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Methylphenidate Dosage

Applies to the following strengths: 20 mg/24 hr; 30 mg/24 hours; 40 mg/24 hr; 10 mg/24 hr; 5 mg; 10 mg; 20 mg; 20 mg/8 hr; 60 mg/24 hours; 50 mg/24 hours; 18 mg/24 hr; 27 mg/24 hr; 36 mg/24 hr; 54 mg/24 hr; 10 mg/8 hr; 5 mg/5 mL; 10 mg/5 mL; 72 mg/24 hr; 30 mg/24 hr; 25 mg/5 mL; 15 mg/24 hr; 2.5 mg; 10 mg/9 hr; 15 mg/9 hr; 20 mg/9 hr; 30 mg/9 hr; 8.6 mg/24 hr; 17.3 mg/24 hr; 25.9 mg/24 hr

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Attention Deficit Disorder

IMMEDIATE-RELEASE (IR) SOLUTION [Methylin(R)]; IR TABLET [Ritalin(R)]:
10 to 60 mg orally in 2 or 3 divided doses per day, preferably 30 to 45 minutes before meals.
Comments:
-Average dosage is 20 to 30 mg/day.
-Advise patients to take the last dose before 6 pm if they are unable to sleep when medication is taken late in the day.

EXTENDED-RELEASE CAPSULE:
ALL:
-Maximum Dose: 60 mg/day
-Duration of Therapy: Discontinue treatment if improvement is not observed after appropriate dosage adjustment over a 1-month period.

Aptensio XR(TM):
-Initial Dose: 10 mg orally once a day in the morning with or without food.
-Maintenance Dose: May increase dose with increments of 10 mg weekly.
-Comments: Advise patients to establish a routine pattern with regard to meals.

Metadate CD(R):
-Initial Dose: 20 mg orally once a day in the morning before breakfast.
-Maintenance Dose: May increase dose with increments of 10 to 20 mg weekly.

Ritalin LA(R):
Patients New to Methylphenidate:
-Initial Dose: 20 mg orally once a day in the morning; may start at 10 mg/day when a lower dose is appropriate based on clinician judgement.
-Maintenance Dose: May increase dose with increments of 10 mg weekly.

Patients Switching From IR or SR Formulations:
-If Current Using IR 5 mg 2 times/day: 10 mg/day of Ritalin LA(R)
-If Current Using IR 10 mg 2 times/day or SR 20 mg/day: 20 mg/day of Ritalin LA(R)
-If Current Using IR 15 mg 2 times/day: 30 mg/day of Ritalin LA(R)
-If Current Using IR 20 mg 2 times/day day or SR 40 mg/day: 40 mg/day of Ritalin LA(R)
-If Current Using IR 30 mg 2 times/day day or SR 60 mg/day: 60 mg/day of Ritalin LA(R)

EXTENDED-RELEASE SUSPENSION [Quillivant XR(R)]:
-Initial Dose: 20 mg orally once a day in the morning with or without food.
-Maintenance Dose: May increase dose with gradual increments of 10 to 20 mg weekly.
-Maximum Dose: 60 mg/day

EXTENDED-RELEASE or SUSTAINED-RELEASE TABLET:
Concerta(R):
Adults Up to the Age of 65 Years:
Patients New to Methylphenidate:
-Initial Dose: 18 or 36 mg orally once a day in the morning with or without food.

Patients Switching From IR Formulation:
-If Currently Using IR 5 mg 2 or 3 times/day: 18 mg of Concerta(R)
-If Currently Using IR 10 mg 2 or 3 times/day: 36 mg of Concerta(R)
-If Currently Using IR 15 mg 2 or 3 times/day: 54 mg of Concerta(R)
-If Currently Using IR 20 mg 2 or 3 times/day: 72 mg of Concerta(R)

All Concerta(R) Patients:
-Maintenance Dose: May increase dose in 18 mg/day increments at weekly intervals if an optimal response at a lower dose has not been achieved.
-Maximum Dose: 72 mg/day
-Duration of Therapy: Discontinue treatment if improvement is not observed after appropriate dosage adjustment over a 1-month period.
-Comments: A 27 mg dosage strength is available for physicians who wish to prescribe between the 18 and 36 mg dosages.

