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You can buy concert methylphenidate online from our dispensary by placing an order through the checkout process. CONCERTA®(methylphenidate HCl) Extended-release Tablets CII is a prescription medication approved for the treatment of attention deficit hyperactivity disorder (ADHD) as part of a total treatment program that may include counseling or other therapies.

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 The pharmaceutical form of Concerta Methylphenidate

CONCERTA is available as an extended-release tablet for once-a-day oral administration containing 18, 27, 36 or 54 mg methylphenidate hydrochloride. It is design to have a 12-hour duration of effect.

CONCERTA 18 mg are yellow capsule-shape tablets, with “alza 18” printed in black ink on one side. It’s 36 mg are white capsule-shape tablets, with “alza 36” print in black ink on one side. It’s 27 mg are grey capsule-shape tablets, with “alza 27” print in black ink on one side. CONCERTA 54 mg are brownish-red capsule-shape tablets, with “alza 54” print in black ink on one side. Buy Concerta 18 mg Methylphenidate

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CLINICAL PARTICULARS OF CONCERTA METHYLPHENIDATE 

Should You Buy Concerta Methylphenidate Online, What are Therapeutic indications?

CONCERTA is indicate for the treatment of Attention Deficit Hyperactivity Disorder (ADHD).

A diagnosis of Attention Deficit Hyperactivity Disorder (ADHD; DSM-IV) implies the presence of hyperactive-impulsive or inattentive symptoms that cause impairment and were present before age 7 years.

Need for a comprehensive treatment program: CONCERTA is indicate as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, and social) for patients with this syndrome. Stimulants are not intende for use in the patient who exhibits symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis. However, Appropriate educational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician’s assessment of the chronicity and severity of the patient’s symptoms.

Long term use:

The effectiveness of CONCERTA for long-term use has not systematically evaluat in control trials. Therefore the physician who elects to use CONCERTA for extend periods. However, it should periodically re-evaluate the long-term usefulness of the drug for the individual patient

Dose and method of administration

CONCERTA is administer orally once daily and should be taken in the morning.
It must be swallow whole with the aid of liquids, and must not chew, divided, or crushed. CONCERTA may administer with or without food. Note that you should only buy concert methylphenidate online from a well recognized pharmacy.
Pre-treatment screening:

Prior to prescribing, it is necessary to conduct a baseline evaluation of a patient’s cardiovascular status including blood pressure and heart rate. However, a comprehensive history should document concomitant medications, past and present co-morbid medical and psychiatric disorders or symptoms, family history of sudden cardiac/unexplained death, and accurate recording of pre-treatment height and weight on a growth chart

Ongoing monitoring:
Growth, psychiatric and cardiovascular status should continuously monitored

  • Blood pressure and pulse should recorded on a centile chart at each adjustment of dose and then at least every 6 months;
  • height, weight, and appetite should recorded at least 6 monthly with maintenance of a growth chart;
  • development of de novo or worsening of pre-existing psychiatric disorders should monitored at every adjustment of dose and then least every 6 months and at every visit. Patients should monitored for the risk of diversion, misuse, and abuse of methylphenidate. However. Dose titration: Careful dose titration is necessary at the start of treatment with methylphenidate. Dose titration should starte at the lowest possible dose.DoseChildren (over 6 years of age) and adolescents: Dosage may adjusted in 9 mg increments between 18 mg and 36mg and consecutively in 18 mg increments to a maximum of 54 mg/day for children aged between 6-12 years and to a maximum of 72 mg/day for adolescents aged between 13-18 years. In general, dosage adjustment may proceed at approximately weekly intervals.

Adults:

  • Dosage can adjusted from an initial dose of 18 or 36 mg/day in 18mg increments to a maximum of 72mg/day taken once daily in the morning. In general, dosage adjustment may proceed at approximately weekly intervals. Patients respond at different dose levels and CONCERTA must titrated to effect on an individual patient needs and response basis. A maximum dose of 108 mg/day have included in clinical trials (see Clinical Trials). Patients New to Methylphenidate: So, the recommended starting dose of CONCERTA for patients who are not currently taking methylphenidate, or for patients who are on stimulants other than methylphenidate, is 18 mg once daily for children and adolescents and 18 or 36 mg once daily for adults. Patients Currently Using Methylphenidate: The recommended dose of CONCERTA for patients who are currently taking methylphenidate two or three times daily at doses of 10 – 60 mg per day is provide in Table 1.

 

Table 1: Recommended dose conversions from methylphenidate regimens to CONCERTA

Previous methylphenidate daily dose

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Recommend CONCERTA starting dose

5 mg methylphenidate three times daily

18 mg every morning

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10 mg methylphenidate three times daily

36 mg every morning

15 mg methylphenidate three times daily

54 mg every morning

page3image13232page3image13712

20 mg methylphenidate three times daily

72 mg every morning

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Clinical judgment should used when selecting the dose for patients currently taking methylphenidate in other regimens. Daily dosage above 54 mg is not recommend for children aged between 6-12 years. Daily dosage above 72 mg is not recommend for adolescents aged between 13-18 years.

