Question: I have been taking methylphenidate for quite a long time and I am having trouble with the short wash out time. My doctor gave me an rx for Methylphenidate ER and it has no stimulant result. In fact, I fall asleep very soon after my dose. What do you think is happening? I would also like to know about Concerta. It is my understanding that it is a longer acting form of methylphenidate. I would like to know the general information, manufacturers, availability and cost.

Dear Dr. Saatiish Jhuntrraa: I'm sure in India the spelling of your name is not unusual. But I don't think I have ever seen so many double letters. I have been to India, and found it to be a lovely spiritual place. I am sad for all the poverty, but visiting your country was a highlight in my life. You asked about why I take methylphenidate. I received a bipolar diagnosis 25 years ago and have taken a long list of medications and combinations over the years. Some of them do not work at all, some have too many side effects, some work for a while then stop working, some work only in tandem with another drug, etc. And when you finally get a cocktail that seems to work for the most part, you don't want to tweek it too much even though the process of adding one on top of the other likely produces at least one, maybe more, of the cocktail that are not really helping. You are just really glad that you are finally feeling better and more able to be active in your life. I am sure you have probably treated people like me who over the course of many years can end up with unusual combinations of medications that have occurred over time but for some unknown reason seem to do the job. I take Parnate and Celexa for their antidepressant properties and Hytrin for excessive sweating. I take Trazodone, Restoril, and Seroquel for sleep, and Klonopin for periodic anxiety. The last 4 are taken at night, and have come about as a group over time. I have trouble falling asleep, staying asleep and waking too early. This combination finally seems to work at least for the time being. Over the years nearly every group of meds for sleep have left me groggy in the morning. The methylphenidate was added a long time ago to combat the lethargy I was having in the morning as well as throughout the day. The doctor added Methylphenidate to help me become more alert and able to accomplish activities throughout the day. It was a miracle to be able to get out of bed and be active again. When the short acting dose taken in the morning wears off I lose energy so I take a second dose at noon. Over time the 20 mg dose twice a day seemed to lose it's potency and the doctor increased the dose to 40mg twice a day. This dosage was effective for quite a long time but recently I started getting groggy again before the next dose was due and I lost complete energy by about 5pm. It is difficult to maintain a reasonable activity level when the positive effect of the standard 20mg tabs of methylphenidate ends so quickly. Two weeks ago the doctor and I discussed the possibility of using Methylphenidate ER capsules rather than increase the dosage of the standard form I had been using. Neither one of us had any reason to think I would experience such an unacceptable response. He is out of town for a while and I am making this inquiry in his absence. The Methylphenidate ER capsules do not have a stimulating effect. Instead, I experience an intense sedating effect shortly after I take each dose. I actually fall asleep for 1 to 2 hours, wake up groggy and stay that way throughout the day. Do you have any insights or ideas on why one form of Methylphenidate would have such a vastly different effect than another. With the standard 20mg methylphenidate, even when the stimulating effects are gone, I am tired but I am never able to sleep without help. It makes no sense to me that a drug that is listed as having the same stimulant properties would be seriously sedating. I would be very grateful to hear any insights or ideas about the possibilities of this very unexpected response I'm having, and any advice you might have that could get me through the next few weeks. Thank you for the other information you offered on Concerta. Maybe it will be a more successful solution to the drowsiness my other medications seem to cause. Regards, XXXX

Thank you, Dr. Jhuntrraa: Your comments make some sense to me and I very much appreciate the explanation. I will review my medications with my doctor when he returns. Regards, XXXX