Methylphenidate Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Attention Deficit Disorder

Immediate release tablets including chewable tablets (Ritalin, Methylin, methylphenidate):
Initial Dose: 10 mg orally 2 or 3 times daily, preferably 30 to 45 minutes before breakfast and lunch, and a third dose between 2 and 4 PM, if necessary. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM.
Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg per day. In some patients, 10 to 15 mg daily may suffice. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM.

Sustained release tablets (Ritalin SR, Metadate ER):
Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets.
Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed.

Extended release capsules (Metadate CD):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 20 mg up to a maximum of 60 mg once daily in the morning. The capsules should not be opened, chewed, or crushed.

Extended release oral suspension (Quillivant XR):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 10 mg to 20 mg up to a maximum of 60 mg once daily in the morning.
Comments: Vigorously shake for at least 10 seconds before each dose. Administer only with the dosing dispenser provided. Wash dispenser after each use (dishwasher safe).

Extended release capsules (Ritalin LA):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
For patients already receiving methylphenidate:
If switching from immediate release tablets 10 mg twice a day or sustained release tablets 20 mg/day: 20 mg once daily.
If switching from immediate release tablets 15 twice a day: 30 mg once daily.
If switching from immediate release tablets 20 mg twice a day or sustained release tablets 40 mg/day: 40 mg once daily.
If switching from immediate release tablets 30 twice a day or sustained release tablets 60 mg/day: 60 mg once daily.
Maintenance Dose: Doses may be increased weekly in increments of 10 mg up to a maximum of 60 mg once daily in the morning. For patients unable to swallow the capsule, the contents may be sprinkled on applesauce and administered.

Extended release tablets (Concerta):
Initial: (Methylphenidate- naive patients) 18 mg once daily in the morning before breakfast.
For patients already receiving methylphenidate:
If switching from immediate release tablets 5 mg 2 or 3 times a day: 18 mg once daily.
If switching from immediate release tablets 10 mg 2 or 3 times a day: 36 mg once daily.
If switching from immediate release tablets 15 mg 2 or 3 times a day: 54 mg once daily.
If switching from immediate release tablets 20 mg 2 or 3 times a day: 72 mg once daily.
.
Maintenance: May increase by 18 mg increments at weekly intervals up to a maximum of 72 mg once daily in the morning before breakfast. Tablets should not be chewed, divided, or crushed.

Transdermal system (Daytrana):
Dose should be titrated to effect based on the following recommended titration schedule:
Week 1: 10 mg/9 hour patch daily
Week 2: 15 mg/9 hour patch daily
Week 3: 20 mg/9 hour patch daily
Week 4: 30 mg/9 hour patch daily
It is recommended to apply the patch topically to hip area 2 hours before an effect is needed and to remove the patch 9 hours after application. However, wear time should be individualized according to the needs and response of the individual patient.

Usual Adult Dose for Narcolepsy

Immediate release tablets (Ritalin, Methylin, methylphenidate):
Initial Dose: 10 mg orally 2 or 3 times daily, preferably 30 to 45 minutes before meals.
Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg per day. In some patients, 10 to 15 mg daily may suffice. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM.

Sustained release tablets (Ritalin SR, Metadate ER):
Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets.
Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed.

Extended release capsules (Metadate CD):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 20 mg up to a maximum of 60 mg once daily in the morning. The capsules should not be opened, chewed, or crushed.

Extended release tablets (Concerta):
Initial: (Methylphenidate- naive patients) 18 mg once daily in the morning before breakfast.
For patients already receiving methylphenidate:
If switching from immediate release tablets 5 mg 2 or 3 times a day: 18 mg once daily.
If switching from immediate release tablets 10 mg 2 or 3 times a day: 36 mg once daily.
If switching from immediate release tablets 15 mg 2 or 3 times a day: 54 mg once daily.
If switching from immediate release tablets 20 mg 2 or 3 times a day: 72 mg once daily.
.
Maintenance: May increase by 18 mg increments at weekly intervals up to a maximum of 72 mg once daily in the morning before breakfast. Tablets should not be chewed, divided, or crushed.