Long-term (more than 12 months) use in children and adolescents:

The safety and efficacy of long-term use of methylphenidate have not systematically evaluated in controlled trials. Methylphenidate treatment should not and need not, indefinite. Methylphenidate treatment is usually discontinue during or after puberty. The physician who elects to use methylphenidate for extended periods (over 12 months) in children and adolescents with ADHD should periodically re-evaluate the long-term usefulness of the drug for the individual patient with trial periods off medication to assess the patient’s functioning without pharmacotherapy. It is recommend that methylphenidate is de-challenge at least once yearly to assess the child’s condition (preferable during times of school holidays). Improvement may be sustained when the drug is either temporarily or permanently discontinued.

Dose reduction and discontinuation:

Treatment must be stopped if the symptoms do not improve after appropriate dosage adjustment over a one-month period. If paradoxical aggravation of symptoms or other serious adverse events occurs, the dosage should be reduced or discontinued.

Special Populations

Use in Infants and children

The use of CONCERTA in patients under six years of age has not been studied in controlled trials. CONCERTA should not be used in patients under six years old.

Use in Elderly

The use of CONCERTA in patients over 65 years of age has not been studied in controlled trials.

Method of administration

CONCERTA must swallowed whole with the aid of liquids.

Tablets should not chewed, divided, or crushed.

The medication is containe within a nonabsorbable shell designe to release the drug at a controlled rate. The tablet shell, along with insoluble core components, is eliminate from the body; patients should not concerned if they occasionally notice in their stool something that looks like a tablet.

Contraindications Of Concerta Methylphenidate- Buy Concerta Methylphenidate Online

CONCERTA is contraindicate:

  • in patients with known hypersensitivity to methylphenidate or any inactive ingredient used in this product(see section 6.1 List of excipients);
  • during treatment with monoamine oxidase inhibitors, and also within a minimum of 14 days following discontinuation of a monoamine oxidase inhibitor (hypertensive crises may result);
  • in patients with hyperthyroidism;
  • Phaeochromocytoma;
  • Diagnosis or history of severe depression, anorexia nervosa/anorexic disorders, suicidal tendencies, psychotic symptoms, severe mood disorders, mania, schizophrenia, psychopathic/borderline personality disorder;
  • Diagnosis or history of severe and episodic (Type I) Bipolar (affective) Disorder (that is not well- controlled);
  • pre-existing cardiovascular disorders including severe hypertension, heart failure, arterial occlusive disease, angina, hemodynamically significant congenital heart disease, cardiomyopathies, myocardial infarction, potentially life-threatening arrhythmias and channelopathies (disorders caused by the dysfunction of ion channels);
  • pre-existing cerebrovascular disorders cerebral aneurysm, vascular abnormalities including vasculitis or stroke.

Special warnings and precautions for the use of concrete Methylphenidate

Use with caution in the following circumstances Depression and Psychosis

CONCERTA should not be used to treat severe depression or for the prevention or treatment of normal fatigue states.

The co-morbidity of psychiatric disorders in ADHD is common and should be taken into account when prescribing stimulant products. In the case of emergent psychiatric symptoms or exacerbation of pre-existing psychiatric disorders, methylphenidate should not be given unless the benefits outweigh the risks to the patient.

Development or worsening of psychiatric disorders should be monitored at every adjustment of dose, then at least every 6 months, and at every visit; discontinuation of treatment may be appropriate.

In psychotic patients administration of methylphenidate may exacerbate symptoms of behavior disturbance and thought disorder.

Treatment-emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in patients without a prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate.

Suicidal tendency

Patients with emergent suicidal ideation or behavior during treatment for ADHD should be evaluated immediately by their physician. Consideration should be given to the exacerbation of an underlying psychiatric condition and to a possible causal role of methylphenidate treatment. Treatment of an underlying psychiatric condition may be necessary and consideration should be given to the possible discontinuation of methylphenidate.

Also Read: Sk Stones USA

Forms of bipolar disorder

Particular care should taken in using methylphenidate to treat ADHD in patients with comorbid bipolar disorder (including untreated Type I Bipolar Disorder or other forms of bipolar disorder) because of concern for possible precipitation of a mixed/manic episode in such patients. Prior to initiating treatment with methylphenidate, patients with comorbid depressive symptoms should adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. Close ongoing monitoring is essential in these patients (see Depression and Psychosis above and section 4.2 Dose and method of administration). Patients should monitored for symptoms at every adjustment of dose, then at least every 6 months, and at every visit.

Tics and worsening of Tourette’s syndrome

Methylphenidate is associated with the onset or exacerbation of motor and verbal tics. Worsening of Tourette’s syndrome has also reported. It is recommend that the family history assessing and that the patient is clinically evaluated for tics or Tourette’s syndrome before initiating methylphenidate. Regular monitoring for the emergence or worsening of tics or Tourette’s syndrome during treatment with methylphenidate is recommende at every dose adjustment and every visit, and treatment discontinued if clinically appropriate.

