ritalin - yes/no?

[madwomanintheattic]

so i had a message from the gp's receptionist this morning saying there were some drugs to pick up.

went up and collected mysterious package - she didn't know what it was for. but it has ds1's name on. anyway, just a tub of tablets, no leaflet, no explanation. have come home and consulted dr google (after leaving a message for the doc to ring me lol) and they are clearly whatever passes for ritalin in these here parts.

30 tablets, one a day - 18mg.

this is not totally out of the blue - ds1 has a few issues and the doc wondered whether an adhd med might tidy up a few of those, as well as give him a leg-up to help his real issue, which is incontinence. (ds1 is 8 btw)

so we had a paed referral, and the paed sent him for bloods/ urine/ x rays etc last week. nothing heard and then a call to collect, well, ritalin, from the original gp...

what do i do? i assume this is a trial... i assume the tests last week all came back clear - do i take it that they can't figure anything else out and so think that he should give ritalin a go and see if it works?

i'm a bit tbh. the paed didn't really bother about the adhd/ sensory/ as type stuff, but just wanted to double check all the continence side...

so, i actually have the tablets here. do i use them?

no.

not until you have spoken to your Pead properly.

DS has just started on equaysium xl at 10mg as he actually has ADD.

18mg i am assuming that Concerta? both are ritalin type meds - just different brands as they work in slightly different ways, although do the same thing ultimatly.

it doesn't have a brand name on the tub - just says Novo-methylphenidate/ methylphenidate 18 mg.

it seems quite high looking at what the other stuff comes in 5/10/20?, but don't know whether it's not as strong as the ritalin/ concerta brand name stuff...

says 'take one tablet once daily in the morning'. feels a bit 'alice in wonderland' - 'eat me'...

i'm a bit ticked at being given a tub of tablets without even a side-effects leaflet tbh...

yeah does sound like a generic form of concerta xl. that comes in 18mg.

I really wouldn't give him the pills.

Speak to the GP/pead and ask lots of questions.
also ask for you DS to have an ECG. it is a very small amount but there is a link between ADHD and heart problems, for some children the medication can cause a strain on the heart.
I dont say that to scare you. it really shouldn't, it is a teeny tiny amount of children that it effects. but it is something your Dr should have taken into account before just pushing the pills on you.

You are also correct in saying you can get similar meds in smaller doses.

IMHO for sure you need the whole story from the doc before you give any of these to your child. what it is, what effect it should have ... is this a low, medium or high dose? how to take it... do you ramp up the dose or just dive straight in? can you stop taking it or do you have to decrease it slowly?? and esp the side effects leaflet. And who prescribed it, the paed or the GP? who would you talk to if there were problems??

I don't think I would use them either until I had some more info.

legally they cant give oyu any medicatins without a leaflet with side effects etc detailed on, my mum used to work as a pharmacist and told me this once, personally i would contact gp/paed and say until you have had an appointment to discuss the tablets and given a leaflet etc you wont b giving them to your child!

and what's more, isn't it a bit strange just to pick up the drugs at the surgery. Just say for argument's sake that it's a mistake, and they're the wrong dose... is there a signed perscription anywhere?? who would be responsible?. we're not talking about calpol FFS

I don't want to be alarmist, and no doubt it's all done with the best intentions, but it just don't feel right to me

sorry - school run!

right, have spoken to the doc (gp not paed). he says the paed sent it as a recommendation after ds's assessment last week.

he did apologise and said he thought the paed had discussed it with me.

he wants to see us in 2 weeks to discuss how it is going...

i asked about the tests etc, and he said there was nothing unusual on bloods/ urine but they were still waiting for the coeliacs result. (sp)

so, now i'm a bit . he referred to them as certera, so is that a pretty high does to start an 8yo with only suspect adhd stuff going on?!

Blimey that's a late school run!.
I don't know who's still around, madwoman, but mamazon sounds like she's got experience in this stuff. If it were me I'd still like to talk to the paed first about it.

I can only give you my experience, and this is totally different drugs and symptoms, but this is what happened to my DS. The hospital consultant recommended a drug. He sent a letter to our local hosp and the paed there drew up a prescription and decided the dose. I had to get repeat perscripts from the GP, and get letters explaining what to perscribe sent to them.

the local paed perscribed a dose that had noticeable side effects, but they told me not to reduce the dose. When we got an appointment with the consultant again, he told me HALF that dose would be fine. Now he's on a lower dose things are much better. Nothing terrible happened, but I worry about these drugs with DC's because they can't always tell us clearly if there are side effects.

Since then I double check everything and I want to know exactly whose decision it is, because it can be confusing to know who to talk to if you need advice, especially with the less common meds that the GP may have little experience in.

not heard of certera. closest i could think of would be Straterra but they are atomoxetine hydrochloride.

i think they are most lkely to be Concerta and he had just mispronounced them.

18mg isn't a particularly high dose but you can get lower doses in similar brands.

if it is concerta they will work by releasing a small amount of the drug in the morning and then smaller doses will be released throughout the day.
they are completely out of the system after 18 hours so if he does have any side effects then at least there are no lasting side effects.

