METHYLPHENIDATE

Immediate & Sustained Release tablet (Ritalin/Ritalin SR)
Children > 6 years old:
Initial: IR: 5 mg/dose PO BID  to TID
Increment:  If tolerated, increase by 5 mg/dose weekly until maintenance dose is reached.
SR: 20 mg PO qAM to BID
Usual maintenance dose: 0.5-1 mg/kg/24 hr.
Maximum:  
2 mg/kg/24 hr or 60 mg/24 hr (children or adolescents) or 80 mg/24 hr (adults)
(side effects may be increased without additional clinical benefit at higher doses)

Extended Release tablets (Concerta)
Children >6 yrs:
Initial: Patients new to methylphenidate should start Concerta at 18 mg PO QAM. See conversion table for patients already receiving methylphenidate IR/SR.
Increment: Children: 9 mg/week.
Adolescents/Adults: 18 mg/week
Maximum: Children: 54 mg/day
Adolescents/Adults: 72 mg/day  

Initial: Patients new to methylphenidate should start Biphentin at 10 mg PO QAM
Increment: Children: 5 mg/week
Adolescents/Adults: 10 mg/week
Maximum: Children/Adolescents: 60 mg/day
Adults: 80 mg/day

CADDRA ADHD guidelines support dosages above manufacturer recommended maximum dosages when prescribed by specialists

CNS stimulant

Immediate Release (IR) Tablet (Ritalin):  5 mg, 10 mg, 20 mg
Sustained Release (SR) tablet (Ritalin SR):  20 mg
Extended Release tablet (Concerta): 18 mg, 27 mg,
36 mg, 54 mg
** The different methylphenidate formulations are non-interchangeable, and are not dose equivalent on a strict mg to mg basis      

Ritalin SR tablets, Concerta tablets and Biphentin capsules must not be crushed or chewed. Biphentin and Foquest capsules may be opened and the contents sprinkled on soft food;  they should not be dissolved in water

Generic Concerta formulations (not stocked at BCCH): considered bioequivalent per Health Canada
Also available but not stocked at BCCH: Foquest (16 hr Extended Release capsules)

Discontinue if no improvement within 3 weeks.

Give IR tablets in divided doses BID-TID (breakfast and lunch, and optionally midafternoon). Give SR form daily or BID (breakfast and 2 PM). Give extended release forms as a single dose QAM.

Supplemental IR doses may be taken in addition to sustained/extended release forms.

Release patterns: Concerta: 22% Immediate Release/78% Delayed Release. Biphentin: 40% Immediate release/60% Delayed Release Foquest (not stocked): 20% Immediate Release/80% Delayed Release

Use with caution in patients with cardiovascular disease including structural abnormalities, hypertension, arrhythmias and personal/family history of sudden cardiac death: monitor heart rate and blood pressure. Obtain ECG prior to starting treatment in patients with identified cardiac abnormalities/risk profile.

Adverse effects; insomnia, restlessness, aggression, anxiety, anorexia, sadness/ dysphoria, vomiting, abdominal cramps, dry mouth, increased blood pressure, psychosis, may cause/worsen tics.

Methylphenidate is commonly abused, and has a significant street value.

Not approved in Canada for use in pre-school aged children (several randomized controlled trials in this age group exist, the largest of which showed reduced efficacy compared with school aged children).

Prescribers must be aware of warnings issued by Health Canada regarding the use of ADHD medications. Refer to the Health Canada website.

Methylphenidate to Concerta Conversion

5 mg methylphenidate BID or TID or 20 mg methylphenidate SR ~= 18 mg Concerta QAM.

10 mg methylphenidate BID or TID, or 40 mg methylphenidate SR ~= 36 mg Concerta QAM

15 mg methylphenidate BID or TID or 60 mg methylphenidate SR ~= 54 mg Concerta QAM

2024-04-13 04:41:23