Drug Dependence

Patients should be carefully monitored for the risk of diversion, misuse, and abuse of methylphenidate. CONCERTA should be given cautiously to patients with a history of drug or alcohol dependence. Chronic abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior.

Patient age, the presence of risk factors for substance use disorder (such as co-morbid oppositional-defiant or conduct disorder and bipolar disorder), previous or current substance abuse should all taken into account when deciding on a course of treatment for ADHD. Caution is called for in emotionally unstable patients, such as those with a history of drug or alcohol dependence, because such patients may increase the dosage on their own initiative.

high-risk substance

For some high-risk substance abuse patients, methylphenidate or other stimulants may not be suitable and non-stimulant treatment should be considered.

Careful supervision is required during withdrawal from abusive use since severe depression may occur. Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up.

Drug Screening

CONCERTA contains methylphenidate which may induce a false positive laboratory test for amphetamines, particularly with an immunoassay screen test.

Potential for Gastrointestinal Obstruction

CONCERTA tablet is non-deformable and does not appreciably change in shape in the GIT. It should not ordinarily be administered to patients with pre-existing severe GI narrowing (pathologic or iatrogenic) or in patients with dysphagia or significant difficulty in swallowing tablets. Due to the prolonged-release design of the tablet, CONCERTA should only be used in patients who are able to swallow the tablet whole.

Sudden Death and Pre-existing Structural Cardiac Abnormalities

Although a causal relationship has not been established, sudden death has been reported in patients with structural cardiac abnormalities treated with ADHD drugs with stimulant effects. These treatments should be used with caution in patients with structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant medicine.

Hypertension and Cardiovascular Conditions

Patients who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden cardiac or unexplained death or malignant arrhythmia,) and physical exam to assess for the presence of cardiac disease, and should receive further specialist cardiac evaluation if initial findings suggest such history or disease. Patients who develop symptoms such as palpitations, exertional chest pain, unexplained syncope, dyspnoea or other symptoms suggestive of cardiac disease during methylphenidate treatment should undergo a prompt specialist cardiac evaluation.

In the laboratory clinical trials in children both CONCERTA and methylphenidate, three times daily increased resting pulse by an average of 2 to 6 bpm and produced average increases of systolic and diastolic blood pressure of roughly 1 to 4 mm Hg during the day, relative to placebo. In placebo-controlled studies in adults, mean increases in resting pulse rate of approximately 4 to 6 bpm were observed with CONCERTA at endpoint vs. a mean change of roughly -2 to 3 bpm with placebo. Mean changes in blood pressure at endpoint ranged from about -1 to 1 mm Hg (systolic) and 0 to 1 mm Hg (diastolic) for CONCERTA and from -1 to 1 mm Hg (systolic) and -2 to 0 mm Hg (diastolic) for placebo. Therefore, caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate.

Cardiovascular status

Cardiovascular status should be carefully monitored. Blood pressure and pulse should be recorded on a centile chart at each adjustment of dose and then at least every 6 months.

The use of methylphenidate is contraindicated in certain pre-existing cardiovascular disorders unless specialist pediatric cardiac advice has been obtained

Misuse and Cardiovascular Events- Buy Concerta Methylphenidate

Misuse of stimulants of the central nervous system may be associated with sudden death and other serious cardiovascular adverse events.

Cerebrovascular disorders

Patients with additional risk factors (such as a history of cardiovascular disease, concomitant medications that elevate blood pressure) should be assessed at every visit for neurological signs and symptoms after initiating treatment with methylphenidate.

Cerebral vasculitis appears to be a very rare idiosyncratic reaction to methylphenidate exposure. There is little evidence to suggest that patients at higher risk can be identified and the initial onset of symptoms may be the first indication of an underlying clinical problem. Early diagnosis, based on a high index of suspicion, may allow the prompt withdrawal of methylphenidate and early treatment. The diagnosis should therefore be considered in any patient who develops new neurological symptoms that are consistent with cerebral ischemia during methylphenidate therapy. These symptoms could include severe headache, numbness, weakness, paralysis, and impairment of coordination, vision, speech, language, or memory.

Treatment with methylphenidate is not contraindicated in patients with hemiplegic cerebral palsy.

Priapism

Prolonged and painful erections requiring immediate medical attention (sometimes including surgical intervention, have been reported with methylphenidate products, including CONCERTA, in both pediatric and adult patients. Priapism can develop after some time on methylphenidate, often subsequent to an increase in dose. Priapism has also appeared during a period of methylphenidate withdrawal (drug holidays or during discontinuation). Patients who develop abnormally sustained erections or frequent and painful erections should seek immediate medical attention.