Usual Adult Dose for Depression

The manufacturers warn that methylphenidate should not be used for severe depression of either exogenous or endogenous origin.

Some studies have shown methylphenidate to be an effective adjuvant medication when used along with other standard antidepressant drug therapy (SSRIs or TCAs) for depression. However, no specific coadministered antidepressant medication or dose of methylphenidate has been generally accepted as optimum therapy. Therefore, no specific therapy or dose of methylphenidate can be recommended at this time for use in patients with depression.

Usual Pediatric Dose for Attention Deficit Disorder

6 years or older:
Immediate release tablets including chewable tablets (Ritalin, Methylin, methylphenidate):
Initial Dose: 2.5 to 5 mg orally twice daily, taken 30 to 45 minutes before breakfast and lunch.
Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg/day in 2 or 3 divided doses. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM.

Sustained release tablets (Ritalin SR, Metadate ER):
Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets.
Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed.

Extended release capsules (Metadate CD):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 20 mg up to a maximum of 60 mg once daily in the morning. Capsules should not be opened, chewed, or crushed.

Extended release oral suspension (Quillivant XR):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 10 mg to 20 mg up to a maximum of 60 mg once daily in the morning.
Comments: Vigorously shake for at least 10 seconds before each dose. Administer only with the dosing dispenser provided. Wash dispenser after each use (dishwasher safe).

Extended release tablets (Concerta):
Initial: (Methylphenidate- naive patients) 18 mg once daily in the morning before breakfast.
If switching from immediate release tablets 5 mg 2 or 3 times a day: 18 mg once daily.
If switching from immediate release tablets 10 mg 2 or 3 times a day: 36 mg once daily.
If switching from immediate release tablets 15 mg 2 or 3 times a day: 54 mg once daily.
If switching from immediate release tablets 20 mg 2 or 3 times a day: 72 mg once daily.
Maximum dose: 6 years to 12 years: 54 mg/day, over 12 years: 72 mg/day; do not exceed 2 mg/kg/day.
Maintenance: May increase by 18 mg increments at weekly intervals up to a maximum of 72 mg once daily in the morning before breakfast. Tablets should not be chewed, divided, or crushed.

Transdermal system (Daytrana):
Dose should be titrated to effect based on the following recommended titration schedule:
Week 1: 10 mg/9 hour patch daily
Week 2: 15 mg/9 hour patch daily
Week 3: 20 mg/9 hour patch daily
Week 4: 30 mg/9 hour patch daily
It is recommended to apply the patch topically to hip area 2 hours before an effect is needed and to remove the patch 9 hours after application. However, wear time should be individualized according to the needs and response of the individual patient.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Methylphenidate is contraindicated in patients with glaucoma, motor tics, and Tourette's syndrome, and within 14 days of taking MAO inhibitors.

Periodic CBC, differential, and platelet counts are advised during prolonged therapy.

It is recommended to avoid use of stimulants, including methylphenidate, in patients with known structural cardiac abnormalities as cases of sudden death, primarily in children, have been reported.

Blood pressure and pulse should also be monitored at appropriate intervals in all patients taking methylphenidate, especially in patients with hypertension.

Data are inadequate to determine whether chronic administration of methylphenidate may be associated with growth inhibition; therefore, growth should be monitored during treatment.

Methylphenidate should be discontinued if no improvement is noted after appropriate dosage adjustment over one month.

Dialysis

Data not available

Other Comments

Drug treatment is not indicated in all cases of attention deficit disorder with hyperactivity and should be considered only in light of the complete history and evaluation of the child. The decision to prescribe amphetamines should depend on the physician's assessment of the chronicity and severity of the child's symptoms and their appropriateness for his/her age. Prescription should not depend solely on the presence of one or more of the behavioral characteristics. Methylphenidate should be used as part of a comprehensive treatment program.

Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.

If aggravation of symptoms or adverse effects are noted, dosage reduction or discontinuation may be indicated.

The transdermal patch should be placed on a different site each day, typically on the opposite hip.

Extended release formulations of methylphenidate should be swallowed whole and not crushed or chewed. It should be noted that Concerta tablets remain intact and exit the gastrointestinal tract as an empty shell.

Patients should avoid alcohol during treatment.

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