ADD, ADHD Stimulant Medication Dosage: The 'Bottom Bewitching Hours'
Posted Nov 17 2008 4:20am
Target the Entire PM for Adequate Dosing
Often ADD/ADHD medications aren't targeted, or dialed carefully in,
for the Entire Day, but rather set for an inadequate objective to just
"get through work or school." This problem has been with us since much
before the 1960s - is paleolithic - and simply does not address the
'bewitching hours' of 4-8 PM. The 'Therapeutic Window' is often simply
New meds can cover the entire day, school and work
alone are no longer the only objectives. Family life, the evening, and
overall cognitive management throughout the day, have become important
treatment objectives with the new medication alternatives. This article
discusses some of those new options for stimulant medication titration
- and thereby adjusting the dosage correctly.
7 Tips to Find and Correct Insufficient Duration Through the Day
Look for that longer objective: It may sound simple, but with the new drugs we can significantly change
our PM objectives. The new drugs such as Vyvanse and Daytrana will last
13-14 hrs easily, but just take some time to ask the questions
carefully and then adjust the dosage.
DOE, 'Duration of Effectiveness,' evaluation must come up at every medication check. If your doctor dosen't ask about it, you must think about it anyway to
encourage the discussion. It is time consuming, but if you are prepared
you will make the medical job easier. One of the main reasons it is
time consuming is because with the new stimulant medications it is more
difficult to assess.
Know The Characteristic Subsets of the PM Drop: - These will be carefully outlined in another full article, but suffice
it to say that with the longer duration medications it is much harder
to recognize. Look for any change in focus, appetite, inattention, even
a vague feeling of decreased motivation can signal the end of the DOE.
How Vyvanse will cover 12-14 hr: Increased
carefully with 10 mg increase in the AM will add about 2-4 hrs on the
the PM bewitching hours. Studies show even in children that an object
of 13-14 hr is reasonable, but don't, repeat that, don't try to do it
all at once. Give the person time to assimilate, to get used to, the
medication, even this excellent product can be overdosed by starting
too high. Give the person about 1-2 weeks with each dosage so they can
find and report the DOE at that specific dose, then the team will be on
target. Adjusting to aggressively, too quickly, will bring more side
How Daytrana can cover 12- 14 hr: I
like both of these medications because compliance goes up with less
afternoon dosing, and there is no need to remember that PM dose. The
company does not recommend cutting the patch, but the patch can easily
be cut to target a specific clinical effectiveness through the day.
Keep the patches in the refrigerator, cut them to increase or decrease
the dose, and don't forget that you can leave them on longer in the PM
to cover evening work. Each person is different, and using PPT 'Post
Patch Time' [should be 3-4hr] will tell you if the daytime dose is
effective. If only 1 hr PPT, the dose is insufficient.
Adderall XR, Concerta, Focalin XR, Metadate CR Durations: Of the collection of stimulant medications it is my experience that
Adderall XR is easier to adjust for about 10 hr, sometimes 12, but the
others routinely fall short. With all of these medications including
Vyvanse and Daytrana: Too little: it isn't covering the PM, too much it
is interfering with sleep.
Teach the children at the outset: It is harder for them to know what to look for setting these PM
treatment objectives. Spending just a little time at the front end will
help them feel like part of the team.
With these tips you will be better able to make essential PM
adjustments with ADD/ADHD stimulant medications to cover the most often
overlooked part of the day, without creating sleep disturbances.
Bottom Line By following simple guidelines and the metaphor of the 'Therapeutic
Window' you will be more able to adjust dosing correctly, and
effectively - so you and yours don't feel like treatment failures. I
invite you to sign up now for my new book "Fixing the ADD Madness: A
Patient's Guide to Stimulant Medication Details," at the top of this page - And enjoy the bonus gifts on the thank you page for signing up early.
See the complete series of these articles on dosing stimulant medications at EzineArticles here.