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ADHD Medication Titration Adderall, Dexedrine and other stimulant medications for ADHD have effects that can last as long as fourteen hours. They have a greater effect than shorter-acting stimulants like methylphenidate. Titrating an medication is the method doctors use to find the appropriate dosage for each individual patient. This article will cover the process of titration, possible adverse reactions and how to know when you have found your “target dose”. Keep a note of your next visit to the doctor! Dosage Titration is the method of determining the dosage that will reduce ADHD symptoms to the greatest degree while minimizing any adverse effects. The doctor will start with a low dose and gradually increase the dosage over time, usually every one to three weeks. The doctor will also play with different kinds of medication to determine the most appropriate one for your child. The titration process can be a long time however it is crucial to keep it up. It is not unusual for children to to test up to three different types of ADHD medications before they find the one that is most effective. The goal is to control your child's symptoms of ADHD and eliminate the negative impact they have on his or her everyday life. Stimulants are the most common treatment for ADHD. Examples include methylphenidate (Ritalin), and amphetamines salts (Adderall). These medications are available in a variety of forms, such as tablets, capsules, chewables and liquid. The dosage can vary but the most common starting limit is 10 milligrams a day. For certain patients, this might suffice to alleviate their symptoms. Some patients will need an increased dose. adhd behavioral therapy is important to also consider the drug release profiles of the drug that is being used. Some stimulants have a fast beginning and fade rapidly, while others have a more gradual effect. Additionally, certain individuals are not able to metabolize the drug, meaning they do not benefit from large doses, however, they may show significant improvement at lower doses. The titration process must be accompanied by a consideration of whether the patient is taking any medications that block CYP2D6 like SSRIs. This will influence how well the drug will benefit them. A thorough titration should involve getting parent/teacher ratings and symptom reports before each dose increase. Use a validated rating scale for ADHD such as the Adult ADHD Symptoms Questionnaire or Follow Up Vanderbilt Form. This will ensure that the information is collected accurately and that the medication is being properly titrated. Some children are sensitive towards certain side effects of ADHD medications, including irritability and a change in appetite. This could indicate that the medicine is not effective for them and needs to be altered. Other adverse effects, like feeling muted or sedated, could be a sign of too much medication and should be addressed by lowering the dosage. Side effects It can take a few weeks or even months to reach the optimal dosage of medication for ADHD. During this time, patients should monitor their symptoms and side effects on a regular basis. It is suggested that this be recorded on a calendar or journals so that it can be easily shared with the doctor. Stimulants are among the most commonly prescribed medication for ADHD. They can trigger various adverse effects. These include headaches and stomachaches and insomnia, dry mouth, loss of appetite, as well as a sudden rise in blood pressure or heartbeat. Patients may also experience tics, which are tiny, repetitive body movements, which can include blinking, grimacing, or repeated facial expressions. These side effects, while not usually serious, should be reported immediately to your doctor. Some stimulant side-effects like irritability or insomnia, tend be more apparent at first but they improve with time. In addition, certain medications are metabolism differently by different people. It is essential to know whether the patient is slow metabolizer or a fast metabolizer so that they can be accurately dosed. It is possible, though not uncommon, that the initial medication prescribed to children suffering from ADHD does not work. In this case the doctor might change to a different medication. It is not uncommon for doctors to switch medications. Parents and children need to support this process and understand the importance of being able to select the correct medication. It is important to remember that, while the process of titration may appear slow, it is important for a child's long-term health. Changes in ADHD medication may cause negative adverse effects or provide no benefit. Titration isn't just for ADHD stimulants, but it can be utilized for all kinds of medications, including non-stimulants such as Strattera and Qelbree as well as other long-term treatments like antibiotics and antidepressants. Titration isn't only employed to treat stimulant medications however, it can also be used to determine the best dose of any medication taken long-term. Schedule Titration is the process of determining the proper dosage for a patient. The dosage is determined by a variety of factors including weight, height and symptoms. It is crucial to understand that the drug release profiles may differ (i.e. the method by which a stimulant like Methylphenidate wears out or affects the body). Your doctor will test all of these things when adjusting your dosage. Most often, a doctor will start with a very low dose of the medication and gradually increase it. This is done to allow the doctor to create a “target dosage” that is effective in managing symptoms, yet is as low in adverse effects as is possible. It is essential that parents and children participate in the titration procedure by filling out ratings scales for each dose, and returning to the clinic to discuss the effectiveness and side effects. It could take months or even weeks for a doctor to bring the child's ADHD symptoms under control with the appropriate medication. Parents need to understand this and collaborate with their doctor so that they do not get frustrated. This is especially true for children younger than the age of 5. They have a harder time getting to the “zone” of the appropriate treatment because they are so engaged and overwhelmed by their daily lives. The schedule for titration can vary from patient to patient but usually will involve increasing the dose in small increments every 2 to 3 weeks. Once the child is taking a prescribed dose and functioning at their highest level with no side effects the physician will reduce the dosage to a maintenance dose. It is recommended to consult your titration prescriber about the best time of day to use the medication. It is usually best to take the medication in the morning to allow your child to concentrate in school. Some patients may feel that taking the medication later in their day is more beneficial since it allows them to concentrate on homework or drive while driving. It is also a good idea to take your medication regularly to avoid forgetting or missing doses. Monitoring The goal is to find a perfect balance of medications to control ADHD symptoms while minimizing side effects. It may take 3-4 weeks or more of a careful titration for the patient to attain this balance. It is vital that the doctor and patient work closely together to evaluate the effects of side effects and the effectiveness. Having the patient fill out rating scales on every dose, like the free Follow Up Vanderbilt forms or Adult ADHD Rating Scales from Frida can be helpful for physicians to track the effectiveness of the medication in a more objective way than just relying on subjective parental and teacher ratings. The response to a particular dose of stimulants can vary dramatically between individuals. For this reason, patients should be gradually titrated up to avoid overdosing. Certain people are inefficient metabolizers of these drugs, and may exhibit symptoms and signs even at small doses (eg atomoxetine, which is found in 7-10% of the population) (Belle et al 2002; Hechtman 2005). Patients taking SSRIs or other drugs that inhibit the CYP 2D6 enzyme are advised to follow slow titration. This will stop patients from developing tolerance to the drug (eg bupropion, atomoxetine and Clonidine). Monitoring of long-term maintenance of medications is an ongoing process. It should include evaluations of the target symptoms, such as the ability to perform homework and school-related activities, as well a review of the sleep and appetite functions, asking parents and educators for a regular assessment of the child's behavior, performance and self-reports by adolescents and adults. [CG] The process of titration can be a source of frustration for some patients, and their families. Understanding the reasoning behind the medication and the expectations for efficiency and tolerance will lessen frustration and disappointment within the family. Similar to that to educate your family members about ADHD will reduce feelings of guilt or shame regarding the child's behavior issues. It is essential that everyone in the family understands that these problems may not be due to lack of discipline or bad parenting, but rather due to medically brain-related issues.