Cerebrovascular disorders

Cerebrovascular disorders (including cerebral vasculitis and cerebral hemorrhage) have been reported with the use of CONCERTA (see section 4.8 Undesirable effects). Consider cerebrovascular disorders as a possible diagnosis in any patient who develops new neurological symptoms that are consistent with cerebral ischemia during CONCERTA therapy. These symptoms could include severe headache, unilateral weakness or paralysis, and impairment of coordination, vision, speech, language, or memory. If a cerebrovascular disorder is suspected during treatment, discontinue CONCERTA immediately. Early diagnosis may guide subsequent treatment.

In patients with pre-existing cerebrovascular disorders (e.g., aneurysm, vascular malformations/anomalies), treatment with CONCERTA is not recommended.

Aggression, anxiety, and agitation

Aggressive behavior marked anxiety, or agitation are often observed in patients with ADHD and have been reported in patients treated with CONCERTA. Anxiety led to discontinuation of CONCERTA in some patients. It is recommended to monitor patients beginning treatment with CONCERTA for the appearance of, or worsening of, aggressive behavior, marked anxiety, or agitation.

Haematologic Monitoring

Periodic full blood count, differential, and platelet counts are advised during prolonged therapy.

Increased intraocular pressure and glaucoma

There have been reports of a transient elevation of intraocular pressure (IOP) associated with methylphenidate treatment. It is recommended to prescribe CONCERTA to patients with open-angle glaucoma or abnormally increased IOP only if the benefit of treatment is considered to outweigh the risk. Patients with a history of abnormally increased IOP or open-angle glaucoma, and patients at risk for acute angle-closure glaucoma (e.g., patients with significant hyperopia) must be closely monitored.

CONCERTA is not recommended in patients with acute angle-closure glaucoma.

Use in patients with renal impairment

There is no experience with the use of CONCERTA in patients with renal insufficiency. After oral administration of radiolabeled methylphenidate in humans, methylphenidate was extensively metabolize and approximately 80% of the radioactivity was excrete in the urine in the form of PPAA. Since renal clearance is not an important route of methylphenidate clearance, renal insufficiency is expected to have little effect on the pharmacokinetics of CONCERTA.

Use in patients with hepatic impairment

There is no experience with the use of CONCERTA in patients with hepatic insufficiency.

Use in children

The safety and efficacy of CONCERTA in children under 6 years old have not established.

Long-term use (more than 12 months) in children and adolescents: The safety and efficacy of long-term use of methylphenidate have not systematically evaluated in controlled trials. Methylphenidate treatment should not and need not, indefinite. Methylphenidate treatment is usually discontinu during or after puberty. Psychiatric disorders to monitor for are describ below and include (but are not limited to) motor or vocal tics, aggressive or hostile behavior, agitation, anxiety, depression, psychosis, mania, delusions, irritability, lack of spontaneity, withdrawal, and excessive perseveration.

The physician who elects to use methylphenidate for extended periods (over 12 months) in children and adolescents with ADHD should periodically re-evaluate the long-term usefulness of the drug for the individual patient with trial periods off medication to assess the patient’s functioning without pharmacotherapy. It is recommend that methylphenidate is de-challenge at least once yearly to assess the child’s condition (preferably during times of school holidays). Improvement may be sustain when the drug is either temporarily or permanently discontinued.

Growth:

Moderately reduced weight gain and growth retardation have reported with the long-term use of methylphenidate in children.

The effects of methylphenidate on final height and final weight are currently unknown and being studied.

Growth should monitored during methylphenidate treatment: height, weight, and appetite should be recorded at least 6 months with the maintenance of a growth chart. Patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted.

Use in the elderly

Methylphenidate should not used in the elderly. Safety and efficacy have not established in this age group.

Interactions with other medicines and other forms of interaction pharmacokinetic interaction:

It is not know how methylphenidate may affect plasma concentrations of concomitantly administered drugs. Therefore, caution is recommend at combining methylphenidate with other drugs, especially those with a narrow therapeutic window.

Methylphenidate is not metabolize by cytochrome P450 to a clinically relevant extent. Inducers or inhibitors of cytochrome P450 are not expecte to have any relevant impact on methylphenidate pharmacokinetics. Conversely, the d- and l- enantiomers of methylphenidate do not relevantly inhibit cytochrome P450 1A2, 2C8, 2C9, 2C19, 2D6, 2E1, or 3A.

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Use with drugs that elevate blood pressure

Caution is advise in patients being treat with methylphenidate with any other drug that can also elevate blood pressure (see also sections on cardiovascular and cerebrovascular conditions Special warnings and precautions for use)

Because of possible hypertensive crisis, methylphenidate is contraindicat in patients being treate (currently or within the preceding 2 weeks) with non-selective, irreversible MAO-inhibitors

Anti-hypertensive drugs

Methylphenidate may decrease the effectiveness of drugs used to treat hypertension.

Use with alcohol

Alcohol may exacerbate the adverse CNS effects of psychoactive drugs, including methylphenidate. It is therefore advisable for patients to abstain from alcohol during treatment.

Use with halogenated anesthetics

There is a risk of sudden blood pressure increase during surgery. If surgery is planne, methylphenidate treatment should not be used on the day of surgery.

