What to Do When Concerta Isn't Working Mid-Prescription
Do not wait for the 30-day supply to run out—increase the dose immediately, as Concerta 18mg is a starting dose, not a therapeutic endpoint, and over 70% of patients require dose optimization beyond 18mg to achieve maximum benefit. 1
Understanding Why 18mg Often Fails
The critical issue is that 18mg is designed as an initial dose for stimulant-naive patients, not a therapeutic dose. 1 The landmark MTA study demonstrated that systematic titration across multiple dose levels resulted in over 70% of children and adolescents responding optimally to methylphenidate, while patients receiving "community treatment as usual" without proper titration showed significantly less beneficial results. 1
Immediate Action: Titrate Up Now
Increase the dose in 9-18mg increments weekly until maximum benefit is achieved, intolerable side effects emerge, or maximum dose is reached. 1 The proper titration sequence is:
- Next step: 27mg 1
- Then: 36mg if further titration needed 1
- Continue weekly increases until optimal symptom control 1
The goal of titration is reducing core symptoms to or close to the levels of individuals without ADHD, which typically requires doses higher than 18mg. 1 Before considering medication failure or switching agents, ensure adequate titration to higher Concerta doses (36-54mg) has been attempted. 1
Why You Shouldn't Wait
Methylphenidate shows first-dose efficacy, with behavioral effects appearing rapidly within 30 minutes to 1 hour after taking Concerta. 1 This means you can assess response to each dose increase within days, not weeks. 2 Systematic titration can be accomplished rapidly on a 7-day basis. 1
The unused 18mg tablets are not wasted—they represent an inadequate trial that needs correction through proper dose optimization rather than passive waiting.
Key Clinical Caveat
Dose response is highly variable and unpredictable between individuals, and calculating dose based on mg/kg has not been helpful. 1 This is why systematic titration is necessary rather than assuming any single dose will work. 1
For Adults Specifically
The average therapeutic dosage for adults is 20-30mg daily of immediate-release methylphenidate (roughly equivalent to Concerta 36-54mg), with a maximum recommended dose of 60mg daily. 1 Adult titration follows the same weekly increment schedule. 1
Common Pitfall to Avoid
Do not assume treatment failure and switch medications prematurely. 2 Ensure adequate dose titration over 4 weeks before declaring treatment failure. 2 The evidence shows that methylphenidate improves ADHD symptoms with small-to-moderate effects when properly dosed. 3, 4