Titrating the Dosage of ADHD Medication

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How do doctors know how much medication you or your child needs? In the initial equation, they will factor in your height, weight, and symptoms, but because biology is an inexact science and every individual is unique, your doctor's first estimate may not be an ideal match. He or she will need to titrate the amount for the greatest effect.

Titration of Medication

Titration is the process of determining the medication dose that reduces your symptoms to the greatest possible degree while avoiding as many side effects as possible. When your doctor titrates a dose, he or she is making adjustments to how much medicine you're taking. This process may be rather quick, or it could take some time.

The purpose of titration is to find that perfect balance of a particular medicine for your body. The goal is for the medication to do its job and produce the desired effects of helping to control your symptoms. At the same time, your doctor wants to reduce or eliminate any negative side effects.

Titrating can be done for any medication that's used on a long-term basis such as antiepileptics, antidepressants, insulin, and blood thinners, as well as stimulants for attention-deficit/hyperactivity disorder (ADHD). If medication adjustments don't create that balance of reducing your symptoms with the fewest side effects, then your doctor may choose to try another medication. With patience, time, and by working closely with your doctor, it's likely that you'll eventually find a suitable medication and dose.

Initial Dosage

Once your doctor provides you with an initial prescription, you will go through a process of determining whether or not your dosage should be increased or decreased. This will also ascertain whether the particular medication your doctor prescribed is the best choice for you or your child.

You and your doctor will be working together to determine whether you're experiencing any of these effects:

  • Too little response: The medication isn't working or the effects are too minimal.
  • Intolerable side effects: The medication may be working to help control ADHD symptoms such as inattention, impulsivity, and hyperactivity, but the side effects are very severe and/or intolerable.
  • Too much response: Instead of gaining greater control over your symptoms, you become passive, depressed, or unlike yourself.

To avoid such problems, if you're beginning a trial of stimulant medication, your doctor will likely start with an initial low dose of stimulant. At this point, it will largely be up to you to watch carefully to determine whether or not the medication is helping to alleviate your symptoms, whether and to what degree you're experiencing side effects, and whether and to what degree any of these noticeable side effects increase or decrease over time.

Consider keeping a diary on yourself or your child regarding any improvement you notice from the medication and side effects you experience. Talk to your child's teachers or, if you're the one on medication, talk to the people you interact with on a daily basis to see if they've noticed any change. These details may help you get to your ideal dose more quickly.

Potential Side Effects

With stimulant medications prescribed for ADHD like Ritalin, Concerta, and Quillivant (methylphenidate), Vyvanse (lisdexamfetamine), Focalin (dexmethylphenidate), and Adderall (dextroamphetamine-amphetamine), there are some potential side effects you can watch for. Your doctor may add to this list, so write them down if needed. It's also a good idea to read through the information you receive from the pharmacy and ask any questions you may have.

Common Side Effects of Stimulant Medication

  • New nervous tics (twitches, unusual blinking, odd facial movement)
  • Irritability or agitation
  • Depression or increased anxiety
  • Unusual physical sensations or hallucinations
  • Decreased appetite
  • Difficulty sleeping

Mild side effects may be reported to your doctor at your next visit, but significant issues or strange symptoms should be reported immediately. Some side effects may decrease or even go away with time as your body adjusts to the medication.

Any problems you experience may be due to the wrong level of medication or to an unusual reaction indicating that the medication is not the right one for you. In this case, don't take your child (or yourself) off his or her medication without talking to your doctor or nurse first since doing so can be dangerous.

Titrating to an Ideal Level

Assuming that the medication you're trying is reducing your symptoms with few or no side effects, your doctor will carefully and gradually adjust (titrate) the dose upwards to adequate levels. Titration helps your body adapt to the medication and also helps you and your doctor find the optimal dose to improve your daily functioning. This gradual increase usually occurs between every week and every three weeks.

Your doctor will eventually increase your dose to the highest dose that you can tolerate. If you begin to see no more improvement in your symptoms as the dosage increases, your doctor will lower the dose to the previous one. If you find that a higher dose produces too many side effects, the dosage will be also lowered.

Keep Communication Open

The optimal dose of medication is one in which your daily function is significantly improved and side effects are minimized. While finding this dose can be frustrating and it may seem like nothing is working, it's important to remember that medication management is a very individualized endeavor that's based on your personal needs and responses. This is why close communication with your doctor is vital. Think of your relationship as a partnership. Be open and communicative about your needs and experiences and together you will arrive at the most beneficial outcome.

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