Use with dopaminergic drugs

Caution is recommend when administering methylphenidate with dopaminergic drugs, including antipsychotics. Because a predominant action of methylphenidate is to increase extracellular dopamine levels, methylphenidate may be associated with pharmacodynamic interactions when co-administered with direct and indirect dopamine agonists (including DOPA and tricyclic antidepressants) or with dopamine antagonists including antipsychotics.

Use with serotonergic drugs

There have reports of serotonin syndrome following coadministration of methylphenidate with serotonergic drugs. If concomitant use of CONCERTA with a serotonergic drug is warrante, prompt recognition of the symptoms of serotonin syndrome is important. CONCERTA must discontinued as soon as possible if serotonin syndrome is suspecte.

Use with antipsychotic drugs

Because a predominant action of methylphenidate is to increase extracellular dopamine levels, CONCERTA may associated with pharmacodynamic interactions when co-administered with some antipsychotics. Caution is warrant in patients receiving both CONCERTA and an antipsychotic, as extrapyramidal symptoms could emerge when these drugs are administer concomitantly or when adjusting the dosage of one or both drugs.

Pharmacological properties of Concerta Methylphenidate

Pharmacodynamic properties

Pharmacotherapeutic group: centrally acting sympathomimetics: ACT code: N06BA04

Methylphenidate is a central nervous system stimulant. The mode of therapeutic action in Attention Deficit Hyperactivity Disorder (ADHD) is not know. However. Methylphenidate is thought to block the reuptake of noradrenaline and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.

Methylphenidate hydrochloride is the racemic mixture of d,l methyl α-phenyl-2-piperidine acetate hydrochloride. The d-isomer is pharmacologically more active than the l-isomer.

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Children

CONCERTA was demonstrate to effective in the treatment of ADHD, in children aged 6 to 12 years, in three pivotal studies. Studies 1 and 2 were single-center, double-blind, double-dummy, randomize, placebo and active-controlled, crossover comparisons (n = 64 and 70). Study 3 was a multicentre, 4 week, double-blind, double-dummy, randomise, placebo and active-controlled, parallel study (n = 282). The primary comparison of interest in all three trials was CONCERTA versus placebo.

The primary efficacy parameter for CONCERTA was the Inattention/Overactivity with Aggression (IOWA) Conners I/O subscale rated by the community school teacher. Statistically significant (p < 0.001) reduction in the Inattention/Overactivity subscale versus placebo was shown consistently across all three controlled studies for CONCERTA once daily.

SKAMP

Onset and duration of efficacy were assesse by the laboratory school teacher using the SKAMP (Swanson, Kotkin, Agler, M-Fynn, and Pelham) combine attention ratings for studies 1 and 2. The onset of efficacy was estimate to be 1.5 hours and duration continued through to 12 hours. Patients demonstrated higher productivity and greater accuracy during CONCERTA treatment.

Adults

Two double-blind, placebo-controlle studies were conducte in 627 adults age 18 to 65 years. The controlled studies compared CONCERTA administered once daily and placebo in a multi-center, parallel-group, 5-week, fixed-dose study (Study 4) (18, 36, and 72 mg/day) and in a multi-center, parallel-group, 7-week dose-titration study (Study 5) (36 to 108 mg/day).

Study 4

was a multi-center, double-blind, randomize, placebo-controlle, parallel-group, dose-response study (5-week duration) with 3 fixed-dose groups (18, 36, and 72 mg). Patients were randomize to receive CONCERTA administered at doses of 18 mg (n=101), 36 mg (n=102), 72 mg/day (n=102), or placebo (n=96). All three doses of CONCERTA were significantly more effective than placebo in improving CAARS (Conners’ Adult ADHD Rating Scale) total scores at the double-blind endpoint in adult subjects with ADHD.

Study 5

demonstrated the effectiveness of CONCERTA in the treatment of ADHD in adults aged 18 to 65 years at doses from 36 mg/day to 108 mg/day based on the change from baseline to final study visit on the Adult ADHD Investigator Rating Scale (AISRS). Of 226 patients who entered the 7-week trial, 110 were randomize to CONCERTA and 116 were randomize to placebo. However,  treatment was initiate at 36 mg/day and patients continue with incremental increases of 18 mg/day (36 to 108 mg/day) base on meeting specific improvement criteria with acceptable tolerability. At the final study visit, mean change scores (LS Mean, SEM) for the investigator rating on the AISRS demonstrate that CONCERTA was significantly superior to placebo.

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Absorption

Methylphenidate is readily absorbing. Following oral administration of CONCERTA to adults, the drug overcoat dissolves and plasma methylphenidate concentrations increase rapidly reaching an initial maximum at about 1 to 2 hours. The methylphenidate contained in two internal drug layers is gradually release over the next few hours. Peak plasma concentrations are achieve at about 6 to 8 hours after which plasma levels of methylphenidate gradually decrease. However, CONCERTA once daily minimizes the fluctuations between peak and trough concentrations associate with immediate-release methylphenidate three times daily. The extent of absorption of CONCERTA once daily is generally comparable to conventional immediate-release preparations given three times daily.

