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ADHD Medication Titration Adderall, Dexedrine and other stimulant medications for ADHD have a long-lasting effect that can last up to fourteen hours. They have a stronger effect than stimulants that have a shorter acting time such as methylphenidate. Titrating a medication is the method doctors use to find the proper dosage for each patient. This article will discuss the procedure of titration, its side effects, and when you've reached your “target dosage”. Keep a note of your next doctor's visit! Dosage Titration is the process of determining the medication dosage that minimizes ADHD symptoms to the maximum degree while minimizing any adverse effects. The doctor will start with a small dose and gradually increase the dosage over time, usually every one to three weeks. The doctor will also play with various types of medications to find the best fit for your child. The titration process could take a few weeks however it is crucial to stick with it. It is not unusual for children to to test up to three different types of ADHD medications before finding the one that is most effective. The aim is to get your child's symptoms under control and to eliminate their negative effects on his or her life. Stimulants are among the most commonly used treatment for ADHD. Some examples include the methylphenidate (Ritalin) and amphetamine salts (Adderall). These drugs are available in a variety of forms, including tablets, capsules, chewables and liquid. The dosage is variable, but the standard is 10 milligrams a day. This dose will be sufficient for some patients to alleviate their symptoms. Others will require an increased dose. It is also important to look at the release profile of the drug that is being taken. Certain stimulants have a rapid beginning and fade rapidly, while others have a more gradual effect. Certain people aren't able to process the stimulants which means they won't benefit from higher doses, but nevertheless, they will show improvement even at smaller doses. The titration procedure should also consider whether the patient is taking any medications that inhibit CYP2D6 such as SSRIs. This will impact the effectiveness of the drug in these cases. A thorough titration should include parents/teachers rating and reports on symptoms prior to each dose increase. It is essential to use a rating scale that is validated for ADHD, such as the Follow Up Vanderbilt form or the Adult ADHD Symptoms questionnaire. This will ensure that the information is gathered accurately and that the medication is being titrated properly. Some children are prone to certain side effects from ADHD medications, including irritation and a change in appetite. This can mean that the medication isn't effective for them and should be adjusted. Other side effects like feeling depressed or sluggish could be an indication that you are taking too much medication. You should reduce the dosage to deal with this. Side effects It can take weeks or months to achieve the ideal dose of medication for ADHD. During this time, patients should keep a daily log of their symptoms and side effects. This should be kept in a journal or calendars to allow the doctor to easily access it. Stimulants are the most commonly prescribed medications for ADHD. what is ADHD titration can trigger various adverse effects. They can cause headaches, dry mouth, stomachaches, insomnia, loss of appetite and a sudden rise in heart rate or blood pressure. Patients might also experience tics, which are small repetitive body movements that may include grimacing, blinking, or repeated facial expressions. These effects, though not typically severe must be reported promptly to your physician. Certain stimulant-related side-effects like irritability and insomnia, tend be more prominent at first, but will improve over time. Additionally, certain medications are metabolism differently by different people. It is essential to determine if a patient has a slow or fast metabolism, so that the appropriate dosage can be prescribed. Although it isn't common, it is possible that the initial medication may not work for a child with ADHD. If this is the case, the doctor will switch to another medication. It is not unusual for doctors to switch their medications. Parents and children should be supportive of this process and know the importance of being able to choose the right medication. It is also important to remember that, even though the process of titration might seem slow, it is vital for a child's overall health. Making changes to ADHD medication too quickly can result in negative side effects and a lack of benefit. Titration can be used not only for stimulants for ADHD but also for other medications, such as antibiotics or antidepressants. While it is most commonly employed for stimulant drugs Titration can help determine the right dosage for any medication taken long-term. Schedule Titration is the process of determining the proper dosage for the patient. The dosage is determined by various factors, such as height, weight and symptoms. It is also important to know that there are variations in drug release profiles (ie the way that a stimulant like Methylphenidate wears off and/or affects the body). Your doctor will try all of these factors when adjusting your dosage. Most doctors will begin with a small amount and increase it gradually. This allows the doctor to create an “target dosage” that is effective at controlling symptoms, but is as low in side effects as possible. It is important for parents and children to be involved in titration, by filling out rating scales at each dose and then returning to the clinic to review the effectiveness and any side effects. It may take weeks or even months for a doctor to bring a child's ADHD symptoms under control using the right medication. Parents need to be aware of this and cooperate with their physician so that they do not become dissatisfied. This is especially important for children in the younger age group who are more difficult to get to the “zone” of the right treatment due to being so engaged and overwhelmed by their daily lives. The schedule for titration may differ from patient-to-patient but generally involves increasing the dose by small increments every two weeks. When the child is at a target dosage and is functioning at their best with no adverse effects, the doctor will gradually reduce the dosage. It's also a good idea to consult your titration physician regarding the ideal time to take the medication. Typically, it is best to take it in the morning so that the child can concentrate on schoolwork. However for some patients taking the medication later in the day might be beneficial as they can use it to get through homework or to concentrate while driving. It is also important to stick to a regular schedule for taking the medication. This will help you avoid missing doses or forgetting to take them. Monitoring The goal is to find the best dose of medication to manage ADHD symptoms while minimizing side negative effects. This balance may be found after 3-4 weeks of careful gradual titration. It is essential that the doctor and patient work closely to monitor the effectiveness of the medication and any side effects. Having the patient fill out rating scales on each dose, such as the free Follow Up Vanderbilt forms or Adult ADHD Rating Scales from Frida can help doctors to monitor the effectiveness of the medication in a more objective way rather than relying on the subjective teacher and parent ratings. The reaction to a certain dose of stimulants can vary greatly among individuals. Therefore, patients should be gradually titrated up to avoid overdosing. Some individuals are not able to metabolize drugs and will show symptoms and signs even at very small doses (eg atomoxetine – in 7%-10% of the population) (Belle et al. 2002; Hechtman, 2005). Patients taking SSRIs or other drugs that block CYP 2D6 are also advised to follow the gradual adjustment. This will stop patients from developing a tolerance to the drug (eg bupropion, atomoxetine, and Clonidine). Monitoring long-term medication maintenance should be a continuous process. It should include evaluation of target symptoms, including the ability to complete homework and school-related tasks as well as an evaluation of the effects on appetite and sleep as well as asking parents and teachers for a regular rating of the impact on the individual child's behavior and functioning and self-ratings from adults and adolescents. [CG] The process of titration can be very frustrating for certain patients and their families. Being aware of the rationale for medication and the expectations that should be set for effectiveness and tolerance can reduce frustration and dismay for the entire family. Similarly, educating the family members on ADHD can reduce feelings of shame or blame for their child's problem behaviors. It is also important to make sure that the entire family understand that these issues aren't caused by a lack of discipline or poor parenting and can be the result of medically mediated deficits in the brains of those with ADHD.