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How Much Ritalin Is Enough?
Q:
"I'm 39 and started taking Ritalin 2 weeks ago. I have been trying to find the right dose to take during the day. I feel better with a higher dose (15-20 mg every four hours), because a lower one gives me a headache. What should I do? How does someone determine the right dose of Ritalin?" 
A:
ADDitude AnswersThe goal with Ritalin is to find the dose that helps the most with no side effects. The dose is not based on age or body weight. It is based on how quickly each person metabolizes the medication. Thus, it appears that 15 or 20 mg every four hours may be best for you. If this dose is working with no side effects, it might be the plan to stay on.
Posted by Larry Silver, M.D. A Reader AnswersDosage is an individual thing—not merely based on body weight and size. Many people don’t realize this and end up taking too much, or too little, to be truly effective. In one of the Webinars ADDitude aired last fall, I believe, the MD stated that an adequate dose should be just enough to help, but not so much as to “feel the rush” when it “kicked in.” And, importantly, the right dose should not be so high as to prevent you from falling asleep. All of this was news to me at the time. It turned out that I was taking far too much Ritalin — enough to provide the rush so I would know it was “working” — but that was actually too much to provide the desired attentiveness and focus. In reality it was making me “wired,” less focused and productive than the lower dosages I now use. I know this doesn’t solve your problem, but I know that what I ultimately realized was best for me was very different from the initial recommended dose. Hopefully your doctor is monitoring your levels and their effects rather than just refilling Rxs. Posted by ladd A Reader AnswersCurrently I take generic Ritalin 20mg three times a day, so I take the max. I love it; it’s worked the best for me out of all the ADHD medication I’ve tried (except for Focalin XR, a long-acting form of Ritalin). I hope you can find a dose that works for you. Adderall would give me energy the first few times I would take it, but after I found it would just make me hyperfocus — and on the wrong things, of course. Ritalin actually calms me down a lot (almost like an anti-anxiety medication) and I can focus on whatever I put my mind to. I used to have to switch between Adderall and Ritalin quite often because I would build up a tolerance, but shortly after the Adderall shortage, I switched back to Ritalin and have been on it ever since. Posted by LittleD1981 A Reader AnswersTrial and error is really the only path to finding the right medication and dosage for you. Essentially: try this med, see how it works... adjust the dosage, see how it works... go to a different med, see how it works, adjust the dosage... observe... on and on... If you have a good psychiatrist, then all you need to do is report the symptoms of the behavior to him and he will initiate change if the med isn’t working. Posted by Phillyman A Reader AnswersI take 10mg of Ritalin 2x/day, 3 times if I really need to concentrate — like if I’m driving home for 3 hours in the evening. More than that caused chest pain for me. This dose helps with focus, but I am still slightly distractible. If there’s anxiety in my life, I have to increase the dosage. Posted by whizinc A Reader AnswersHere are my thoughts based on my experiences, though I’m not a doctor, so take my input with a grain of salt. Ritalin (the stimulant methylphenidate) comes in two forms, short acting (3-4 hours), and long (8+). Long is the same as short-acting mainly, but the pill slowly releases the drug. The drug usually takes about a week or so to get used to. The amount of drug that you need is particular to you, you may need 10mg a day, or 70+. You and your doctor will probably try different stimulant types, dosages, and track your improvements, concerns, and side-effects. The benefits or effects can range from life-changing (for the better) to a sorry disappointment. You can lose your appetite but you should be able to pay attention. You may finally feel ‘normal’ or you may feel like you drank 25 bad espressos — if you feel the latter, go back to your doctor. My doctor approved my taking Concerta (long-acting methylphenidate) as an alternative to the generic drug which has worked great for me. I always felt horrible when coming down from the short-acting medications. However Concerta can be very expensive if your insurance doesn’t cover it, so it’s not a possibility for everyone. In any case, best of luck with your experimentation! Posted by michael:affectfocus.com A Reader AnswersDifferent medications work differently for every person based on many factors, including the food you eat (and when), other drugs you take, your metabolism, how much exercise you get, and even the job you do. As you can see by the replies, everyone is different. Experiment with your dosage, but carefully. Increases are done slowly so that you have time to identify problems and cut back the amount. Take the time and get things right — it’ll be worth it in the long run. Posted by Augie Curious about how dosage for ADHD medication like Ritalin is determined? You might like: Medication Mistakes Even Doctors Make 7 Rules for Using ADHD Medications Safely
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9 Rules for Using ADHD Meds Safely
Larry Silver, M.D., is clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. and director of training in child and adolescent psychiatry at Georgetown University School of Medicine. He is a former acting director and deputy director of the National Institute of Mental Health, as well as the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities.
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