ADHD med question-Focalin

[petesgirl]

My son is 11 yrs old and I have decided it is time to start ADHD meds. He has done OK in school so far, but 6th grade is starting off a bit rough and I just think he needs the help. His Dr prescribed Focalin 24 hr Extended Release, 20 mg capsules. Does this seem like a normal starting dose? From what I've been reading elsewhere it seems high to start at 20 mg and I am really worried that the 24 hr ER is going to affect his sleep--he already has a hard time settling at night. He is on the shorter and thinner side of boys his age, for reference. Most sources I've been looking at say to start at 2.5 mg and titrate up with 20 mg being the max pediatric dose. Thoughts please?

[o_mom]

I thought Focalin only came in regular (immediate release) and XR (extended release)?

https://www.additudemag.com/adhd-med...nonstimulants/

I think the 24hr may just refer to the dosing interval. The effectiveness of the XR is 8-12 hrs. It still may interfere with sleep, though. 20mg is right in the middle of the range for the XR, and the doctor may be going by experience on what dose works for similar patients.

[petesgirl]

I thought Focalin only came in regular (immediate release) and XR (extended release)?

https://www.additudemag.com/adhd-med...nonstimulants/

I think the 24hr may just refer to the dosing interval. The effectiveness of the XR is 8-12 hrs. It still may interfere with sleep, though. 20mg is right in the middle of the range for the XR, and the doctor may be going by experience on what dose works for similar patients.

I should ask about that. It says "24 hr Extended release" on the drug info sheet.

[gatorsmom]

De3 tried Focalin but it made him very emotional. He’d get mad and couldn’t get past it and became bitter, difficult and on a few occasions full of rage. It just wasn’t the best fit for him. But I know several kids who take it and love it. He takes Concerta now.

If you otherwise like and trust your doctor, I would give that dosage a try. If he’s starting your ds at a dosage that seems high, it may be because of his diagnostic testing or his size. Maybe your Ped feels your son’s saving you time from working up the dosage. It can be quite a long, slow process to give each dosage a try to find the right level. Or maybe that is the normal lowest dosage. I can’t remember what dosage we started with.

I wouldn’t worry too much about your Ds not sleeping. I’ve found that my ds3 actually falls asleep more easily when he’s had his medication later in the day so it’s still affecting him at bedtime. The meds make him more calm and focused so he’s able to relax and quiet his mind more easily. We’ve just increased his dosage and now he’s falling asleep studying with me at night! In the summers when we occasionally don’t give him his meds, he has a very hard tim calming down at the end of the day enough to fall asleep. He’s like a squirrel.

I hope you can find a dosage and ADHD medication that your ds loves without too many tries.

[lizzywednesday]

Focalin is contraindicated for my DD, so we've stuck with the usual Adderall XR (which works for her for focus, but not emotional regulation and you can tell when she's metabolized it because she gets extremely weepy) and Concerta (which is an extended release formulation of Ritalin?) She has fewer emotionally disruptive symptoms if she's had a full night's rest, which for DD means about 8 hours.

Figuring out how to time the dosage takes a little fiddling; for us, taking it about an hour before she has to be at school helps buy us time for the medicine to kick in before classes begin, and it's typically out of her system by about 6pm. If we dose her on weekends, we can give the medicine as late as 1pm with very little impact on her sleep, but I wouldn't recommend that for school days.

[AnnieW625]

Focalin helped DD2 focus better (it was the first medication she tried after being on Vyvanse for about 18 months), but it made her develop anxiety out of nowhere (she is still horribly afraid of shots….something she never had an issue with prior) and sometimes she would be just plain mean when she wasn’t on it. She was 8 and 9 when she was on it but I don’t recall the dosage. She is currently taking Concerta 27 mg and she says it is working (we have yet to get a progress report yet though). She has been on it since March or April, but she started on the lower dose 18mg dose then, and started the 27mg at the end of the school year. She has also taken Adderall, and Vyvanse; but tbh I am not sure how much of the Adderall she was actually taking because she would say she was swallowing the pills, but in reality she was holding them under her tongue and tossing them out (I started finding them when we started working from home due to covid and she would forget to flush the toilet or think I wouldn’t notice them in the trash). I think Concerta works the best and she doesn’t complain about it making her not feel right which she did with a few of the other medications.


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[carolinacool]

DS started on Focalin XR in third grade. I believe he started at 10MG and over the years went up to 20 MG. For the most part he did well on it, but the lack of appetite was becoming an issue for him. By the second half of 6th grade this spring, he was asking every day not to take it so that he could eat. Lowering the dosage didn't help, so we just switched to Strattera, which we are still figuring out. But at least he's eating.

I really liked Focalin, though. I agree that starting at 20MG doesn't match our experience. (DS is thin, but has always been slightly tall for his age.) However, he was at that dosage by 6th grade.

[bisous]

Can you follow up with the doctor? I don't think it is a good idea to compare different meds (like at all so don't get me wrong, lol!)...but DS3 (age 11 and VERY skinny) is at 20mg of a different stimulant (Metadate CD). He started at 10 mg though. I guess I'm questioning where you're getting the 2.5mg, as that might be on the very low side, but think the 20 might also be a bit on the high side? Maybe you can get the doctor's reasoning for the dosage. I will say too that the nice thing about stimulant meds is that if it is a truly disastrous dosage it can usually be seen quite soon! I'd follow up with the doctor and get his take. So maybe you can talk him into letting you try the 10mg (which carolinacool used successfully at first with her DS) with the idea that you could move it up to 20mg and just observe? Anyway, I'd correspond with the doctor if you can and propose that plan and see what he says! (I'm always careful to follow the advice of the doctor regarding psych meds!)

[o_mom]

Can you follow up with the doctor? I don't think it is a good idea to compare different meds (like at all so don't get me wrong, lol!)...but DS3 (age 11 and VERY skinny) is at 20mg of a different stimulant (Metadate CD). He started at 10 mg though. I guess I'm questioning where you're getting the 2.5mg, as that might be on the very low side, but think the 20 might also be a bit on the high side? Maybe you can get the doctor's reasoning for the dosage. I will say too that the nice thing about stimulant meds is that if it is a truly disastrous dosage it can usually be seen quite soon! I'd follow up with the doctor and get his take. So maybe you can talk him into letting you try the 10mg (which carolinacool used successfully at first with her DS) with the idea that you could move it up to 20mg and just observe? Anyway, I'd correspond with the doctor if you can and propose that plan and see what he says! (I'm always careful to follow the advice of the doctor regarding psych meds!)

2.5 is the lowest dose of the immediate release version of Focalin, which is probably where OP saw it. Focalin XR is available from 5-40 mg in 5 mg increments. 20 mg is higher than the suggested starting dose, but it is right in the middle of the range.

[WatchingThemGrow]

My 90lb 13yo is on 15mg of Focalin XR. He's still playing Formula 1 games and watching YouTube in school. Could you put in a call and ask for a slightly lesser dose as you're worried about sleep? Mine has no worries with sleep as he's doing XC and swim...and he loves sleep. It has taken forever to get up to this dose, so I'd be thankful they didn't say 5mg for 3 mos, then 10 for 3 mos.