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ADHD Medication Titration Stimulant medication for ADHD, such as Adderall and Dexedrine are long-acting drugs that last up to 14 hours. They exert a greater effect than stimulants with less time to act such as methylphenidate. The procedure of titrating medication is utilized by doctors to determine the right dosage for every patient. This article will discuss the titration process, possible adverse effects, and how to determine if you have found your “target dose”. Keep a note of your next appointment with your doctor! Dosage Titration is the method of determining the dosage that minimizes ADHD symptoms to the greatest degree while minimizing any adverse effects. The doctor will start with a low dose and increase it gradually over time. This usually happens every three to four weeks. The doctor will also play with different types of medications to determine the most appropriate one for your child. It is essential to stick on the titration path, even if it takes a few weeks. It is not uncommon for children to to test up to three different types of ADHD medications before finding the one that is most effective. The goal is to control the symptoms of ADHD in your child and eliminate the negative impact they can have on their daily life. Stimulants are the most common medication used to treat ADHD. Some examples are methylphenidate (Ritalin) and amphetamine salts (Adderall). These medications are available in various forms, including tablets, capsules, chewables and liquid. The dosage can vary but the most common is 10 milligrams a day. For certain patients, this may suffice to alleviate their symptoms. Others will require a higher dose. It is also crucial to take into consideration the release profile of the medication that is being taken. Certain stimulants are quick-acting and wear off quickly while others take a longer time to show an effect. Additionally, certain individuals are poor metabolizers of the drug, which means they will not benefit from high doses, but may still show significant improvement even at lower doses. The titration should also consider whether the patient is taking any medications that inhibit CYP2D6, like SSRIs. This can affect the effectiveness of the drug for them. Prior to each dose increase, it is important to collect ratings from parents and teachers as well as symptoms 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 that the information is collected accurately and that the medication is being adjusted appropriately. Certain children are prone to certain side effects of ADHD medications, like an increase in irritability or appetite. This could mean that the medicine is not effective for them and should be adjusted. Other side effects, such as feeling dizzy or sleepy could be an indication that you are taking too much medication. You should reduce the dosage to treat this. Side effects It can take several weeks or even months to reach the right dosage of medication for ADHD. During this period, patients should monitor their symptoms and side effects on a regular basis. It is recommended that this be recorded on a calendar or journals so that it can be easily shared with the doctor. Stimulants, the most frequently prescribed medications for ADHD, can cause various side effects. These include headaches and stomachaches as well as insomnia, dry mouth and a loss of appetite and an abrupt rise in heart rate or blood pressure. Patients may also suffer from the tics. These are minor, repetitive motions of the body, such as squinting, blinking or repeated facial expressions. While these effects are typically not serious, they should still be reported to the doctor immediately. Some stimulant side effects, like insomnia or irritability are more prominent when they first start taking the medication. However, they tend to improve over time. Different individuals metabolize certain medications differently. It is essential to determine if the patient has a slow or a fast metabolism, so that the right dosage can be determined. It is possible, but not often, that the first medication prescribed to children suffering from ADHD is not effective. In this instance the doctor could switch to another medication. This is not a rare occurrence, and it is essential for parents and children to be willing to assist in this process and understand the importance of finding the right medication for their child. It is important to keep in mind that even though the titration may appear slow, it is important for your child's health in the long term. Changing ADHD medication too quickly can cause negative side effects and ineffectiveness. Titration is not just for ADHD stimulants, but can be used for any type of drugs including non-stimulants like Strattera and Qelbree as well as other long-term treatments such as antibiotics and antidepressants. Titration isn't just used for stimulant medication however, it can be used to find the optimal dosage of any medication used long-term. Schedule Titration is the process of determining the right dosage for patients. The dosage is determined by several factors including weight, height and symptoms. It is important to be aware that drug release profiles can vary (i.e. the method by which a stimulant like Methylphenidate wears out or affects the body). Your doctor will test all of these aspects when titrating your dosage. The majority of doctors start with a small dose and gradually increase it. This is so that the doctor can design an “target dose” that is effective in reducing symptoms but has the fewest side effects. It is essential that children and parents participate in the titration process by taking a rating scale for each dose, and returning to clinic to review effectiveness and adverse effects. It can take months or even weeks for a doctor to get a child's ADHD symptoms under control with the right medication. It is essential that parents are aware of this and work with their clinician to ensure that they are not irritable. This is particularly true 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 timing of titration can vary from patient to patient, however, it is generally a matter of increasing dosage in small increments every one to 2 weeks. Once the child reaches the dosage they want and is functioning at their peak with minimal side effects the clinician will gradually reduce the dosage. It is an excellent idea to speak with your titration doctor about 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 in school. titration adhd adults might discover that taking the medication later in the day is more beneficial since it lets them concentrate on their homework or driving. It is also recommended to take your medication on a regular basis to avoid missing doses or forgetting to take them. Monitoring The aim is to find the ideal balance of medications to control ADHD symptoms while minimizing the negative side effects. This balance may take up to 3-4 weeks of careful gradual titration. It is essential that the physician and patient work closely to monitor the effectiveness of the medication and any adverse effects. It is helpful for doctors 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 monitor the effectiveness more objectively manner than relying solely on subjective ratings by parents and teachers. Stimulants exhibit a wide range of inter-individual variability in terms of response to a specific dose. To prevent overdosing, patients need to be gradually titrated. Certain people are inefficient metabolizers of these medications, and may show signs and symptoms at very small doses (eg atomoxetine – in 7-10 percent of the population) (Belle et al 2002; Hechtman 2005). Patients taking SSRIs or other drugs that block CYP 2D6 are also advised to use a slow titration. This will help prevent patients from developing a drug tolerance (eg bupropion and clonidine as well as atomoxetine). Monitoring long-term medication maintenance must be a continuous process. It should include a review of the symptoms that are targeted, including the ability to complete homework and school-related activities and a review of appetite and sleep functions, asking parents and educators for an annual assessment of the child's behavior, performance and self-reports by adults and adolescents. [CG] The titration process can be extremely frustrating for some patients and their families. Being aware of the motivation behind taking medication and the expectations that need to be set for effectiveness and tolerance can lessen frustration and dismay for the entire family. In the same way, educating your family about ADHD will reduce feelings of guilt or shame regarding their child's problematic behaviors. It is also important to make sure that the entire family understand that these problems are not caused by a lack of discipline or poor parenting. They could be the result of medically mediated deficits in the brains of those who suffer from ADHD.