Im a bit of an expert at the moment as i have spent the last few weeks researching these drugs as our Pead had recommended them for DS (9)
we started him on the equaysium on tuesday. despite a very shakey first day he does seem to have clamed down a little. I wont give them over weekends so will see how next week goes, then we see our pead to discuss how we feel it going. Ds has also been involved throughout these discussions and decision making.

you might like to have a read of this.. it's pretty short and has loads of info...and a fairly easy read. you can work out whether it's a high or low dose from the info in there.

www.wmic.wales.nhs.uk/pdfs/shared_care_protocols/methylphenidate_sc_cv42_v1.0.pdf

I'm going to stop poking my nose in now, and be off to bed g'nite to you both x

lol lauree, it's an early school run @ 2pm on a friday i'm living in canada at the mo! that link was v useful, thanks. it looks probably that it is concerta as that is listed as having 18mg as the lowest dosage.

slightly curious though - was there an adhd drug at one point called certera/ setera/ or similar? i wonder if it's still referred to as that here... or mispronounciation/ hearing lol. i'm sure it is concerta though - the doc also said to take them with breakfast so that if there are any difficulties it will be out of his system come bed time (ish)...

ho hum. will have to discuss with dh tonight. i suppose i'm slightly happier that it seems like a lower dose, and he does intend to review in 2 weeks. i guess i could give it a try and stop straight away if anything odd happens... (also slightly worried about the height issue, ds is already going to be shorter than his sisters, i swear)

i have a friend whose son's ritalin trial ended in a massive sz (in the uk), so am still a bit shocked at the relative ease of access...

mamazon, i'd love to hear how it's going. i don't think we'll do anything this week anyway, we have half term looming, and i think i might like to keep an eye on him if we do decide to trial...

thanks all x

if its ritlen based then its a 'speed' dirivitive...

having been on that stuff for years i can tell you it doesnt so much calm them down as mute them everything.
everything is muted it really is like being in a fog..

thats just my own experiances but becareful and find out more

edit to my original posr

if your ds incontinence is caused by lack of attention or something similar then ritlen or another focusing aid may help.

if not i cant see how it would assist

you and your son have my sympathies
having that sort of issue at that age isnt fun

it sounds like slow release ritalin ds is on concerta, 18mg is the smallest dosage he's on both 18mg and 36 mg and it has been so much better than the normal release ritalin.

thanks all - we're leaving it this week and will probably start to trial next week... am going to read up a bit more though. odd having the pills sitting in the cupboard though!

Parents get so paranoid and righteous about children being exposed to cannabis etc. and then they go and willingly expose their children to amphetamine-like stimulants. Would you be happy for your child to take speed, a neurotoxic substance? No?

Just fyi one of the more recent findings about ritalin is that in some kids it works in really quite tiny doses and it's now bad practice to start them on anything but the lowest dose you can get hold of. I can see why they want slow-release if they think the incontinence is related, but Equasysm I think comes in a 10mg slow-release dose which would be a better start, switching to 18mg if no improvement.

Re: drugs called "certera" there is another brand called "strattera" which is not the same chemical as ritalin. So doses, protocols etc. will be different. It's the thing they try next if the ritalin doesn't work; ritalin has a better success rate so they try ritalin first.

Fwiw, I'm on Concerta (45mg) and I find if I take it at 7am it's out by about 8pm. Actually, that might cause a homework issue as I do get a bit of a dip as it comes out. So maybe keep an eye on that.

I agree with all that's been said here about caution, more info etc. Also, does he have ADHD? That is what that particular drug seems to be for. If its not ADHD but more ASD then Risperidone might be more suitable. DS has been on Risperidone for a few years but we had a LONG debate with Dev Paed, easy access by email in case of concerns or questions, very regular appointments to assess and all direct with Dev Paed, not with GP. DS also has annual blood tests to monitor kidney function etc which is another issue in itself as he is reluctant to say the least! This is a big step, they need to give you more info, time and follow up.

Just wanted to say this is an old thread that seems to have been inadvertently bumped by bletering... (i am the op though...)

for info - we still haven't trialled - we have a new gp who wants to get to know ds a bit better. the (double) incontinence is still our main problem with him by far, although other factors have not been ruled out (adhd-ish tendencies with add on sensory quirks, but i'm pretty certain not spectrum based)

new gp is very woo and wants to try some hyno stuff to see if we can get some improvement with the continence - he's been on/ off so many drugs purely for that we can't see the wood for the trees... if we can deal with the continence we can see what we're left with!

bletering - i'm not happy with my 8yo urinating and defecating in his underwear daily, or being unable to sit and eat a meal, or concentrate in class, either, to be frank. having dealt with it for 5 years since potty training age, i'm, willing for a doctor to prescribe medication if he thinks it will help him (and us). but i do understand your concerns re drugs, presumably the same concerns i had, as i felt that the gp had not made a thorough enough assessment before prescribing this type of medication.

but thanks for sharing your opinion.

r3dh3d, thanks for sharing that - 8pm would be perfect though . going to try the parts therapy thing first and keep meds as next option. good that you have found a dosage that works for you.

Bletering, if my child had diabetes I would give him insulin. I would be upset that he didn't produce normal amounts of insulin like most kids do; I would wish it wasn't so; but then I would just give him the drug that would improve his life or save it.

I've spent 5 holier-than-thou years refusing to countenance a drugs-based solution for our son's problems. The adhd / sensory processing / aspergers / 'badly-parented' type issues that have torn our family life to shreds.

My son is now old enough to be depressed about the situation for himself. I am keeping my fingers crossed that he will be lucky enough to be offered a Concerta trial after some forthcoming assessments.

Put that in your righteous hat and smoke it.

Jeez I ripped a secretary a new one yesterday after the mention of ritalin in a letter to the head that hadn't been discussed with me (and before assessments have been finished etc!)

So absolutely NO WAY!

Not until you have had a discussion with the prescribing doctor and you have been given the opportunity to make an informed choice about these drugs.

You are struggling to make the decision because you basically dont know enough about it to make a decision... there is only one solution then - get the information you need from the dr!

Hi Nickof Time
My ds has concerta but I did read that in the US they occasionally use a really old drug called imipramine.. and I know that's also used to treat bedwetting. So if you do decide to trial drugs at some point, maybe that's one to get your GP to find out more about?