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ADHD Medication Titration Adderall, Dexedrine and other stimulant medications for ADHD have a long-lasting effect that can last for up to 14 hours. They are more effective than stimulants with shorter durations, such as methylphenidate. The process of titrating a medication is used by doctors to determine the appropriate dosage for every patient. This article will discuss the titration, side effects, and when you've reached your “target dosage”. Take notes for your next appointment with your doctor! Dosage Titration is the method of determining the dosage that minimizes ADHD symptoms to the maximum extent while minimizing the side effects. The doctor will start with a low dose and gradually increase it over time. This usually happens every one to three week. titration for adhd will also try different kinds of medications to determine which is best for your child. The titration process could be a long time, but it is important to stay with it. It's not uncommon for a child to have to test two or even three types of ADHD drugs before finding the best one that is a good match. The aim is to reduce the symptoms of ADHD in your child and minimize the negative impact they can have on their daily life. Stimulants are the most popular medication used to treat ADHD. Examples include methylphenidate, (Ritalin) and amphetamines salts (Adderall). These drugs are available in a variety of forms, such as chewables, capsules, tablets and liquid. The dosage is variable but the most common is 10 milligrams per day. This dose is sufficient for some patients to reduce their symptoms. Some patients will need an increased dose. It is also crucial to take into consideration the release profile of the drug that is being used. Certain stimulants have a quick start and fade quickly and others show a more gradual effect. Additionally, some people are unable to metabolize the drug, meaning that they will not benefit from large doses, but they could still experience significant improvement even at lower doses. The titration process should be accompanied by a consideration of whether the patient is taking any medication that block CYP2D6 like SSRIs. This will impact how the drug will work for them. Before each dose increase, it is important to obtain ratings from teachers and parents and the symptom reports. Use a scale of rating that is validated for ADHD such as the Adult ADHD Symptoms Questionnaire or Follow-Up Vanderbilt Form. This will ensure the information is correctly collected and the medication dosage is correct. Some children are sensitive to certain negative effects of ADHD medications, like irritability or a change in appetite. This can mean that the medication isn't working well for them and should be changed. Other adverse effects, like feeling tired or sedated could 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 dosage of medication for ADHD. During this time patients must keep a daily log of symptoms and side effects. This should be kept in a journal or calendars so that the doctor can easily access it. Stimulants are the most commonly prescribed medications for ADHD. They can cause various adverse effects. These can include headaches and dry mouth, stomachaches, nausea, insomnia and a sudden rise in heart rate or blood pressure. Patients may also experience tics, which are small, repetitive body movements that may include grimacing, blinking, or repeated facial expressions. These side effects, although not typically severe must be reported promptly to your doctor. Certain stimulant-related side effects, such as insomnia or irritability tend to be more noticeable when people first begin taking the medication and improve with time. Different people process certain medications in a different way. It is essential to determine whether the patient has a slow or fast metabolism, so that the appropriate dosage can be prescribed. It is possible, though not common, that the first medication prescribed to children suffering from ADHD does not work. If this is the case the doctor will then switch to an alternative medication. This is not an uncommon scenario, and it's important that parents and children are in agreement with this process and be aware of the importance of finding the appropriate medication for their child. It is also important to keep in mind that, even though the process of titration may appear to be slow, it's vital for a child's overall health. Changing ADHD medication too quickly can cause negative side effects and ineffectiveness. Titration isn't just for ADHD stimulants, but can be utilized for all kinds of drugs including non-stimulants like Strattera and Qelbree and other long-term treatments such as antidepressants and antibiotics. Although it is typically used for stimulant medications however, titration can assist in determining the optimal dose of any medication used for long-term use. Schedule Titration is a process to determine the appropriate dosage of medication for a person. The dosage is determined by several factors, including weight, height and symptoms. It is important to be aware that the profiles of drug release can vary (i.e. the way a stimulant like Methylphenidate wears off or affects the body). Your doctor will test all of these things when adjusting your dosage. The majority of times, doctors will begin with a low dosage of the medication, and then gradually increase the dosage. This is done to ensure that the physician can create a “target dose” that is effective in reducing symptoms but has the fewest side effects. It is important that parents and children participate in the titration procedure by making ratings scales for each dose, and returning to clinic to review effectiveness and side effects. It can take weeks or months for a physician to manage a child’s ADHD symptoms with the right medication. It is crucial for parents to understand this and cooperate with their physician so that they do not become frustrated. This is especially important for children in the younger age group who have a harder time getting to the “zone” of the appropriate treatment because they are so active and overstimulated in their daily lives. The schedule of titration varies from patient to patient however, it is generally a matter of increasing the dosage in small increments every 1 to 2 weeks. Once the child is on a targeted dose and functioning at their highest level with no side effects the doctor will decrease the dose to a maintenance dose. It is an excellent idea to speak with your titration prescriber regarding the ideal time of day to use the medication. In general, it is recommended to take it in the morning to ensure that your child is able to concentrate on schoolwork. Some patients might discover that taking the medication later in the day is beneficial as it allows them to focus on their homework or driving. It is also important to stick to a regular schedule to take the medication. This will allow you to avoid slipping up on doses or ignoring them. Monitoring The goal is to find the perfect dosage of medications to manage ADHD symptoms while minimizing any adverse effects. This may take up to 3-4 weeks of carefully adjustment. It is essential that the physician and patient work closely to monitor effectiveness and side effects. It is helpful for physicians to have the patient rate each dose using the free Follow Up Vanderbilt form or Adult ADHD rating scales from Frida. This allows them to track the effectiveness in a more objective way rather than relying on the subjective opinions of teachers and parents. The response to a particular dose of stimulants can differ dramatically among individuals. To avoid overdosing, patients should be gradually titrated. Some individuals are not able to metabolize drugs and may exhibit signs and symptoms even at very small doses (eg atomoxetine – in 7%-10% population) (Belle et al. 2002; Hechtman, 2005). Patients taking SSRIs or any other drugs that block CYP 2D6 are also advised to use gradual titration. This will stop patients from developing a tolerance to drugs (eg bupropion and clonidine as well as atomoxetine). Monitoring long-term medication maintenance must be a continuous process. It should include evaluation of symptoms to be monitored, including the ability to finish homework and school related activities and reviewing the effect on appetite and sleep as well as asking parents and teachers for a periodic assessment of the impact on the child's behavior and performance and self-ratings from adults and adolescents. [CG] The titration process can be very stressful for certain patients and their families. Being aware of the motivation behind taking medication and the expectations that can be set for both effectiveness and tolerance can reduce frustration and dismay for the family. Also, educating the entire family about ADHD can reduce feelings of blame or shame for their child's behavior issues. It is crucial that everyone in the family understands that these issues may not be due to lack of discipline or bad parenting, but rather medically brain-related issues.