release times of 30% in the morning and 70% in the afternoon. The Ritalin LA had a 50% 50% release time. So with the Ritalin we found that the extra 5mg was too much for him in the morning even though it had been helpful with the quillivant.

I can still give him 5mg immediate release after school to help with homework, but I usually don’t because he has low weight issues even prior to taking stimulant medication.

[Onthemove1971 in reply to Testarossa1975]

I am sorry to say I was so focused on the medication helping him that I didn't even realize about the % during the day.

[Testarossa1975 in reply to Onthemove1971]

No need to be sorry...remember not to be too hard on yourself. You’re obviously trying your best to help your child. Figuring out what works is often not clear cut, and what works now, may not work as well later. Learning new information and trying new things is an ongoing process, but hang there! Being a part of a group like this can help you to keep learning different ways you may help your child; sometimes you will find a piece of advice fitting, others times not.

[Ldydy24]

Hi there. We do a combo of short and long acting Focalin in the am just to get my son to noon. He has a very high metabolism and chews through meds in 3-4 hours. We give him a 10 ml short acting with breakfast at 6:45 then he takes a 10 ml XR at 7:15 as he’s going out the door. We find this gets the meds in him quicker bcz if we give it to him after he eats it really delays the release. He starts school at 7:40 and it’s kicked in by then and last him until noon. Then the nurse gives him 15 ml short acting Focalin for the afternoon. He eats lunch at 12:30 and the meds hold him until 4. If he has a lot of homework/studying to do then he takes a 5 ml at 4 and that also helps him transition into the night. Previously he only took short acting meds and was having to go to the nurse at 10:30 and 1:30 so it was a big win with the combo of meds allowing him to only see the nurse once a day. We have also seen improved grades thus far and he says it has helped him concentrate more. Praying it stays this well for the next 2 months.

[Onthemove1971]

Wow! I am so impressed at this system you have set up. I feel like I need a book "ADHD and medication for dummies"...

So good to know, my son would die before going to a school nurse, but he is in middle school so even the color of his earphone are a major deal.

Thanks for sharing!