ADHD Medication Titration

Adderall, Dexedrine and other stimulant medications for ADHD have a long-lasting effect that can last for up to 14 hours. They are more effective than stimulants that have less time to act, such as methylphenidate.

The process of titrating a medication is used by doctors to determine the appropriate dosage for each patient. This article will explain the titration process, possible adverse reactions and how to determine if you have discovered your "target dose". Take notes for your next doctor's visit!

Dosage

Titration is a procedure which determines the dose of medication that will lessen ADHD symptoms the most while minimizing side-effects. The doctor will start with a small dose and increase it gradually over time. It is typically done every one to three week. The doctor will also try different kinds of medications to find out which one is most suitable for your child.

The titration process can be a long time but it's important to keep it up. It's not uncommon for children to need to try three or more kinds of ADHD drugs before finding the best match. The goal is to bring your child's symptoms under control and eliminate their negative effects on his or her life.

Stimulants are among the most commonly used medication used to treat ADHD. Some examples include the methylphenidate (Ritalin) and amphetamine salts (Adderall). These drugs are available in different forms, such as chewables, capsules, tablets and liquid. The dosage can vary but the most common starting limit is 10 milligrams a day. This dose is sufficient for some patients to improve their symptoms. Some patients will need a higher dosage.

It is important to also take into consideration the release profiles of the drug that is being taken. Some stimulants have a fast onset and wear off quickly and others show an effect that is more gradual. Some people are not able to metabolize and therefore may not benefit from higher doses but nevertheless, they will show improvement even at lower dosages. The titration process must also consider whether the patient is taking any medication that block CYP2D6 like SSRIs, since this can impact how the drug will benefit them.

Before every dose increase, it is important to get parent/teacher ratings and symptom reports. Utilize a valid rating scale for ADHD like the Adult ADHD Symptoms Questionnaire or Follow-Up Vanderbilt Form. This will ensure that the data is gathered accurately and that the medication is properly titrated.

Some children are sensitive to certain side effects of ADHD medications, for example irritability or a change in appetite. This could indicate that the medicine isn't working and they should alter their dosage. Other side effects, such as feeling depressed or sluggish could be an indication that you're taking too much medication. It is recommended to reduce the dosage to treat this.

Side effects

It can take weeks or even months to reach the right dosage of medication for ADHD. During this period patients must keep a daily journal of their symptoms and side effects. This should be done in a diary or a calendar to allow the doctor to easily access it.

Stimulants, the most frequently prescribed medications for ADHD can trigger various adverse effects. They can cause headaches as well as dry mouth, stomachaches nausea, insomnia and a sudden rise in blood pressure or heart rate. Patients may also experience tics, which are tiny, repetitive body movements that can include grimacing, blinking, or treat repeated facial expressions. While these effects are typically not serious but they should be notifying the doctor as soon as they occur.

Some stimulant side effects, like irritability or insomnia are more noticeable when people first begin taking the medication and improve with time. Different individuals metabolize certain medications in different ways. It is essential to know whether the patient is a slow metabolizer or a fast metabolizer so that they can be correctly dosed.

Although it isn't common, it is possible that the initial medication may not work for a child with ADHD. In this instance, the doctor may change to a different medication. It is not uncommon for doctors to switch their medications. Parents and children need to be supportive of this process and know how important it is to select the correct medication.

It is important to remember that, even though the titration may appear slow, it is vital for your child's wellbeing in the long run. Making changes to ADHD medication too quickly can cause negative side effects and loss of benefits.

Titration is not just for ADHD stimulants, but it can be used for all types of medication including non-stimulants like Strattera and Qelbree and other long-term treatments such as antidepressants and antibiotics. Titration isn't just used to treat stimulants however, it can be used to find the most effective dose of any medication that is long-term.

Schedule

Titration is a process to find the right dosage of medication for a particular person. The dosage is determined by various factors, such as weight, height and signs. It is also important to know that there are variations in the drug release profiles (ie the way a stimulant such as Methylphenidate is absorbed and/or impacts the body). These are all things that your doctor will test when increasing your dosage.

Most doctors begin with a very small dose and gradually increase it. This is so that the physician can create a "target dose" that is effective in controlling symptoms but has the fewest adverse effects that are possible. It is essential for parents and children to take part in titration adhd treatment by completing ratings scales for each dose, and then returning to the clinic to review the effectiveness and side effects.

It can take weeks or months for a doctor to manage the child's ADHD symptoms using the appropriate medication. It is important for parents to be aware of this and collaborate with their doctor so that they do not become dissatisfied. This is especially true for children in the younger age group who have a harder time getting to the "zone" of appropriate treatment because they are so engaged and overwhelmed by their daily lives.

The titration schedule varies from patient to patient, however, it is generally a matter of increasing the dosage in small increments every one to 2 weeks. Once the child is on a target dosage and is functioning at their peak level with no adverse side effects, the doctor will decrease the dosage to a minimum.

You should also discuss with your doctor who prescribes titration the best time to take the medication. It is usually best to take the medication in the morning so that your child can concentrate at school. However for some patients, taking the medication later in the day could be more beneficial for them since they may use it to finish their work or concentrate while driving. It is also essential to adhere to a strict schedule to take the medication. This will help you avoid forgetting doses or missing them.

Monitoring

The goal is to find the best balance of medication to help manage ADHD symptoms with minimal adverse effects. This balance could be found after 3-4 weeks of careful titration service. It is vital that the patient and doctor closely evaluate the effects of side effects and the effectiveness. Having the patient fill out rating scales for each dose, for instance the free Follow Up Vanderbilt forms or Adult ADHD Rating Scales from Frida can be helpful for doctors to monitor the effectiveness of the medication in a more objective manner than just relying on subjective teacher and parental ratings.

Stimulants have a great inter-individual variation in terms of response to a specific dose. For this reason, patients should be gradually titrated up to avoid overdosing. Some people are poor metabolizers and will show symptoms and signs even at very low doses (eg atomoxetine, which is found in 7%-10% population) (Belle et al. 2002; Hechtman, 2005). Slow titration is also recommended for patients taking any medication that block CYP 2D6, such as SSRI's. This will stop patients from developing a drug tolerance (eg bupropion or clonidine, atomoxetine, etc.).

Monitoring long-term medication maintenance should be a continuous process. It should include assessments of the target symptoms, such as the ability to complete homework and school-related activities and a review of the sleep and appetite functions, asking parents and educators to provide an annual assessment of the child's behavior, performance and self-ratings from adolescents and adults. [CG]

The titration can be frustrating for some patients, and their families. Understanding the reasons behind the medication and the expectations of effectiveness and tolerance will help reduce frustration and disappointment in the family. Similar to that to educate your family members about ADHD can help alleviate feelings of guilt or shame regarding the child's behavior issues. It is important that everyone in the family understands that these issues might not be caused by a lack discipline or poor parenting, but rather medically mediated brain deficits.