CONCERTA 27MG TABS 30S

Concerta (methylphenidate HCl 18 mg) is a once-daily extended-release formulation of methylphenidate, a central nervous system stimulant indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children (6 years and older), adolescents, and adults. Concerta uses the OROS (Osmotic Controlled-Release Oral delivery System) technology, which delivers approximately 22% of the dose immediately and the remaining 78% over the following 8–10 hours

This provides a smooth, sustained plasma concentrations throughout the school or working day while minimising the peaks and troughs associated with immediate-release formulations.

Methylphenidate acts as a CNS stimulant by blocking the reuptake of dopamine and norepinephrine into presynaptic neurons, thereby increasing their concentrations in the synaptic cleft, particularly in the prefrontal cortex.

The 18 mg dose is the starting dose for Concerta, with titration based on clinical response. Concerta tablets must be swallowed whole, crushing, chewing, or splitting destroys the controlled-release mechanism and delivers the full dose immediately, which is both less effective and potentially dangerous.

Concerta is taken orally once daily in the morning, with or without food. The tablet must be swallowed whole, do not crush, chew, split, or dissolve. The tablet shell does not dissolve and may appear in the stool; this is normal.

Children (6–12 years) and Adolescents (13–17 years), Not Previously on Methylphenidate

•     Start: 18 mg once daily in the morning.

•     Titration: Increase in 18 mg increments at weekly intervals based on response and tolerability.

•     Maximum dose: 54 mg/day in children 6–12 years; 72 mg/day in adolescents 13–18 years.

Adults, Not Previously on Methylphenidate

•     Start: 18–36 mg once daily in the morning.

•     Titration: Increase in 18 mg increments at weekly intervals.

•     Maximum dose: 72 mg/day in adults.

Switching from Immediate-Release Methylphenidate

•     Patients on 5 mg 2–3 times daily → Concerta 18 mg once daily.

•     Patients on 10 mg 2–3 times daily → Concerta 36 mg once daily.

•     Patients on 15 mg 2–3 times daily → Concerta 54 mg once daily.

Clinical Notes

•     If no benefit is seen after 1 month at an appropriate dose, discontinue and reassess the diagnosis.

•     Periodic treatment-free trials may be considered to assess continued need.

•     Monitor height and weight in children at every follow-up, stimulants may temporarily suppress growth.

Side effects vary in frequency and severity. Not every patient will experience all listed effects. Seek immediate medical attention for any serious or unexpected reactions.

•     Cardiovascular risk: Screen for personal and family history of sudden death, cardiac disease, or arrhythmias before initiating. Monitor heart rate and blood pressure at baseline and during treatment.

•     Abuse and dependence: Methylphenidate is a Schedule II/IV controlled substance. High abuse potential. Prescriptions should be for short periods; monitor for signs of misuse or diversion.

•     Psychiatric effects: May cause or worsen psychosis, mania, or aggression. Assess for psychiatric comorbidities before starting.

•     Growth: Long-term stimulant use may reduce growth velocity in children. Monitor height and weight regularly. Consider drug holidays during growth periods.

•     Seizure threshold: Use with caution in patients with epilepsy. Although Concerta rarely lowers seizure threshold, monitor for any change in seizure frequency.

•     MAOIs: Concurrent use is absolutely contraindicated; allow 14 days after stopping an MAOI before starting methylphenidate.

The following interactions are clinically significant. Always inform your healthcare provider of ALL medicines, supplements, and herbal products you are taking.

•     MAO inhibitors: Contraindicated, risk of hypertensive crisis and serotonin syndrome.

•     Antihypertensive agents: Methylphenidate may reduce the effect of antihypertensive drugs.

•     Vasopressor agents: May potentiate pressor effects.

•     Coumarin anticoagulants (warfarin): Methylphenidate may inhibit warfarin metabolism; monitor INR.

•     Anticonvulsants (phenobarbitone, phenytoin, primidone): Methylphenidate may inhibit their metabolism; monitor plasma levels.

Store at 25°C; excursions permitted to 15–30°C. Store in the original, child-resistant container. Keep away from heat, moisture, and light. This is a controlled substance, store in a secure, locked location.

Concerta 18 mg is a Schedule IV controlled substance. At dispensing, counsel caregivers and patients that the tablet must be swallowed whole without alteration to the OROS shell. Verify that a pre-treatment cardiac evaluation has been documented. Screen for concurrent MAOIs (absolute contraindication). Monitor for signs of diversion or misuse, particularly in adolescent and adult patients. Growth parameters (height, weight) should be recorded at each dispensing encounter for paediatric patients. Pharmacists should note that the tablet shell may be found intact in the stool, this is normal and does not mean the drug was not absorbed.

Q1: Why must the Concerta tablet be swallowed whole?

A: Concerta uses a special technology that releases the medicine slowly over 10–12 hours. Crushing or splitting the tablet destroys this mechanism and releases the full dose at once, which can cause harmful effects and the medicine will not last the whole day.

Q2: How soon will Concerta start working?

A: The effect begins within 1–2 hours of the morning dose and lasts approximately 10–12 hours, covering the school or work day. Unlike atomoxetine, methylphenidate works the same day.

Q3: My child does not want to eat lunch since starting Concerta, is this dangerous?

A: Appetite suppression is the most common side effect of methylphenidate and typically affects lunchtime appetite when the drug is at peak effect. Encourage a good breakfast before the dose and a nutritious dinner. If weight loss is significant, consult your doctor who may adjust the dose or timing.

Q4: Is Concerta addictive?

A: Methylphenidate has abuse potential, particularly when misused (crushed and inhaled, or taken in higher doses). When used as prescribed by a doctor, the oral extended-release form has low addiction risk. However, it must be kept securely and not shared.

Q5: Will my child always need ADHD medication?

A: Not necessarily. Some children grow out of ADHD symptoms by adolescence, while others continue to need support into adulthood. Periodic evaluation of continued need (including drug holidays) is recommended to assess whether ongoing treatment is still necessary.