Concerta XL and coca cola

[Whitecarnation]

Hi everyone. My son who is 18 has just taken his first dose of Concerta today and his ‘prescriber’ who is titrating him, doesn’t seem to want to answer the question about Coca Cola. I know you are supposed to avoid caffeine, but would it be ok to have the odd coke in the evening 2 to 3 times a week? It does seem a trivial question but having autism as well as ADHD, he has a restrictive diet when it comes to drinks, and it is one of his treats. Thanks

[STEM_Dad]

I know that both are stimulants, so that might be why that's the advice.

Really, that's a question for your doctor or pharmacist. I'll tell you my thoughts, because I think there are several considerations around your question.

There is a caffeine free version of Coca-Cola, but it can be very hard to find. (I come across it every few years.) But the caffeine level in Coke is lower than the amount usually found in coffee, black tea (I think), many energy drinks, and even some other sodas.

The amount consumed is also a consideration. A 12 oz can would obviously have less caffeine overall than a 20 oz bottle.

Timing is also a consideration. Stimulant medications taken in the morning have worn off for many people by evening time. So, a Coke might not be a problem that late in the day anyway

My 11 y.o. son likes soda. I make sure that he doesn't drink too much, and he often has trouble settling down to fall asleep before 10pm, even though his weeknight bedtime is 8:30pm. I don't let him have a caffeinated soda (like Coke or Dr. Pepper) with dinner, because I know that he will have trouble falling asleep. (He is allowed to read if he's in bed and can't fall asleep, and that usually helps settle his mind so that he can fall asleep, but not if he's had caffeine in the evening.) An 18 y.o. is very different from an 11 y.o., so the comparison is irrelevant, but the consideration is about how your son does with caffeine late in the evening...will it affect his sleep?

(I'm very different from my son. For most of my life, I could drink coffee right up until bedtime and still fall asleep just fine. That only changed in recent years, so now I avoid caffeine most nights.)

[STEM_Dad]

By the way, did you know that there is also a CHADD ADHD parents group on this site?

You're welcome to join that group, too (if you haven't already).

Most of the discussions there are about parenting younger children than 18, but I find the breadth of experience between both of these groups to be very informative.

(My own kids aren't diagnosed with ADHD, but definitely have ADHD traits, but definitely more mildly than I do... except for my grown son, whose ADHD traits seem just like mine. I still find the information on the parents forum helpful with my younger kids, though.)

[Whitecarnation in reply to STEM_Dad]

Thank you I have seen it . I will join as I am still parenting!!

[Whitecarnation]

Thank you for your reply. We’ve just been out for the day and he has only had a small apple juice and wouldn’t have anything else to drink. Coke is his go to when we are out. Water is not an option!!! He’s had a squash now, but he feels there isn’t anything for him to have when we go for a meal.

I will see if I can find some no caffeine coke and try and think of some alternatives for when we are out.

I really hope this medication will work for him. He has no interest in anything really, which he knows himself, and no motivation . He was diagnosed 18 months ago and it’s taken this long to get the meds, too late for his A levels.

[STEM_Dad in reply to Whitecarnation]

You mentioned that your son has ADHD and autism.

I've often heard that people with autism (particularly children) can be very particular and certain things: food and beverage likes and dislikes, sensory stimuli, routines and types of activities. I've observed these tendencies in most of the people that I know who are on the autistic spectrum.

So, I understand (at least conceptually) where you're coming from about your son's food and drink preferences.

I checked on the website Drugs.com for what's known about interactions with Concerta (methylphenidate) and caffeine. The site did not list any interactions between the two, but did have a warning about the duplication of effect, because both are stimulants (cerebral stimulants).

It didn't say that they DO effect each other, but implied that they CAN do so. Specifically, it said: "The recommended maximum number of medicines in the 'stimulants' category to be taken concurrently is usually one."

This is a general recommendation for all stimulant medication. However, when I was prescribed Adderall XR, I did not seem to have any negative impact from continuing to consume coffee (and the occasional tea or cola). My doctor did tell me that it was okay for my to drink "up to two cups" of coffee per day (though to be honest, I was consuming 3).

But I'm a man in my 40s, who only took Adderall for 5-6 months, and who has a coffee habit going back to 12 years old (I only drank one small cup a day then), so I have a tolerance built up for caffeine.

The Adderall (and now atomoxetine/Strattera) has reduced my craving and dependence on caffeine, so I usually drink less than I did before starting on ADHD meds (which was often the equivalent of 4-6 cups, with 6 oz as standard measure of a coffee cup).

[Betsy74]

I’m on concerta and I’ve never been told to avoid caffeine and I drink a pot of coffee a day with no issues. I’m only an occasional pop drinker but do drink coke aswell if I fancy it. Sounds like that’s generic advice as if the stimulant effect of caffeine worked on us we wouldn’t need the meds!

[Whitecarnation in reply to Betsy74]

That’s interesting. Well we had one can of coke left in the house last night and he had it! We’d been out for the and he was a bit stressed. I don’t think the tablets have kicked in yet, he said he didn’t feel any affect, so we didn’t think it would harm. Maybe when he is taking 3 tablets a day, he might feel a different reaction.

[Goofy1 in reply to Whitecarnation]

Is he getting Concerta in the am and then a second dose of Ritalin later in the day? They usually only give one dose of Concerta but have regular and extended release.

[Whitecarnation in reply to Goofy1]

He’s just taking a morning dose, of the controlled release. He is just starting the titration so is just on 18mg for a week, before it increases.

