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ADHD Medication Titration Adderall, Dexedrine and other stimulant medications for ADHD have a long-lasting effect that can last up to fourteen hours. They have a greater effect than shorter-acting stimulants such as methylphenidate. The process of titrating a medication is used by doctors to find the right dosage for every patient. This article will cover the process of titration, possible adverse reactions and how to know when you have discovered your “target dose”. Keep a note of your next visit to the doctor! Dosage Titration is the method of determining the dose that reduces ADHD symptoms to the greatest degree while minimizing side effects. The doctor will begin with a low dosage and gradually increase it over time, typically every one to three weeks. The doctor will also test different kinds of medications to find out which one is best for your child. It is important to stay in the titration process even if it takes weeks. It is not uncommon for children to be required to try two or even three kinds of ADHD drugs before settling on the best combination. The aim is to reduce your child's ADHD symptoms and reduce the negative effects they have on their everyday life. The most popular stimulants used to treat ADHD are methylphenidate (Ritalin) and amphetamine salts (Adderall). Some examples are methylphenidate (Ritalin) and amphetamine salts (Adderall). These medications are available in various forms, such as tablets, capsules, chewables and liquid. The dosage can be varied but the most common is 10 milligrams daily. For some patients, this will suffice to alleviate their symptoms. Others may require an increased dose. It is also important to consider the drug release profiles of the medication that is being used. Certain stimulants have a rapid onset and wear off quickly and others show a more gradual effect. Some people are poor metabolizers, so they may not benefit from higher doses, but still experience improvement with lower dosages. The titration process should also include consideration of whether the patient is taking any medication that block CYP2D6, such as SSRIs, as this will influence how well the drug will benefit them. Before each dose increase, it's important to obtain ratings from teachers and parents as well as the 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 information is collected correctly and that the dosage of medication is accurate. Some children are sensitive towards certain side effects from ADHD medications, such as irritability and a change in appetite. This can mean that the medication isn't working well for them and should be altered. Other negative side effects, like feeling tired or sedated can be a sign of too much medication and is best addressed by reducing the dosage. Side effects It could take weeks or even months to reach the optimal dose of medication for ADHD. During this time patients should keep a daily log of symptoms and side effects. This should be recorded in a diary or on a calendar to allow the doctor to easily access it. Stimulants are among the most commonly prescribed medications for ADHD. They can trigger many adverse reactions. They can cause headaches, dry mouth, stomachaches sleepiness, a loss of appetite, and a sudden increase in blood pressure or heart rate. Patients may also experience tics. These are small, repetitive motions of the body, like glancing, blinking or repeated facial expressions. While these side effects are usually not severe however, they should be notifying the doctor as soon as they occur. Certain stimulant-related side-effects, such as irritability and insomnia, are more prominent at first, but they improve with time. In addition, certain medications are processed differently by different people. It is important to know whether a patient is slow metabolizer or a fast metabolizer so that they can be correctly dosed. It is possible, but not uncommon, that the initial medication prescribed for a child suffering from ADHD does not work. If this is the case the doctor will change to another medication. It is not uncommon for doctors to switch medications. Parents and children should be supportive of this procedure and understand the importance of being able to select the correct medication. It is also important to remember that, even though the process of titration might appear slow, it is important for a child's long-term health. Making changes to ADHD medication too quickly can cause negative side effects and ineffectiveness. Titration isn't only for ADHD stimulants, but it can be used for all types of medications, including non-stimulants such as Strattera and Qelbree and other long-term treatments, such as antibiotics and antidepressants. Although it is typically used for stimulant medications Titration can help determine the most effective dose of any medication used for long-term use. Schedule Titration is a process to determine the proper dosage of medication for a particular person. The dosage is determined by various factors, such as height, weight and symptoms. It is crucial to understand that drug release profiles can differ (i.e. the ways a stimulant such as Methylphenidate wears off or affects the body). These are all things your doctor will experiment with when increasing your dosage. The majority of times, doctors will start with a very low dosage of the medication, and then gradually increase it. This is done to allow the doctor to determine an “target dosage” that is effective at controlling symptoms, and has as little side effects as possible. It is important for parents and children to participate in titration by filling out rating scales at each dose, and then returning to the clinic to review the efficacy and side effects. It could take weeks or months for a physician to manage the child's ADHD symptoms using the appropriate medication. It is crucial for parents to understand this and collaborate with their doctor so that they do not get dissatisfied. This is particularly true for children younger than the age of 5. They are more difficult to get to the “zone” of appropriate treatment due to being so engaged and overwhelmed by their daily lives. The schedule for titration can differ from patient to patient but usually involves increasing the dosage by small increments every 1-2 weeks. Once the child is taking a prescribed dosage and is performing at their best with minimal side effects, the doctor will decrease the dosage to a maintenance dose. It is an excellent idea to talk with your titration prescriber regarding the ideal time of day to use the medication. It is usually best to take the medication in the morning, so that your child is able to concentrate at school. Some patients might find that taking the medication later in the day is more beneficial because it allows them to concentrate on homework or drive while driving. It is also crucial to adhere to a regular schedule to take the medication. This will help you avoid forgetting doses or missing them. Monitoring The goal is to find the best dose of medication to control ADHD symptoms with minimal adverse side effects. It may take 3-4 weeks or more of a careful titration for the patient to be in this ideal balance. It is important that the doctor and patient work closely to monitor efficiency and adverse effects. The patient should fill out rating scales for each dose, for instance the free Follow Up Vanderbilt forms or Adult ADHD Rating Scales from Frida can help doctors to measure the effectiveness of the medication in a more objective manner than just relying on the subjective teacher and parent ratings. Stimulants have a great inter-individual variation in terms of response to a specific dose. Therefore, patients should be gradually ramped up to avoid overdosing. Certain people are not able to process drugs and may exhibit signs and symptoms even at very small doses (eg atomoxetine – in 7%-10% of the population) (Belle et al. 2002; Hechtman, 2005). Slow titration is also recommended for patients taking any drugs that inhibit CYP 2D6 such as SSRI's. This will prevent patients from developing an addiction to the drug (eg bupropion, atomoxetine and clonidine). Monitoring long-term maintenance of medication should be a continuous process. It should include evaluation of symptoms to be monitored, including the ability to complete homework and school-related tasks and an evaluation of the effects on appetite and sleep, asking parents and teachers for a periodic assessment of the effect on the individual child's behavior and functioning, as well as self-ratings from adults and adolescents. [CG] The titration process can be extremely frustrating for some patients and their families. Being aware of the reasons behind medication and the expectations that can be set for effectiveness and tolerance can help reduce frustration and disappointment for the entire family. In the same way, educating the family members about ADHD can help reduce feelings of guilt or shame for their child's behavior issues. It is crucial that everyone in the family realizes that these problems may not be due to lack of discipline or bad parenting, but rather due to medically affected brain disorders.