Metadate ER(R); Ritalin-SR(R):
-May be used in place of IR tablets when the 8-hour dosage of the ER or SR Tablets corresponds to the titrated 8-hour dosage of the IR tablets.

EXTENDED-RELEASE CHEWABLE TABLET [Quillichew ER(TM)]:
-Initial Dose: 20 mg orally once a day in the morning with or without food.
-Maintenance Dose: May be titrated up or down weekly in increments of 10, 15, or 20 mg.
-Maximum Dose: 60 mg/day
-Duration of Therapy: Discontinue treatment if improvement is not observed after appropriate dosage adjustment over a 1-month period.
Comments:
-If Switching From Other Methylphenidate Products: Discontinue that treatment and use the usual titration schedule for the ER chewable tablet.
-Do not substitute for other methylphenidate products on a milligram-per-milligram basis because of different methylphenidate base compositions and differing pharmacokinetic profiles.

Use: Part of a total treatment program for Attention Deficit Hyperactivity Disorder (ADHD), that may include other measures (psychological, educational, social) for patients with this syndrome.

Usual Adult Dose for Narcolepsy

IMMEDIATE-RELEASE (IR) SOLUTION [Methylin(R)]; IR TABLET [Ritalin(R)]:
10 to 60 mg orally a day in 2 or 3 divided doses, preferably 30 to 45 minutes before meals.
Comments:
-Average dosage is 20 to 30 mg/day.
-Advise patients to take the last dose before 6 pm if they are unable to sleep when medication is taken late in the day.

EXTENDED-RELEASE [Metadate ER(R)]; SUSTAINED-RELEASE TABLET [Ritalin-SR(R)]:
-May be used in place of IR tablets when the 8-hour dosage of the ER or SR Tablets corresponds to the titrated 8-hour dosage of the IR tablets.

Use: Treatment of Narcolepsy

Usual Pediatric Dose for Attention Deficit Disorder

UNDER AGE 6 YEARS (All Formulations): Not recommended.

AGE 6 YEARS AND OLDER:
ALL:
-Maximum Dose: 60 mg/day (for all formulations EXCEPT Concerta(R) extended-release tablet)
-Concerta(R) Maximum Dose: Age 6 to 12 Years: 54 mg/day; Age 13 to 17 Years: 72 mg/day, not to exceed 2 mg/kg/day
-Duration of Therapy: Discontinue treatment if improvement is not observed after appropriate dosage adjustment over a 1-month period.

IMMEDIATE RELEASE (IR) SOLUTION [Methylin(R)]; IR TABLET [Ritalin(R)]:
-Initial Dose: 5 mg orally twice a day before breakfast and lunch.
-Maintenance Dose: May increase dose with gradual increments of 5 to 10 mg weekly.

EXTENDED-RELEASE CAPSULE:
Aptensio XR(TM):
-Initial Dose: 10 mg orally once a day in the morning with or without food.
-Maintenance Dose: May increase dose with increments of 10 mg weekly.

Metadate CD(R):
-Initial Dose: 20 mg orally once a day in the morning before breakfast.
-Maintenance Dose: May increase dose with gradual increments of 10 to 20 mg weekly.

Ritalin LA(R):
Patients New to Methylphenidate:
-Initial Dose: 20 mg orally once a day in the morning; may start at 10 mg/day when a lower dose is appropriate based on clinician judgement.
-Maintenance Dose: May increase dose with increments of 10 mg weekly.

Patients Switching From IR or SR Formulations:
-If Current Using IR 5 mg 2 times/day: 10 mg/day of Ritalin LA(R)
-If Current Using IR 10 mg 2 times/day or SR 20 mg/day: 20 mg/day of Ritalin LA(R)
-If Current Using IR 15 mg 2 times/day: 30 mg/day of Ritalin LA(R)
-If Current Using IR 20 mg 2 times/day day or SR 40 mg/day: 40 mg/day of Ritalin LA(R)
-If Current Using IR 30 mg 2 times/day day or SR 60 mg/day: 60 mg/day of Ritalin LA(R)

EXTENDED-RELEASE SUSPENSION [Quillivant XR(R)]:
-Initial Dose: 20 mg orally once a day in the morning with or without food.
-Maintenance Dose: May increase dose with gradual increments of 10 to 20 mg weekly.