[Hominid711]

I am the same as Betsy74 with the coffee. Can't get enough of the stuff. Always have done since my teenage years and it helped with my migraine too.Let him have his caffeine-containing coke Whitecarnation. I'm a GP with cardiology experience and it's absolutely fine to continue with whilst on the meds.

[Whitecarnation in reply to Hominid711]

Thank you. I don’t think the caffeine dose is not very high (35mg per can). They seem to be making a big thing about the affects on the heart. But it is so annoying the ‘prescriber’ who we haven’t even spoken to, and is just communicating through the portal, won’t answer the question. I might message to Psychiatrist who definitely knows what he is talking about, if I have further questions.

[Hominid711 in reply to Whitecarnation]

Agree! Really annoying.

[Hominid711]

...and let him have as much as he wants. Honestly! Completely safe. I'll find you the science behind it if you want me to.

[BlessedLady]

Pharmacists are the best ones to answer questions about medications and interactions with other medications and non medications.

[Whitecarnation]

I am a pharmacy technician, so am going to ask my boss. As we know the knowledge pharmacists have is amazing.

[FindingTheAnswers]

Before I was diagnosed with ADHD and given Adderall, Coca Cola would have the same effect as Adderall (of course very short lived). There was one time where my mind was running 100 mph, and I opened a Coke and got pretty much instant relief (again, for a very short time). As I drank it, and felt some relief, I was like 'This is what addiction is like. This is one of the reasons people (some non-diagnosed ADHD people like me) get addicted to alcohol or whatever it takes to stop your mind from running 100 mph'. Relief. Relief. My addiction is worry and Coca Cola is still my drug of choice ( of course along with Adderall).

I know this didn't answer your question. This is just my story. But did you notice your son seem like he felt better after drinking a Coke?

[Whitecarnation in reply to FindingTheAnswers]

I think it is one of the things that psychologically makes him feel better and he does get a bit of energy from it. He is permanently tired, so I am hoping the medication will help with his mental tiredness.

[MaudQ]

I’m on concerta and I have a cup of coffee or 2 in the morning. I also have a kid with autism. Obviously ask your prescriber - or another medical professional if you can’t pin the prescriber down. But my personal take is that sometimes autism trumps doing things the ideal way. If there’s no drug interaction with caffeine and he can still get to sleep at night, maybe it’s ok. My ASD kid will go to a restaurant like once every six months. If the Coke is part of going out for your family and it helps facilitate the socialization, life skills and family bonding, (and it’s familiar, tasty and celebratory) that counts for something. Sometimes providers (just like anyone) can have a bee in their bonnet about things like sugar or caffeine - so I’d ask around and see what other professionals have to say.

[Whitecarnation in reply to MaudQ]

Thank you. That’s just the problem, I don’t want to put him off the meds, cos I really want him to have a new lease of life. He has just left school and is going to a disability college, where they are going to build up his confidence and getting him ready for work. I have high hopes that he will come out of his shell, find something in life that interests him, now he doesn’t have school telling him what to do.

[MaudQ]

That all sounds really great. I bet there’s a Goldilocks solution that includes soda and medication 😊 Maybe none of it’s an issue, maybe he needs to wait for the Concerta to be out of his system to have the Coke, or if it’s too risky, maybe he would be willing to switch to Sprite 🤷🏻‍♀️ You’ll figure it out. Also, I don’t know where your kid is at with decision making, but my daughter does really well when she’s included in certain choices. My personal take is that it’s better for her to practice self reflection and advocacy than it is to get everything “right.”

[Ejcox2002]

Hey! I've been on Concerta for year's..

I drink alcohol, tea and coke! Which I don't tell the doctor. I am not encouraging it! - but my tip- moderation. Things have different effects when you start meds- so you have to relearn.

Alcohol, is shows the biggest change- now I only have two drink max, as anymore makes me either low or drunk. Which is different

Learn what the balance is. I know your his parent and I am not giving politically correct advise

[Knitting20projects]

I’m a pediatrician and think it’s ok, unless he has heart/blood pressure issues. I wouldn’t let him drink 3-5, but he can likely have 2/day. Both my kids have ASD & ADHD, feeding/texture issues, & I understand some of what you’re experiencing. You and he need to survive. Ironically, some people with ADHD actually sleep better on their stimulant medication or after drinking caffeine, because it calms their hyperactive brain. I have ADHD & joke that I should take a teeny dose of Adderall at bedtime. Ask your pharmacist or doctor next time you can about the Coke, but until then, I think it’s fine. Poor guy!!!! He deserves his treat.

[Whitecarnation]

Thank you. Looking at the caffeine we are fairly happy with the coke. He had a can on Friday and not had one since so he is not excessive. He started drinking coffee in the mornings to wake him up, but didn’t really like it. So we thought he wouldn’t mind just not having it anymore. But he said he was missing it so we got some good quality decaf and he says it has a funny taste, we think it is fine, so we are still working on that.

Can I ask about the side effects. He’s had a headache since he started the meds on Friday, not serious just in the background. Will this wear off as he gets used to the meds? We will be doing his BP at the end of the week and he will be due to increase to 2 tablets on Friday.

[Knitting20projects in reply to Whitecarnation]

Headaches can be a side effect of stimulants. I think it’s good they’re checking his blood pressure this week. I don’t think you said this, but if he cut back a lot on caffeine when starting the medication, he could have a caffeine withdrawal headache.