RitalinSR vs Concerta? Differences?

[cloudmonger]

From what I understand, RitalinSR is intermediate-acting (lasts up to 5 hours) where RitalinLA and Concerta are both longer-acting (like up to 8+ hours) Other than this, is there any other difference between the 2?

Do you feel different on each of them? For me, with RitalinSR, the effect was fairly quick, peak action within 2 hours, but would wear off usually within 4 hours. The good thing though, was that I would get tired in the afternoon/early evening and sleep really really well. If I were to go on Concerta, would it wreck my sleep schedule?

 

[JustNuts]

Ritalin SR is the oldest sustained release formulation of methylphenidate. It was developed before the acute tolerance issue was discovered (which happened during ALZA's development of Concerta), and hence it contains inherent design flaws that make it markedly less effective than BID methylphenidate. It is the absolute worst methylphenidate delivery mechanism, notably inferior to every single other marketed delivery mechanism, and so its use should be avoided as much as possible.

Ritalin LA utilizes a system called SODAS for sustained drug delivery. This system is rather similar to the system used in Adderall XR and Dexedrine LA. SODAS is also used in Focalin XR. It has a biphasic release profile intended to mimic the results of BID methylphenidate, and functions relatively well, lasting approximately 8 hours.

Concerta uses a very advanced drug delivery system called the OROS PSOP. It lasts approximately 12 hours, although a number of people augment it with a small dose of IR methylphenidate towards the end of the day for better/stronger full-day coverage (which may extent beyond 12 hours with augmentation).

These are only three of the eight extended release methylphenidate formulations available (not counting Focalin XR, which is functionally identical to Ritalin LA anyways). Three of the other five are intended for children and not usually prescribed to adults outside of special cases (QuilliChew ER - a chewable tablet lasting approximately 8 hours, Daytrana - a transdermal patch lasting approximately 11 hours, and Quillivant XR - a oral suspension (liquid) formulation lasting approximately 12 hours). The remaining two are Metadate CD (8-10 hour duration, unremarkable design) and Aptensio XR (a US rebrand of the Canadian drug Biphentin, which is designed for a 12 hour duration).

Time to onset of action is similar with all formulations. Most of the longest-lasting meds have a greater potential to affect some people's sleep, but of those, Concerta and Daytrana have the highest potential, and Aptensio XR would be expected to have the lowest potential. However, a higher potential does not necessarily mean that it will affect your sleep - a lot of people have no sleep issues with Concerta/Daytrana. The shorter-lasting formulations would be generally expected to have minimal effects on sleep.

At identical overall dosages, shorter-lasting formulations will generally have a somewhat stronger effect than longer-lasting formulations purely because the total dose is concentrated into a shorter time period.

Everyone responds differently to each individual formulation, so what works well for one person may not work so well for the next.

Edited February 7, 2017 by JustNuts

[cloudmonger]

On 2/7/2017 at 3:45 AM, JustNuts said:

Ritalin SR is the oldest sustained release formulation of methylphenidate. It was developed before the acute tolerance issue was discovered (which happened during ALZA's development of Concerta), and hence it contains inherent design flaws that make it markedly less effective than BID methylphenidate. It is the absolute worst methylphenidate delivery mechanism, notably inferior to every single other marketed delivery mechanism, and so its use should be avoided as much as possible.

Ritalin LA utilizes a system called SODAS for sustained drug delivery. This system is rather similar to the system used in Adderall XR and Dexedrine LA. SODAS is also used in Focalin XR. It has a biphasic release profile intended to mimic the results of BID methylphenidate, and functions relatively well, lasting approximately 8 hours.

Concerta uses a very advanced drug delivery system called the OROS PSOP. It lasts approximately 12 hours, although a number of people augment it with a small dose of IR methylphenidate towards the end of the day for better/stronger full-day coverage (which may extent beyond 12 hours with augmentation).

Time to onset of action is similar with all formulations. Most of the longest-lasting meds have a greater potential to affect some people's sleep, but of those, Concerta and Daytrana have the highest potential, and Aptensio XR would be expected to have the lowest potential. However, a higher potential does not necessarily mean that it will affect your sleep - a lot of people have no sleep issues with Concerta/Daytrana. The shorter-lasting formulations would be generally expected to have minimal effects on sleep.

At identical overall dosages, shorter-lasting formulations will generally have a somewhat stronger effect than longer-lasting formulations purely because the total dose is concentrated into a shorter time period.

Everyone responds differently to each individual formulation, so what works well for one person may not work so well for the next.

