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I Am Psychiatry for ADHD like Adderall and Dexedrine are long-acting drugs that last for 14 hours. They are more effective than stimulants that have a shorter time-to-act, such as methylphenidate. Titrating an medication is the method doctors employ to determine the appropriate dosage for each individual patient. This article will discuss the procedure of titration, its side effects, and when you've reached your “target dosage”. Note down your next doctor's appointment! Dosage Titration is a process that determines the amount of medication that reduces ADHD symptoms the most, while minimizing any adverse effects. The doctor will start with a small amount and gradually increase it over time. This is usually done every one to three week. The doctor may also play with various types of medications to determine the most appropriate one for your child. The titration process could take several weeks but it's important to stick with it. It's not uncommon for children to have to test two or three different kinds of ADHD drugs before finding the best combination. The goal is to control the symptoms of ADHD in your child and minimize the negative impact they can have on their daily routine. Stimulants are the most common treatment for ADHD. Examples include methylphenidate, (Ritalin) and amphetamines salts (Adderall). These drugs are available in various forms, such as tablets, capsules, chewables and liquid. The dosage can vary but the most common is 10 milligrams daily. This dosage will suffice for some patients to reduce their symptoms. Others will require more of a dose. It is also important to be aware of the drug release profiles of the medication that is being taken. Some stimulants have a fast beginning and fade rapidly while others have a more gradual effect. In addition, certain people are not able to metabolize the drug, meaning that they will not benefit from high doses, but may still show significant improvement when they take lower doses. The titration process should be accompanied by a consideration of whether the patient is taking any medication that inhibit CYP2D6 like SSRIs, since this can influence how well the drug can be effective for them. Prior to each dose increase, it's important to obtain ratings from teachers and parents as well as symptom reports. Utilize a valid rating scale for ADHD such as the Adult ADHD Symptoms Questionnaire or Follow Up Vanderbilt Form. This will ensure the information is correctly collected and the dosage of medication is correct. Some children are sensitive towards certain side effects of ADHD medication, like irritation and a change in appetite. This could indicate that the medication isn't working and need to alter it. Other side effects like feeling dizzy or sleepy could be a sign that you are taking too much medication. You should lower the dosage to address this. Side effects It can take weeks or even months to reach the right dosage of medication for ADHD. During this time, patients should monitor their symptoms and side effects on a regular basis. It is recommended that this be done on a calendar or a journal so that it can be easily shared with the doctor. Stimulants are among the most commonly prescribed medication for ADHD. They can trigger various adverse reactions. They can cause headaches, stomachaches, dry mouth, sleepiness, a loss of appetite, and a sudden increase in heart rate or blood pressure. Patients may also experience tics, which are tiny, repetitive body movements that can include squinting, grimacing or repeated facial expressions. These effects, though not typically severe are important to report immediately to your physician. Certain stimulant-related side effects, such as irritability and insomnia, tend be more noticeable at first but improve over time. In addition, certain medications are processed differently by different people. It is crucial to determine if the patient has a slow or fast metabolism, so that the appropriate dosage can be determined. It is possible, but not common, that the first medication prescribed for children suffering from ADHD does not work. If this happens the doctor will change to a different medication. This isn't a rare scenario, and it's crucial for parents and children to be in agreement with this process and comprehend the importance of finding the right medication for their child. It is also important to keep in mind that even though the process of titration might appear slow, it is vital for a child's overall health. Changes in ADHD medication could result in negative side effects or no benefit. Titration can be used not just to help with stimulants for ADHD but also for other medications like antidepressants or antibiotics. Titration is not only used for stimulant medication however, it can be used to determine the best dose of any medication taken long-term. Schedule Titration is the process of determining the right dosage for the patient. The dosage is determined by a variety of factors including height, weight and symptoms. It is important to know that drug release profiles can differ (i.e. the method by which a stimulant like Methylphenidate wears out or affects the body). Your doctor will test all of these factors when adjusting your dosage. Most of the time, a doctor will start with a very low dose of the medication and gradually increase the dosage. This allows the doctor to establish an “target dosage” that is effective at controlling symptoms, and has as little side effects as possible. It is important that parents and children participate in the titration process by taking a rating scale for each dose, then returning to the clinic to review the effectiveness of the medication and any adverse effects. It could take months or even weeks for a doctor to bring the child's ADHD symptoms under control using the proper medication. It is important that parents understand this and work with their physician to make sure they are not irritable. This is especially important for children younger than the age of 8. more active and have a lot of stimulation in their daily life. The titration schedule can vary from patient to patient but usually involves increasing the dosage by small increments every 1-2 weeks. Once the child has reached the dosage they want and is operating at their peak with minimal side effects the clinician will decrease the dosage to a maintenance dosage. It is an excellent idea to talk with your titration prescriber regarding the ideal time to take the medication. It is usually best to take the medication in the morning to allow your child to concentrate in school. However for some patients, taking the medication later in the day could be more beneficial for them because they could use it to help complete their homework or concentrate when driving. It's also a good idea to take the medication on a regular schedule to avoid forgetting or missing doses. Monitoring The aim is to find the perfect dosage of medication that will help control ADHD symptoms with minimal adverse effects. It could take 3-4 weeks or more of meticulous adjustment to be in this ideal equilibrium. It is essential that the patient and doctor work closely together to evaluate the effects of side effects and the effectiveness. It is beneficial for physicians to ask 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 method rather than relying only on subjective ratings from parents and teachers. The response to a given dose of stimulants can differ greatly between individuals. To avoid overdosing, patients should be gradually adjusted. Certain individuals are not able to metabolize of these drugs and will exhibit symptoms and signs at low dosages (eg atomoxetine – in 7-10 percent of the population) (Belle et al 2002; Hechtman 2005). Patients taking SSRIs or other drugs that inhibit the CYP 2D6 enzyme are advised to take a slow adjustment. This will stop 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 complete homework and school-related tasks, as well as an evaluation of the effects on appetite and sleep, asking parents and teachers to provide a regular assessment of the effect on the child's behavior and functioning and self-ratings by adults and adolescents. [CG] The process of titration can be extremely frustrating for certain patients and their families. Having a clear understanding of the motivation behind taking medication, and the expectations that can be established for effectiveness as well as tolerance can reduce frustration and disappointment for the entire family. Similarly, educating the family about ADHD can decrease feelings of shame or blame for their child's behavior issues. It is important that everyone in the family understands that these issues may not be due to a lack discipline or poor parenting, but rather due to medically brain-related issues.