Expert: Dr Billy Levin - 1/12/2012

Question
Hi - I had no problem with an 18-mg dose of Concerta for the first week - in fact, I seemed calmer and easier to be around, etc. (but this may have been the 'Placebo Effect').  

I then asked for, and received, an Rx to 36-mg Concerta.  It was very expensive (I am in Thailand).  

The first two days on the 36-mg dose were okay.  But sometime during the afternoon of the third day, I went berserk. It was like I had just drunk 10 espressos. I had dry mouth, an anxious feeling, a total incapability to deal with anything, and each night, I could not fall to sleep until the sun came up the next morning.
My questions:  
(1)  Is there data to indicate that these side-effects may have gone away after a week or two?  (I called Janssen, they spit out a lot of statistics, but didn't help me at all with my questions.)

(2)  Is this reaction unusual?  (Especially considering the fact that I had two good days on the higher dosage.)

(3)  Should I wait a couple of weeks and try it again (under my dr's supervision)?

This has been devastating, really, because it exasperated my symptoms instead of helping me (understatement).

I am really not in a position to buy another round of 18-mg Concerta right now.  I am stuck with these 36-mg pills if I don't use them.  Concerta is very controlled here in Thailand - and only available directly from the hospital.

One thing, I slept for a full day after getting off of them.  Only then did I get my sanity back.  Maybe I had a sleep deficit in the first place (?) - i.e., if I were to take them again when I was in good health and rested, maybe I wouldn't have the same, bad reaction.  
Thanks for sharing any experience you might have with this medication that might help me decide what to do next.

Answer
Sadly, nothing you have stated makes any medical sense and without examining you it would be impossible to offer any good advice. Next, the dosis is not a guessing game and never just a simple request from a patient for a bjgger dose.  An optimal dose is essential and is titrated by an experienced doctor using monitoring systems like the Conners rating scale. As the medication fades within 12 hours a dose in the morning cannot keep you awake for so many hours. If there was no unacceptable reaction for the first 2 days it is unlikely to suddendly have a  NEGATIVE  reaction on the 3rd day especially your reaction happened when the dose was fading. An overdose makes you more inhibited. My advice is see a medical expert to not only diagnose and treat correctly but fully inform you of all the aspects. That you had to ask the people who market the product and who are not experts in management and treatment, suggests the doctor did not fully inform you. Are you on any other medications? What is the official diagnosis? What time did you take the medication?