Following the administration of CONCERTA 18 mg once daily in 36 adults, the mean pharmacokinetic parameters were Cmax 3.7 ± 1.0 ng/mL, Tmax 6.8 ± 1.8 h, AUC∞ 41.8 ± 13.9 ngh/mL, and t1/2 3.5 ± 0.4 h. No differences in the pharmacokinetics of CONCERTA were note following single and repeate once-daily dosing indicating no significant drug accumulation. The AUC and t1/2 following repeate once-daily dosing are similar to those following the first dose of CONCERTA 18 mg.

Following administration of CONCERTA

In single doses of 18, 36, and 54 mg/day to adults, Cmax and AUC0-∞of d-methylphenidate were proportional to dose, whereas l-methylphenidate Cmax and AUC0-∞ increased disproportionately with respect to dose. Following administration of CONCERTA, plasma concentrations of the l-isomer were approximately 1/40th of the plasma concentrations of the d-isomer.

In healthy adults, single and multiple dosing of once-daily CONCERTA doses from 54 to 144 mg/day resulted in linear and dose-proportional increases in Cmax and AUCinf for total methylphenidate (MPH) and its major metabolite, (alpha)-phenyl-piperidine acetic acid (PPAA). The single-dose and steady-state (Day 4) clearance and half-life parameters were similar, indicating that there was no time dependency in the pharmacokinetics of methylphenidate. The ratio of metabolite (PPAA) to the parent drug (MPH) was constant across doses from 54 to 144 mg/day, both after single-dose and upon multiple dosing.

Pharmacokinetic equivalence

Pharmacokinetic equivalence has demonstrated for two 27-mg CONCERTA tablets with three 18-mg CONCERTA tablets. The mean values of the treatment ratio (2 x 27 mg fasted/3 x 18 mg fasted) of the log-transform pharmacokinetic values for Cmax, Tmax and AUCinf were 101.1%, 104.3%, and 100.3% respectively. The 90% CIs for the treatment ratios were within the pre-specified 80% – 125% range. In a multiple-dose study in adolescent ADHD patients aged 13 to 16 administered their prescribed dose (18 to 72 mg/day) of CONCERTA, mean Cmax and AUCTAU of methylphenidate increased proportionally with respect to dose.

Studies on the effects of dosing after overnight fasting, after consumption of a normal breakfast, and a high-fat breakfast showed no differences in pharmacokinetics or pharmacodynamics of CONCERTA. There is no evidence of dose dumping in the presence or absence of food.

Distribution

Plasma methylphenidate concentrations in adults decline biexponentially following oral administration. The terminal plasma half-life of methylphenidate in adults following oral administration of CONCERTA was approximately 3.5 hours.

Metabolism

In humans, methylphenidate is metabolis primarily by de-esterification to α-phenyl-piperidine acetic acid (PPAA) which has little or no pharmacologic activity. In adults the metabolism of CONCERTA once daily, as evaluated by metabolism to PPAA, is similar to that of methylphenidate three times daily. The metabolism of single and repeat once-daily doses of CONCERTA is similar.

Elimination

After oral dosing of radiolabelle methylphenidate in humans, about 90% of the radioactivity was recover in the urine. The main urinary metabolite was PPAA, accounting for approximately 80% of the dose. Since renal clearance is not an important route of methylphenidate clearance, renal insufficiency is not expect to have a significant effect on the pharmacokinetics of CONCERTA.

Preclinical safety dataCarcinogenicity

In a lifetime dietary carcinogenicity study carried out in mice, methylphenidate cause an increase in hepatocellular adenomas at a dose of 60–80 mg/kg/day, and in males only, an increase in hepatoblastomas (a relatively rare rodent malignant tumor type) at 60 mg/kg/day. These dose levels are approximately 3–8 fold the maximal recommend clinical dose on an mg/m2 basis. There was no increase in tumours at 30-40 mg/kg/day (approximately 1-4 fold the maximal recommend clinical dose on an mg/m2 basis).

The mouse strain use is sensitive to the development of hepatic tumors, and the significance of these results to humans is not know. There was no evidence of carcinogenicity in two strains of transgenic mice administer methylphenidate in the diet for 24 weeks at doses up to 60–74 mg/kg/day (approximately 3–8 fold the maximal recommend clinical dose on an mg/m2 basis) or in a lifetime dietary study in rats at doses up to 50 mg/kg/day (approximately 4–10 fold the maximal recommend clinical dose on an mg/m2 basis).

Mutagenicity

Methylphenidate was not mutagenic in the in vitro assays (Ames reverse mutation assay, mouse lymphoma cell forward mutation assay). However, Methylphenidate was weakly clastogenic in vitro (Chinese Hamster ovary cells) but was negative in vivo (mouse bone marrow micronucleus assay). Sister chromatid exchange assay results were positive only at high (cytotoxic) concentrations.