Thanks. This is interesting. I didn't know that the Ritalin SR was "sub-effective" Do you mean that the flawed delivery system provides no reliable effect, or the release mechanism makes levels erratically go up & down? When you say Ritalin BID, I'm assuming you mean Ritalin Immediate-Release? I have not tried the Ritalin-LA since the effect is 8 hours, maybe a good one for me to try. 6-8 hours tops is a good duration for me. I need most support in the morning/daytime to get going, but I must be able to wind down around 5pm before dinner time.

The Ritalin Immediate Release didn't work well for me, it would "kick in" and then it would wear off super quick and I had a noticeably depressive/irritable "crash" The Ritalin SR was much better/smoother in this regard, but the coverage was a bit "iffy" sometimes I felt it wasn't doing anything at all, and sometimes i would feel a peak and then nothing after.

I'd be interested in looking into Concerta, however, I'm afraid that if it lasts a full 12 hours I'll be unable to fall asleep. :-( Dex and Adderall seem a bit "harder core" (possibly more addictive?) I'm sure I'd never find a pdoc who would agree to RX either of those.

Edited February 8, 2017 by cloudmonger

[cloudmonger]

Wanted to add another question for you (or someone here) can hopefully help with:

Ritalin was initially prescribed as an add-on for my depression combo. My pdoc at the time suggested it because I've had poor response/side effects to SSRI's, SNRIs, and even Wellbutrin has no effect. He said it can be effective to minimize cognitive/sedation/apathy side effects of antidepressants (although really off-label this way). I tried it and it worked extremely well for me, so he included the diagnosis of "Adult ADD" due to my positive response as well as the ADD-type symptoms I have in addition to major depression.

Problem is, I moved (I'm outside of the US) and current pdoc will not prescribe it (even though I have legitimate Dx/Rx from another pdoc that gave it to me!!) My current pdoc said she would have to refer me to someone else because she is unable to "legally prescribe it" Wtf?! It's so upsetting because it's been a med that really really helped my chronic symptoms with no side effects. I am worried if I go to this new pdoc and he will have to give me a full ADHD test & interview because it is a controlled substance, and they want to limit use for only people that were officially diagnosed ADHD as children....whatever.....

Do you have any suggestions? I can simply tell the new pdoc that my last doc prescribed it and he has a summary that confirms I had a positive response....What else can I do?  What if I "fail" his ADHD test/interview?

Edited February 8, 2017 by cloudmonger

[JustNuts]

On 2/7/2017 at 4:03 AM, cloudmonger said:

Thanks. This is interesting. I didn't know that the Ritalin SR was "sub-effective" Do you mean that the flawed delivery system provides no reliable effect, or the release mechanism makes levels erratically go up & down? When you say Ritalin BID, I'm assuming you mean Ritalin Immediate-Release? I have not tried the Ritalin-LA since the effect is 8 hours, maybe a good one for me to try. 6-8 hours tops is a good duration for me. I need most support in the morning/daytime to get going, but I must be able to wind down around 5pm before dinner time.

The Ritalin Immediate Release didn't work well for me, it would "kick in" and then it would wear off super quick and I had a noticeably depressive/irritable "crash" The Ritalin SR was much better/smoother in this regard, but the coverage was a bit "iffy" sometimes I felt it wasn't doing anything at all, and sometimes i would feel a peak and then nothing after.

I'd be interested in looking into Concerta, however, I'm afraid that if it lasts a full 12 hours I'll be unable to fall asleep. :-( Dex and Adderall seem a bit "harder core" (possibly more addictive?) I'm sure I'd never find a pdoc who would agree to RX either of those.

Ritalin SR is less effective than BID methylphenidate due to the inherently flawed pharmacokinetic profile. This reduces efficacy and reliability.

BID methylphenidate refers to taking 1/2 of the overall dose of the extended release drug in immediate-release methylphenidate twice per day, with the doses spaced approximately 4 hours apart.

Among all extended-release formulations of methylphenidate, Aptensio XR delivers the strongest effect in the morning due to 40% of its overall dose being in the form of immediate-release methylphenidate.

IR methylphenidate wearing off too quickly can be a sign that you are on too low of a dose, although a non-biphasic release system (Concerta being the "benchmark" system of this type) is theoretically better suited to producing an optimal pharmacokinetic profile than BID/TID/QID IR methylphenidate or a biphasic release system is (i.e. you may do better on one of those systems).

Yes, the amphetamine-based drugs are often viewed as "harder" than methylphenidate, but Vyvanse is a bit of an exception to that and a lot of pdocs don't really differentiate between methylphenidate and amphetamine in general. Keep in mind that the amphetamines have inherently longer half-lives than methylphenidate, so they may not be the best route if sleep is a major concern for you.

