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ADHD Medication Titration Stimulant medication for ADHD, such as Adderall and Dexedrine are long-acting drugs that last for 14 hours. They have a stronger effect than stimulants with shorter duration of action like methylphenidate. Titrating an medication is the method doctors use to determine the appropriate dosage for each patient. This article will cover process of titration, the adverse effects, and when you've reached your “target dosage”. Keep a note of your next doctor's visit! Dosage Titration is the process of determining the dosage that will reduce ADHD symptoms to the highest degree while minimizing any adverse effects. The doctor will begin with a low dosage and gradually increase it over time, typically every one to three weeks. The doctor may also play with various types of medications to determine the most suitable one for your child. The titration process could take several weeks, but it is important to stay with it. It's not uncommon for a child to have to test two or three different kinds of ADHD medications before settling on the perfect one that is a good match. The aim is to reduce your child's symptoms of ADHD and minimize the negative impact they have on their daily life. Stimulants are among the most commonly used treatment for ADHD. Some examples are methylphenidate (Ritalin) and amphetamine salts (Adderall). These drugs are available in different forms, such as tablets, capsules, chewables and liquid. The dosage is subject to change however the common starting point is 10 milligrams per day. For some patients, this will suffice to reduce their symptoms. Others will require more of a dose. It is important to also consider the drug release profiles of the medication that is being taken. Certain stimulants have a rapid start and fade quickly while others have a more gradual effect. Additionally, certain individuals are poor metabolizers of the drug, meaning they do not benefit from large doses, but may still show significant improvement at lower doses. The titration process should also include consideration of whether the patient is taking any medication that block CYP2D6, such as SSRIs, since this can affect how well the drug will work for them. Before every dose increase, it's important to collect ratings from parents and teachers as well as symptom reports. Use a scale of rating that is validated for ADHD like the Adult ADHD Symptoms Questionnaire or Follow Up Vanderbilt Form. This will ensure the information is collected correctly and the dosage of medication is correct. Some children are sensitive to certain negative effects of ADHD medications, for example irritability or a change in appetite. This could mean that the medicine is not working well for them and should be adjusted. Other side effects such as feeling mute or sedated can be an indication that you're taking too many medications. You should reduce the dosage to treat this. Side effects It could take weeks or months to reach the right dose of medication for ADHD. During this period, patients should keep a daily log of their symptoms and side effects. It is recommended that this be recorded on a calendar or in a journal to be easily shared with the doctor. Stimulants are the most commonly prescribed medications for ADHD. They can cause many side effects. They can cause headaches, dry mouth, stomachaches, insomnia, loss of appetite and a sudden rise in blood pressure or heart rate. Patients can also be prone to antics. These are small, repetitive motions of the body, like glancing, blinking or repeated facial expressions. Although these side effects are typically not serious but they should be notifying the doctor as soon as they occur. Some stimulant side-effects, such as irritability and insomnia, tend be more prominent at first, but they improve with time. Additionally, certain drugs are processed differently by different people. It is crucial to determine whether the patient is slow metabolizer or fast metabolizer, so that they can be appropriately dosed. It is possible, but not common, that the first medication prescribed for a child suffering from ADHD is not effective. If this is the case the doctor will then switch to another medication. It is not uncommon for doctors to switch their medications. Parents and children need to be supportive of this process and know the importance of being able to find the right medication. It is important to remember that, even though the titration might appear slow, it is vital for your child's wellbeing in the long run. The process of changing ADHD medication too quickly could cause negative side effects as well as a ineffectiveness. Titration isn't just for ADHD stimulants, but can be used for all types of drugs, including non-stimulants such as Strattera and Qelbree, as well as other long-term treatments like antidepressants and antibiotics. Although it is typically employed for stimulant drugs Titration can help determine the right dosage for any medication that will be used for long-term use. Schedule Titration is the process of finding the appropriate dosage for the patient. The dosage is determined by a variety of factors, including weight, height and symptoms. It is also important to note that there are variations in drug release profiles (ie the way that a stimulant like Methylphenidate is absorbed and/or impacts the body). These are the things your doctor will experiment with when you are titrating. The majority of doctors start with a very small dose and gradually increase it. This allows the doctor to establish 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 be involved in titration by filling out scales of rating at each dose, and then returning to the clinic for a review of effectiveness and side effects. It could take months or even weeks for a doctor to bring the child's ADHD symptoms under control using the proper medication. Parents need to understand this and collaborate with their doctor so that they do not become annoyed. This is especially true for children younger than the age of 5. They struggle to get to the “zone” of the right treatment because they are so engaged and overwhelmed by their daily lives. The titration schedule can vary from patient to patient but usually involves increasing the dosage by small increments every 1-2 weeks. Once the child has reached the dosage they want and is functioning at their peak with minimal side effects the clinician will reduce to a maintenance dosage. It is recommended to speak with your titration physician about the best time of day to take the medication. Generally, it is best to take it in the morning so that the child can concentrate in school. However for some patients, taking the medication later in the day could be more beneficial for them as they can use it to finish their work or concentrate while driving. It is also important to stick to a regular schedule for taking the medication. This will help you avoid forgetting doses or missing them. Monitoring The goal is to find the ideal dosage of medication that will help manage ADHD symptoms while minimizing adverse side effects. It may take 3-4 weeks or more of careful titration for the patient to be in this ideal balance. It is essential that the doctor and patient closely monitor the efficiency and adverse effects. Inviting the patient to complete rating scales for every dose, like the free Follow Up Vanderbilt forms or Adult ADHD Rating Scales from Frida can be helpful for doctors to measure the effectiveness of the medication in a more objective way than just relying on subjective parental and teacher ratings. The reaction to a certain dose of stimulants can differ significantly between individuals. Therefore, patients should be slowly titrated up to avoid overdosing. Some individuals are poor metabolizers of these drugs, and will exhibit symptoms and signs at small doses (eg the atomoxetine drug – which affects 7 to 10 percent 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 the patients from developing tolerance to the drug (eg bupropion, atomoxetine and Clonidine). Monitoring long-term maintenance of medication should be an ongoing process. titrating medication should include a review of target symptoms including the ability to complete homework and school-related activities and a review of sleep and appetite functions, asking parents and educators for an annual assessment of the child's behavior, functioning, and self-ratings by adolescents and adults. [CG] The process of titration is often frustrating for some patients and their families. Being aware of the reasons behind medication, and the expectations that should be set for both effectiveness and tolerance can reduce frustration and disappointment for the family. Also, educating the entire family members about ADHD can reduce feelings of shame or blame for their child's problem behaviors. It is essential that everyone in the family understands that these issues might not be caused by an absence of discipline or poor parenting, but rather to medically brain-related issues.