Impairment of fertility

Dietary administration of methylphenidate to male and female mice at doses up to 150–160 mg/kg/day did not impair fertility in an 18–week continuous breeding study in which both parents and offspring were treat. This dose was approximately 7–16 fold the maximal recommend human dose on an mg/m2 basis

Can I Buy Concerta Methylphenidate Online Without prescription?

You can only Buy CONCERTA Methylphenidate Online if you have a prescription. CONCERTA® is a federally controlled substance (CII) However, because it can be abused or lead to dependence. Keep CONCERTA® in a safe place to prevent misuse and abuse. Selling or giving away CONCERTA® may harm others, and is against the law.

What is CONCERTA use for- Buy Concerta Methylphenidate?

CONCERTA is using to treat Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents aged 6 – 18 years.

It is part of a comprehensive treatment program that usually includes psychological, educational, and social therapy.

It’s a stimulant that increases attention and decreases impulsiveness and hyperactivity in patients with ADHD.

CONCERTA tablets are made in an extend-release form. This means that they release the active ingredient slowly. The outer layer of the tablet dissolves right after it is swallow in the morning, giving an initial dose of methylphenidate hydrochloride.

The tablets have a special shell that allows the rest of the methylphenidate hydrochloride to released from the tablet at a slow rate throughout the day.

The tablet shell does not dissolve completely after all the drug has been released and sometimes the tablet shell may seen in your stool. This is normal.

Your doctor may have prescribed CONCERTA for another reason. Ask your doctor if you have any questions about why this medicine has been prescribed for you/your child.

Before you Buy Concerta Methylphenidate;

You need to know when you must not take it. Here we are simply saying you should know your dose before you buy concert Methylphenidate Online

Do not Buy Concerta Methylphenidate if you/your child have an allergy to:

  • methylphenidate hydrochloride (the active ingredient in CONCERTA) or
  • any of the other ingredients in CONCERTA. See Product Description at the end of this leaflet for a list of ingredients.

Symptoms of an allergic reaction may include: rash, itching, or hives on the skin; shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue, or other parts of the body.

Do not Buy Concerta Methylphenidate if you/your child have any of the following medical conditions:

  • severe anxiety, tension, or agitation because the use of this drug may make these conditions worse
  • Tourette`s syndrome (tics) or a family history of this disorder
  • glaucoma (increased pressure in the eye)
  • overactive thyroid gland
  • severe angina (chest pain)
  • irregular heartbeat
  • severe depression or other mental illness
  • currently taking or have taken a monoamine oxidase (MAO) inhibitor, medicines used to treat major depression (eg. phenelzine, tranylcypromine), or medicines used in Parkinson`s disease (eg. selegiline) within the last 14 days
  • phaeochromocytoma (a tumor of the adrenal gland)
Do not buy concert methylphenidate if the packaging is torn or shows signs of tampering.
Do not buy concert methylphenidate beyond the expiry date (month and year) printed on the pack.

If you/your child takes CONCERTA after the expiry date it may not work. So even before you purchase Concerta Methylphenidate, make sure to check the drug’s expiry date.

buy concerta methylphenidate 36mg online

Before you/your child start to take it

You must tell your doctor if you/your child:

  • are/is pregnant or planning to become pregnant
  • are/is breastfeeding or wish to breastfeed
  • Is or have/has been alcohol or drug dependent
  • have/has seizures or fits
  • Has heart problems
  • have/has high blood pressure
  • Has aggressive behaviour or hostility
  • have/has a narrowing or blockage in your digestive tract (stomach, small or large intestine)
  • Has blurred vision
  • have/has liver or kidney problems

Your doctor may need to adjust the dose or adapt your treatment if you/your child have any of these conditions.

If you have not told your doctor or pharmacist about any of the above, tell them before you/your child start taking CONCERTA.

Taking other medicines:

Tell your doctor or pharmacist if you/your child are taking any other medicines, including medicines you can buy without a prescription from a pharmacy, supermarket, or health food shop.

In particular, tell your doctor or pharmacist if you/your child are taking any of the following:

  • Monoamine oxidase (MAO) inhibitors such as phenelzine, selegiline
  • Clonidine a medicine used to treat high blood pressure
  • medicines that increase blood pressure
  • medicines used to treat depression such as amitriptyline and imipramine
  • Selective Serotonin Reuptake Inhibitors (SSRIs), medicines used to treat depression, obsessive-compulsive disorders, and anxiety disorders such as fluoxetine, fluvoxamine, citalopram, escitalopram, paroxetine, and sertraline
  • medicines used to prevent seizure such as phenytoin, phenobarbitone, and primidone
  • medicines used to prevent blood clots such as warfarin

CONCERTA

These medicines may affect by CONCERTA or may affect how well CONCERTA works. Your doctor or pharmacist can tell you what to do if you/your child are taking any of these medicines.