On 2/7/2017 at 4:24 AM, cloudmonger said:

Wanted to add another question for you (or someone here) can hopefully help with:

Ritalin was initially prescribed as an add-on for my depression combo. My pdoc at the time suggested it because I've had poor response/side effects to SSRI's, SNRIs, and even Wellbutrin has no effect. He said it can be effective to minimize cognitive/sedation/apathy side effects of antidepressants (although really off-label this way). I tried it and it worked extremely well for me, so he included the diagnosis of "Adult ADD" due to my positive response as well as the ADD-type symptoms I have in addition to major depression.

Problem is, I moved (I'm outside of the US) and current pdoc will not prescribe it (even though I have legitimate Dx/Rx from another pdoc that gave it to me!!) My current pdoc said she would have to refer me to someone else because she is unable to "legally prescribe it" Wtf?! It's so upsetting because it's been a med that really really helped my chronic symptoms with no side effects. I am worried if I go to this new pdoc and he will have to give me a full ADHD test & interview because it is a controlled substance, and they want to limit use for only people that were officially diagnosed ADHD as children....whatever.....

Do you have any suggestions? I can simply tell the new pdoc that my last doc prescribed it and he has a summary that confirms I had a positive response....What else can I do?  What if I "fail" his ADHD test/interview?

Prescribing psychostimulants as an add-on for depression is a very controversial use. While there is a somewhat solid body of evidence in support of short-term benefits from the use of psychostimulants (primarily methylphenidate) as augmentative agents for the treatment of depression, the evidence for long-term benefits is much murkier, and the inherent risks to prescribing psychostimulants generally outweigh the benefit for most people. In the real world, this is completely dependent on your pdoc's views on the matter.

Stimulant response cannot be used to diagnose ADHD, although it is sometimes misused for this purpose (often with good intentions - but as you've seen, this can cause problems). It is still generally a good idea to mention that you responded well to the medication, as many doctors will consider that as a factor in favor of continuing the medication or at least continuing with testing to see if you have ADHD.

I don't know what country you're in, so I have no clue what laws apply and what stimulant medications are even available (the ones available can vary significantly from country to country, as do the laws regarding prescribing psychostimulants). The US is more permissive when it comes to prescribing psychostimulants than many other countries are. What's more, irregardless of where you are in the world, it is not uncommon to have doctors refuse to prescribe psychostimulants outside of ADHD/narcolepsy, refuse to prescribe psychostimulants in any case, or require varying levels of documentation of a diagnosis of ADHD/narcolepsy to prescribe them. Doctors willing to prescribe psychostimulants off-label are generally the exception, not the rule (although as always pdocs are usually significantly better than other doctors about this).

So basically, I don't know what situation you're in (and have no way of knowing with the information I've been given). For example, if you are in France, only methylphenidate is available and it always requires a hospital-initiated prescription from a neurology, psychiatry, or pediatric specialist. That is one of the more extreme approaches I'm aware of. In other countries, you may just be required to see a specific type of specialist for a prescription. Or perhaps you are in a country where pdocs can prescribe these meds, but your pdoc is uncomfortable prescribing the med (either broadly or for your particular case), hence her decision to refer you elsewhere. Or perhaps she truly cannot prescribe these meds and only certain pdocs are allowed to prescribe these meds? I think some countries might only allow child psychiatrists to prescribe psychostimulants, or even limit the use of ADHD meds to children only...

IMO the most likely scenario is that you'll have to be tested for ADHD and the results of that testing will determine if you have a psychostimulant prescribed to you. Testing for ADHD varies broadly in depth and scope. It can range from a few questions on a simple form to hours of neuropsychological testing, so I can't really tell you what to expect. I can't really give you a definitive answer on how a non-diagnosis result would be handled - typically you can get a second opinion on that with another provider, but that may be viewed as doctor shopping and depending on the country's health system you may not even have this opportunity. If you get a second opinion, it's best to get it from someone with a lot of experience in diagnosing and/or treating ADHD so that you're assured of its quality. Depending on the country you're in a psychologist may be able to diagnose ADHD too.

[Flash]

On 2/6/2017 at 0:11 PM, cloudmonger said:

From what I understand, RitalinSR is intermediate-acting (lasts up to 5 hours) where RitalinLA and Concerta are both longer-acting (like up to 8+ hours) Other than this, is there any other difference between the 2?

Do you feel different on each of them? For me, with RitalinSR, the effect was fairly quick, peak action within 2 hours, but would wear off usually within 4 hours. The good thing though, was that I would get tired in the afternoon/early evening and sleep really really well. If I were to go on Concerta, would it wreck my sleep schedule?

 

I much preferred regular Ritalin. 10 mg every 2 hours was the best (7 times/day). With 54 mg concerta, I still needed to supplement with two 10 mg tabs). And it didn't lift my mood all that much. It used to make me very sleepy, but doesn't work that way any more, unfortunately. Adderall Worked much better on my mood, but only in extremely high doses (35 mg at a time) that were obviously not a real option.