my brother started taking CONCERTA for ad/hd a week ago. he told me today that his HEARTBEAT has been different for the last FEW DAYS--not quite pounding, but he can feel it, and his pulse seems to be sped up.I told him about the dangers, but HE REFUSES

	Asked by askmeddoc (Male; 27; ad/hd; healthy; no known heart defects; minimal family history of heart problems; Relevant drugs:concerta 56 mg; prozac 10 mg; seroquel 8-16 mg (stopped a few days ago) ) on Mon 19, Oct 2009 02:34am
	my brother started taking CONCERTA for ad/hd a week ago. he told me today that his HEARTBEAT has been different for the last FEW DAYS--not quite pounding, but he can feel it, and his pulse seems to be sped up. I told him about the dangers, but HE REFUSES TO SEE A DOCTOR. concerta has been a miracle drug for him. he's afraid he will not be able to try other stimulants. he said that strattera is not effective for everyone and not as effective as stimulants when it does work. he's also afraid he won't be able to try it either. he fears being left with no medication. he's been barely functional for years without it. what can i tell him? will he be able to try other stimulants? how can i prove it to him? he's 27, healthy, has no known heart defects. the only history of defects in our family is our dad's afib. thank you worried, denver
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	Answer by Dr Bhupinder K, MD (doctor) on Mon 19, Oct 2009 04:42am: Hello, Welcome to the AMD forum. I can understand your concern for these kind of symptoms that your brother is having. The symptoms are an indication of the side effect of the drug, Concerta(methylphenidate extended release tablets). It is a central nervous system stimulant which is used for the treatment of ADHD in adults. But tachycardia (increased heart rate) and palpitations (awareness of one’s own heart beat) are common side effects of this drug. Moreover it has psychological drug dependence as well as withdrawal effects. So careful supervision is required during withdrawal from abusive use since severe depression may occur. Now I agree that for adult ADHD , CNS stimulants are the main treatment, but Straterra which is a selective norepinephrine reuptake inhibitor has been approved by FDA as a non stimulant used in the treatment of adult ADHD. Antidepressants are the second choice of medications for adult ADHD. My sincere advice would be to consult a psychiatrist and discuss these medicines with him. We cannot stop Concerta suddenly as the dose needs to be tapered off very slowly and gradually. This is to be compensated with other medicines some of which I have described. This should be done under a psychiatrist’s guidance and observation. I sincerely hope it helps. Take care and please do keep me posted in case you’ve any additional doubts. You can get the information from the following website : http://www.rxlist.com/concerta-drug.htm
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	Comments: Response by Dr. A. Srivastava on Tue 20, Oct 2009 01:15am: Hi Denver, I completely agree with the valuable suggestions made by Dr. Bhupinder about Concerta & Strattera. Firstly, Concerta/Strattera is used as part of a comprehensive treatment program for ADHD, and whichever needs to be prescribed should be decided after assessment of the treating doctor only. Although, both the drugs have few side effects (eg. increase in heart rate), but I am sure that your brother’s doctor has a valid reason for prescribing Concerta. Despite the fact that this medicine has no contraindication to its use in family history of heart diseases, but it should be used with caution in hypertensive patients. In addition, treating doctor has to decide, if there has been no improvement in the symptoms after one month of treatment with the Concerta, it could be stopped. Even if the symptoms are improving, the medicine should be stopped from time to time, usually at least once a year, so that the condition can be assessed, and to check if the medicine is still needed or not. However, in both the cases, this medicine must not be stopped suddenly without the doctor's advice, as this could reveal symptoms such as over-activity and depression. In addition, before stopping the treatment, medicine should be withdrawn gradually as well as need to follow the instructions given by the treating doctor. Hope this helps. Please do keep us informed for your additional queries/doubts. Take Care & Regards.
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