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ADHD Medication Titration Adderall, Dexedrine and other stimulant medications for ADHD have effects that can last as long as fourteen hours. They exert a greater effect than stimulants that have shorter duration of action, such as methylphenidate. Titrating an medication is the method doctors use to determine the appropriate dosage for each individual patient. This article will cover the process of titration, possible adverse reactions and how to determine if you have discovered your “target dose”. Take notes for your next visit to the doctor! Dosage Titration is the method of determining the dosage that will reduce ADHD symptoms to the greatest degree while minimizing side effects. The doctor will start with a small amount and increase it gradually over time. This usually happens every one to three weeks. The doctor will also play with different kinds of medication to find the best fit for your child. It is important to stay with the titration process, even if it takes several weeks. It is not uncommon for children to to test up to three different kinds of ADHD medication before settling on the one that works best for them. The aim is to get your child's symptoms under control and reduce their negative impact on their lives. Stimulants are the most common medication used to treat ADHD. Examples include methylphenidate (Ritalin) and amphetamine salts (Adderall). These medications are available in various forms, such as tablets, capsules, chewables and liquid. The dosage can vary, but the standard starting limit is 10 milligrams a day. For certain patients, this might be enough to improve their symptoms. Some patients may require a higher dosage. It is also important to take into consideration the release profile of the drug that is being used. Certain stimulants have a fast-acting effect and are able to wear off quickly, while others take a longer time to show an effect. Additionally, some people are not able to metabolize the drug, meaning that they are not able to benefit from high doses of the drug, but they could still experience significant improvement at lower doses. The titration process must also include consideration of whether the patient is taking any medication that block CYP2D6, such as SSRIs, as this will impact how the drug will work for them. A thorough titration should include getting parent/teacher ratings and symptoms reports prior to each dose increase. 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 accurately collected and that the medication is properly titrated. Some children are sensitive to certain side effects of ADHD medicines, such as irritation or a change in appetite. This can mean that the medicine is not effective for them and should be changed. what is ADHD titration , such as feeling muted or sedated, could be a sign of too much medication and should be addressed by lowering the dosage. Side effects It could take weeks or months to reach the right dosage of medication for ADHD. During this period, patients should keep track of symptoms and side effects on a regular basis. It is recommended that this be recorded on a calendar or in an account book to be easily communicated to the physician. Stimulants, the most commonly prescribed medication for ADHD can cause a range of side effects. They can cause headaches as well as dry mouth, stomachaches, insomnia, loss of appetite and a sudden rise in heart rate or blood pressure. Patients can also suffer from tics. These are tiny repeated movements of the body, such as squinting, blinking or repeated facial expressions. These effects, though not always serious must be reported promptly to your physician. Some stimulant side effects, such as insomnia or irritability, tend to be more apparent when you first start taking the medication, and improve over time. Additionally, certain medications are processed differently by different people. It is crucial to determine whether the patient is a slow metabolizer or a fast metabolizer in order that they can be correctly dosed. It is possible, though not often, that the first medication prescribed for children suffering from ADHD is not effective. In this case, the doctor may switch to a different medication. It is not uncommon for doctors to switch medications. Parents and children must 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 may seem slow, this is crucial for your child's health in the long term. Changes in ADHD medication could cause negative side effects or be of no benefit. Titration is not just to help with stimulants for ADHD, but also for other medications such as antibiotics or antidepressants. Although it is typically used in conjunction with stimulants however, titration can assist in determining the most effective dose of any medication long-term. Schedule Titration is the process of finding the right dosage for patients. The dosage is determined by a variety of factors like height, weight and symptoms. It is also important to know that there are a variety of drug release profiles (ie the way a stimulant such as Methylphenidate is absorbed and/or impacts the body). These are all things your doctor will experiment with when you are titrating. Most doctors will begin with a small dose and gradually increase it. This is to allow the doctor to create an “target dosage” that is effective in managing symptoms, yet has as little adverse effects as is possible. It is important that children and parents are involved in the titration procedure by taking a rating scale for each dose, and returning to the clinic to review effectiveness and adverse effects. It could take weeks or even months for a physician to manage a child’s ADHD symptoms with the right medication. Parents need to be aware of this and cooperate with their physician so that they do not get annoyed. This is especially important for children younger than the age of 5. They are more difficult to get to the “zone” of the appropriate treatment because they are so busy and overwhelmed in their daily lives. The titration schedule can differ from patient-to-patient but typically involves increasing the dose by small increments every two weeks. Once the child is on a target dose and performing at their best with minimal side effects, the clinician will reduce the dosage to a maintenance dose. It is also important to discuss with your titration prescribing doctor the ideal time to take the medication. It is recommended to take the medication in the morning to allow your child to concentrate in school. Some patients may find that taking the medication later in the day is more beneficial because it lets them concentrate on homework or drive while driving. It is also recommended to take the medication regularly so that you can avoid forgetting or missing doses. Monitoring The aim is to find the best balance of medication to help control ADHD symptoms while minimizing adverse negative effects. This balance may take 3-4 weeks of careful adjustment. It is vital that the patient and doctor closely monitor side effects and effectiveness. 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 monitor the effectiveness of the medication in a more objective manner than relying solely on the subjective opinions of parents and teachers. Stimulants exhibit a wide range of inter-individual variability in the way they respond to a specific dose. Therefore, patients should be gradually titrated up to avoid overdosing. Some individuals are not able to metabolize drugs and will exhibit signs and symptoms even at very small doses (eg atomoxetine – in the 7%– 10% population) (Belle et al. 2002; Hechtman, 2005). It is also recommended to slow down the titration process for patients taking any drugs that block CYP2D6 such as SSRI's. This will prevent the patients from developing a tolerance to the drug (eg bupropion, atomoxetine and Clonidine). Monitoring long-term maintenance of medication is an ongoing process. It should include a review of target symptoms, including the ability to finish homework and school-related tasks and reviewing the effect on appetite and sleep, asking parents and teachers for a regular rating of the effect on the individual child's behavior and performance and self-ratings by adults and adolescents. [CG] The process of titration can be extremely frustrating for some patients and their families. Understanding the reasons behind the medication and the expectations of effectiveness and tolerance will reduce frustration and disappointment within the family. In the same way informing your family members about ADHD will reduce feelings of guilt or shame over their child's problematic behavior. It is crucial that everyone in the family understands that these issues might not be due to an absence of discipline or poor parenting, but rather medically brain-related issues.