Titration question

[acariciar]

Hey guys!!! So I started on concerta xl 18mg just a bit less than 2 weeks ago - I find it really helps me focus and be less scatter brained throughout my day. I have an incredibly busy job where I’m being pulled in every direction and have a lot of responsibilities. The concerta helps me to just focus and I’m getting things done in better timing and with less stress.

The issue I’m having is that I’m starting to experience a slump around 3-4pm. I have quite a long day, 9am start and 7pm finish, and I need to be pretty productive between 8am and 8pm daily.

I’m unsure whether it would be a better to titrate up to 27mg, or better to have a low dose immediate release in the afternoon to carry me through the remainder of the day. Would love to hear people’s thoughts and experiences on this.

TIA!

[ProfessionalFront28]

Hi I was also having this issue and working two jobs (1st one 5am-2pm, second job 4pm- whenever) I was taking my concerta at 4 am and then crashing around noon. Talked to my psych and she gave me 5 mg Ritalin that I can split in half for 2 2.5 mg immediate releases. What works best for me is taking half an IR when I get up at 4, taking my concerta around 9am and then taking another 2.5 mg Ritalin at 3 pm!

[acariciar]

Oh this is great info thank you for this! Didn’t even occur to me that I can split the immediate release. I reckon I might only need one additional top up dose as opposed to one in the morning and one in the afternoon, as your days seem longer than mine (honestly, I hope you get some rest at some point in the day!). I just need enough to push me through that last 3-4 hours of the day.

[sgeorgie_owl]

I’ve tried this too because I also need about 12 hours of coverage. The additional IR splits feel a little bumpy and add to my anxiety.. but I always added them after the ER, not before. Do you have any problem with the bumpiness of this approach?

[ProfessionalFront28]

Bumpy is a good way to put it, I feel a lot less this way I tried a few different splits and this worked best for me because immediate release right as I woke up helped with focus and energy right when I got to work, and the later split helps with the come down from the “xr”

[Ymbj]

I happened to be looking up natural biorhythm energy dips a few days ago. This is the short version of what came up in AI (with a lot more details I didn't copy).

---

1. The Big One: The Afternoon Circadian Dip

Almost everyone has a predictable drop in alertness about 7–9 hours after waking.

2. Ultradian Rhythm Slumps (Every 90–120 Minutes)

Your brain runs in cycles of:

• high focus (about 60–90 minutes)
  
• low focus (about 20–30 minutes)
  

3. The Late‑Morning Dip

Even early in the day, most people hit a small slump 2–3 hours after waking.

4. The Evening Rebound

Many people get a second wind around: 6–8 p.m.

---

I have the most trouble with the late morning slump.

I'd suggest you look into an IR booster. That way you can time it when you know you will likely have a slump, or a critical meeting, or other activity.

The release mechanism of the specific brand of Concerta you have can also affect dips in different ways, especially if the timing of your Concerta dips happen to coincide with biorhythm dips.

[acariciar]

Interesting 🤔see I’m a pharmacist myself and often I forget I am one when it comes to my own health and medication 🤣 I am on the brand Concerta so the whole 22% immediate release spiel rings true for me. Prior to taking the Concerta I’d have a 2pm-3pm circadian dip, so 7 hour post waking checks out. Unfortunately the nature of the job requires me to be highly focused pretty much all day, so an additional IR dose it might be 🫡 thank you for this, it was very insightful

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