New Medication For ADHD: Concerta™A major emphasis in pharmaceutical research recently has been delivery systems of medication. In other words, how do we get the medication to where it works in the body at the dosages that are most effective for the patient? The F.D.A. has just approved one of Alza Pharmaceuticals’ medications named Concerta, a methylphenidate extended-release capsule for ADHD in patients six or older. For the past year I have been involved in the research using Concerta and would like to share my knowledge and experiences. This medication uses the OROS patterned-release delivery system. The OROS system has been used safely for 20 years in widely accepted prescriptions and over-the-counter medications, including medications taken by children. The OROS system provides more controlled therapeutic drug levels in the blood throughout the dosing period. Therefore, it solves a major problem of Ritalin (methylphenidate) and Dexedrine immediate release compounds. The two medications usually only last 4 hours and create peaks and troughs in the blood levels, thereby requiring multiple doses during the day. Children are sometimes embarrassed by having to go to the nurse during the school day to take their medication. Some patients have problems with this up and down effect, particularly those who are prone to rebound or who quickly metabolize the medication and do not get the full 4 hours effect. There are sustained release forms of methylphenidate (RitalinSR, MetadateER, MethylinER) but the release and absorption rates vary in different individuals and are dependent on foods in the stomach. There is an immediate-release methylphenidate drug overcoat, which starts to act immediately. When the capsule hits the stomach, fluid is drawn into the capsule and dissolves the drug in the core. The drug is then released through a laser-drilled hole at the controlled rate. This medication has a mechanical release and, therefore, is not affected by what a person has eaten. The research data shows that Concerta lasts for twelve hours without much variation between individuals and therefore allows once daily dosing. The side effects were similar to methylphenidate and Dexedrine except for the rebound issues. Adderall is also a long acting stimulant but uses a mixture of amphetamine and Dexedrine salts. In my experience, some patients metabolize Adderall rapidly and, therefore, require multiple doses per day. It will be interesting to see research comparing Adderall to Concerta, but that has not been done scientifically as of yet. I have asked both companies if they would like to support the Tarnow Center to carry out this research. I have not received a definitive answer but I will keep you informed.
Jay D. Tarnow, M.D. Diplomate of the American Board of Psychiatry and Neurology Certified in General Psychiatry and Child and Adolescent Psychiatry Clinical Associate Professor of Psychiatry – University of Texas Medical School at Houston The Medication Corner, provided by the Tarnow Center for Self-Management, will be a featured article in each of the ADDA Newsletters. The article will provide you with the latest information and research about the medications which are being used to treat Attention Deficit Disorder. Jennifer McKay, M.D. and Jay Tarnow, M.D. will keep you abreast of all the latest happenings in the medical community. In order for us to address your needs,we would like to encourage you to “ask the professionals” your questions. Write the Tarnow Center for Self-Management with your questions and we will see that they are answered in each edition of the newsletter. You may contact us at: Tarnow Center for Self-Management: The Medication Corner, 1001 West Loop South #215, Houston, Texas 77027, or fax: (713)621-7015, or call: (713)621-9515. Visit the
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