For some people, attention and focus are no problem during the day. They can operate just fine, getting through all their daily tasks. For people with attention deficit hyperactivity disorder (ADHD) or narcolepsy, this can be much harder to achieve. ADHD in particular is characterized by inattention, hyperactivity, and impulsivity beyond what is considered age-appropriate, and these can have significant impacts on day-to-day life, social relationships, and work or school. People with narcolepsy may struggle to remain awake throughout the day.
Fortunately, these symptoms can often be managed with treatment including the use of Concerta, a brand name of methylphenidate. This medication can genuinely change the lives of people struggling to manage their ADHD or narcolepsy symptoms. However, before starting this prescription, it’s important to understand it. This includes knowing what to expect when starting Concerta, potential risks and side effects, and how to safely stop using Concerta.
Understanding Concerta
Concerta is a brand name for methylphenidate. This central nervous system (CNS) stimulant is primarily used to treat attention deficit hyperactivity disorder (ADHD), but may also be used as a secondary treatment for narcolepsy.
It works by blocking the reuptake of norepinephrine and dopamine, which increases how much of these neurotransmitters remain in synaptic clefts. By doing so, the increased levels of dopamine and norepinephrine create a stimulant effect. Dopamine in particular is necessary for the reward system in the brain, and people with ADHD tend to have lower levels of this neurotransmitter.
This medication has a high potential to be misused, especially by people who don’t have ADHD. Concerta can raise their dopamine levels quickly to create a euphoric feeling or high, particularly when taken in high doses.
Uses and Benefits
Primarily, Concerta helps children and adults manage their symptoms of ADHD. In adults with narcolepsy, it improves wakefulness. However, this drug is sometimes used for off-label treatments, including:
- Treating fatigue in cancer patients
- Treating refractory depression in elderly patients
- Managing apathy in people with Alzheimer’s disease
- Improving cognitive performance, such as memory
People with ADHD who take this medication often see improvements in hyperactivity and impulsive behaviors. It can improve their ability to concentrate. While it works well long-term, some find that they do not need to continue taking it permanently. Current guidelines show it’s effective for up to two years, but studies reveal that continued usage can still benefit those who take it. As such, doctors generally recommend an annual review to determine if continued use is needed.
Risks and Side Effects
Concerta can be addictive, especially if taken in a way that’s inconsistent with how your doctor has prescribed it. Taking too much or taking it too frequently can increase your tolerance and lead to you requiring a higher dose or the medication no longer working to control your symptoms.
This medication is also not recommended during pregnancy or breastfeeding. While in some cases a doctor will recommend continuing the medication if the benefit to you is higher than the potential risks to the developing fetus, many pregnant people find themselves weaning off the medication. Because Concerta passes through breast milk, a nursing infant must also be monitored for potential side effects.
Beyond that, children may experience stunted growth while taking Concerta. Some studies suggest that growth may be slowed by between 1 and 1.5 cm per year while taking this medication. If your child is prescribed Concerta, their doctor will regularly check on their growth to determine if they must come off it.
Generally, people may experience some side effects on Concerta, including:
- Headaches
- Irritability, aggression, depression, or anxiety
- Insomnia
- Loss of appetite and subsequent weight loss
- Nausea
- Malaise
- Dry mouth
While these symptoms typically aren’t alarming, they can be uncomfortable. If they bother you or persist even after your body adjusts to taking the medication, mention it to your doctor. You may need a dosage change or require a different medication altogether.
More serious side effects can occur, but they’re generally uncommon. Mention to your doctor immediately if you experience:
- Personality or mood changes
- Thoughts of self-harm or harming others
- Heart palpitations (irregular heartbeat) or rapid heartbeat
- Hallucinations (seeing, feeling, or hearing things that aren’t real)
- Facial tics (uncontrollable movements in your face)
In very rare cases, people starting Concerta may experience a serious allergic reaction that causes anaphylaxis. This is a medical emergency and warrants a call to your local emergency services immediately. The signs include:
- Swelling in the mouth, tongue, throat, or lips
- Struggling to breathe or wheezing
- Struggling to swallow
- Skin turning blue, gray, or pale on the lips, tongue, or palms of your hands
- Sudden dizziness, drowsiness, or confusion
- Unconsciousness
- Limpness
- Swollen, raised rashes on the skin
Precautions and Considerations
Certain people should not take Concerta. Your doctor should thoroughly screen you before prescribing it, but be sure to mention any personal or family history of the following:
- Any allergic reactions to methylphenidate or other medications
- Heart problems
- Overactive thyroid
- Any difficulty swallowing (this may determine which form of the medication is appropriate for you)
- Pheochromocytoma, a tumor in the adrenal gland
- Mental health conditions, such as psychosis, mania, depression, or anxiety
- Glaucoma
- Tics or a family history of Tourette’s syndrome
- Epilepsy
- High blood pressure or vascular issues
- If you are trying to or are already pregnant or breastfeeding
- Substance abuse
This personal and family medical history helps your doctor weigh the potential risks of this medication, helping them determine if Concerta is safe for you.
Additionally, be sure to include a list of all medications you currently take. Some medications should not be taken with Concerta, including MAO inhibitors for depression, as drug interactions are known to occur.
Dosage and Administration
Typically, Concerta is taken orally as an extended-release tablet in a dosage of 18 mg, 27 mg, 36 mg, and 54 mg. Most people take it in the morning with or without food and start at the 18 mg dosage if they have never taken methylphenidate before. This is true for children 6 years and older and adults, though adults may start at 36 mg per day instead.
Children ages 6-12 years may take a dosage of up to 54 mg per day while adolescents and adults may need to take up to 72 mg per day.
If you are switching to Concerta after taking methylphenidate previously, your doctor may adjust your starting dosage accordingly. Likewise, doctors may incrementally increase your dosage by 18 mg per week until optimal symptom management is obtained.
Treatment Duration and Withdrawal
Concerta, like other medications for ADHD, is often a long-term part of a treatment plan. While some people may find their symptoms subside with time, others may need to remain on Concerta for years, or even potentially a lifetime. However, in some cases, a doctor may recommend that you stop taking it, which can lead to withdrawal symptoms.
Because the brain and body may become dependent on Concerta, when someone stops taking it, their body has to adjust to living without it. Concerta increases dopamine and norepinephrine levels in the brain, which help you focus and boost attentiveness. When you stop taking Concerta, your body doesn’t make enough neurotransmitters to make up the difference. This produces the withdrawal effects until your body starts producing enough neurotransmitters on its own.
Withdrawal symptoms rarely pose a serious threat to those experiencing them but are often uncomfortable. Typical symptoms include:
- Fatigue
- Boosted appetite
- Sleeping too much or too little
- Vivid dreams
- Agitation
- Fidgeting
- Depression
- Anxiety
- Decreased heart rate
- Hyperactivity
Typically, withdrawal symptoms set in somewhere between a few hours and a few days after stopping the use of Concerta. Most people find that their withdrawal symptoms subside after about two weeks, but some people may experience them for longer.
Some doctors may recommend tapering off your dosage slowly to avoid these symptoms. If you’re considering stopping the use of Concerta, discuss your concerns candidly with your doctor and follow their advice.
Conclusion
Concerta is an effective form of treatment for ADHD and narcolepsy. If your doctor recommends Concerta as part of your treatment plan, consider giving it a chance to work and improve your life. Likewise, talk to your doctor in advance before stopping this medication.