Taking CONCERTA- Buy Concerta Methylphenidate Online

Follow the directions given to you by your doctor and pharmacist.

These directions may differ from the information contained in this leaflet.

How much to take:

Children and Adolescents 6 -18 years

  • The starting dose is one CONCERTA 18 mg extend-release tablet in the morning
  • If you/your child are currently taking other formulations of methylphenidate, your doctor will decide the best starting dose
  • The maximum dose is 54 mg a day take as one dose.

How to take it:

  • CONCERTA should be swallow whole with a glass of liquid. It should not chew, broken, or crush
  • CONCERTA may taken with or without food.

If you do not understand the instructions provided with this medicine, ask your doctor or pharmacist for help.

If you/your child forget to take it

  • It may be best to wait until the following morning to take the next dose. Remember the effects of CONCERTA are design to last approximately 12 hours from the time it is take.
  • Do not take or give your child a double dose to make up for the dose missed.

You/your child have missed more than one dose, or are not sure what to do, check with your doctor or pharmacist.

If you have trouble remembering when to take your medicine, ask your pharmacist for some hints.

If you/your child have taken too much (overdose)

Immediately telephone your doctor or the Poisons Information Centre for advice, or go to Accident and Emergency at your nearest hospital.

Do this even if there are no signs of discomfort or poisoning. You/your child may need urgent medical attention.

Poisons Information Centre telephone numbers:

  • Australia: 13 11 26
  • New Zealand: 0800 POISON or 0800 764 766

Keep these telephone numbers handy.

If you/your child takes too much CONCERTA you/your child may experience symptoms such as vomiting, headache, irregular heartbeat, dilated pupils, convulsions/fits, breathing problems, confusion, and seizures.

Before you Buy Concerta Methylphenidate

Things you must do

  • Always follow your doctor`s instructions carefully
  • Take CONCERTA exactly as your doctor has prescribed. Like all stimulants, CONCERTA may become habit-forming and can be abused by some people. If you/your child take it correctly as instructed by your doctor, abuse or dependence should not be a problem, either now or later in life
  • Be sure to keep all of your doctor`s appointments so that your/your child`s progress can be checked
  • Your doctor will want to check your/your child`s blood pressure and pulse and do a blood test from time to time to prevent unwanted side effects from happening
  • Tell your doctor if you become pregnant while taking CONCERTA
  • Parents and/or caregivers should be alert for the development of thoughts or acts of self-harm, hallucinations, abnormal thinking (psychosis) or new or worsening hostility. These were uncommon symptoms see in clinical studies with CONCERTA and it is not know if they were causinf by CONCERTA. Contact your/your child`s doctor or mental health professional straight away or seek urgent medical attention if these occur.
  • Parents and/or caregivers should contact their/their child`s doctor or seek urgent treatment if they/their child develops chest pain, tightness in the chest, shortness of breath, irregular heartbeat, feeling faint, or loss of consciousness while taking Concerta
  • If you/your child are about to start taking a new medicine, tell your doctor and pharmacist that you/your child are taking CONCERTA.

Things you must not do

  • Do not buy CONCERTA Methylphenidate to treat any other complaint unless your doctor says so.
  • Not give this medicine to anyone else, even if their symptoms seem similar.
  • Do not stop treatment without first checking with your doctor.

If you/your child suddenly stop taking this medicine, you/your child`s condition may reappear or you/your child may get unwant effects such as depression. Your doctor may want to gradually reduce the amount of medicine taken each day before stopping it completely.

Side Effects

All medicines can have side effects. Sometimes they are serious, most of the time they are not. You/your child may need medical treatment if you get some side effects. Do not be alarm by this list of possible side effects. You/your child may not experience any of them.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you/your child experience any of the following and they worry you:

  • headache
  • loss of appetite
  • trouble sleeping
  • stomach pain
  • dizziness

Tell your doctor immediately if you notice any of the following:

  • high fever and muscle stiffness
  • signs of allergy such rash, itching, or hives on the skin; shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue, or other parts of the body
  • fast or abnormal heartbeat
  • increased blood pressure
  • confusion or hallucinations
  • nausea and/or vomiting
  • unusual tiredness or weakness
  • blurred or double vision
  • depression.

Other side effects not listed above may also occur in some people. Tell your doctor if you notice any other effects.

After using CONCERTA

Storage

buy concerta methylphenidateKeep the tablets in the bottle until it is time to take them.

Store CONCERTA in a cool dry place where the temperature is below 25 degrees C. Keep the container tightly close.

Keep medicines where children cannot reach them.

A lock cupboard at least one-and-a-half meters (1.5 m) above the ground is a good place to store medicines.

Do not store CONCERTA, or any other medicine, in the bathroom or near a sink. Do not leave medicines in the car or on windowsills. Heat and dampness can destroy some medicines.

Disposal

If your doctor tells you/your child to stop taking CONCERTA extend-release tablets or the medicine has passed its expiry date, ask your pharmacist what to do with any medicine that may be leftover.

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