EXTENDED-RELEASE or SUSTAINED-RELEASE TABLET:
Concerta(R):
Patients New to Methylphenidate:
-Initial Dose: 18 mg orally once a day in the morning with or without food.

Patients Switching From IR Formulation:
-If Currently Using IR 5 mg 2 or 3 times/day: 18 mg of Concerta(R)
-If Currently Using IR 10 mg 2 or 3 times/day: 36 mg of Concerta(R)
-If Currently Using IR 15 mg 2 or 3 times/day: 54 mg of Concerta(R)
-If Currently Using IR 20 mg 2 or 3 times/day: 72 mg of Concerta(R)

All Concerta(R) Patients:
-Maintenance Dose: May increase dose in 18 mg/day increments at weekly intervals if an optimal response at a lower dose has not been achieved.
-Comments: A 27 mg dosage strength is available for physicians who wish to prescribe between the 18 and 36 mg dosages.

Metadate ER(R); Ritalin-SR(R):
-May be used in place of IR tablets when the 8-hour dosage of the ER or SR Tablets corresponds to the titrated 8-hour dosage of the IR tablets.

EXTENDED-RELEASE CHEWABLE TABLET [Quillichew ER(TM)]:
-Initial Dose: 20 mg orally once a day in the morning with or without food.
-Maintenance Dose: May be titrated up or down weekly in increments of 10, 15, or 20 mg.
-Comments: If switching from other methylphenidate products to this extended-release chewable tablet, discontinue that methylphenidate product then use the usual titration schedule for Quillichew ER(TM).

TRANSDERMAL PATCH [Daytrana(R)]:
Week 1: 10 mg/9 hour patch per day
Week 2: 15 mg/9 hour patch per day
Week 3: 20 mg/9 hour patch per day
Week 4: 30 mg/9 hour patch per day
Comments:
-Instruct parents/caregivers to apply one patch to a clean, dry area of the child's hip 2 hours before an effect is needed; application sites other than the hip can have different absorption characteristics and have not been adequately studied.
-Direct parents/caregivers to remove the patch 9 hours after application; may remove earlier than 9 hours if a shorter duration of effect is desired or late day side effects appear.
-Consult the manufacturer product information for additional information about patch application/removal/disposal.

Use: Part of a total treatment program for Attention Deficit Hyperactivity Disorder (ADHD), which typically includes remedial measures for a stabilizing effect in children with this behavioral syndrome.

Usual Pediatric Dose for Narcolepsy

UNDER AGE 6 YEARS (All Formulations): Not recommended.

AGE 6 YEARS AND OLDER:
IMMEDIATE-RELEASE (IR) SOLUTION [Methylin(R)]; IR TABLET [Ritalin(R)]:
-Initial Dose: 5 mg orally twice a day before breakfast and lunch.
-Maintenance Dose: May increase dose with gradual increments of 5 to 10 mg weekly.
-Maximum Dose: 60 mg/day
-Duration of Therapy: Drug treatment should not be indefinite and usually may be discontinued after puberty; discontinue treatment if improvement is not observed after appropriate dosage adjustment over a 1-month period.

EXTENDED-RELEASE [Metadate ER(R)]; SUSTAINED-RELEASE TABLET [Ritalin-SR(R)]:
-May be used in place of IR tablets when the 8-hour dosage of the ER or SR Tablets corresponds to the titrated 8-hour dosage of the IR tablets.

Use: Treatment of Narcolepsy

Renal Dose Adjustments

Data not available.

Liver Dose Adjustments

Data not available.

Dose Adjustments

Aggravation of Symptoms or Other Adverse Reactions Occur: Reduce dosage (and/or reduce wear time for the transdermal patch) or discontinue treatment if necessary.

Precautions

US BOXED WARNING:
This drug as well as other CNS stimulants, methylphenidate-containing products, and amphetamines have a high potential for abuse and dependence. Give this drug cautiously to patients with a history of drug dependence or alcoholism. Assess the risk of abuse prior to prescribing, and monitor for signs of abuse and dependence while on therapy.

Chronic abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral abuse. Careful supervision is required during drug withdrawal, since severe depression may occur. Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up.

Safety and efficacy have not been established in patients younger than 6 years; this drug is not recommended for use in these patients.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule II

Dialysis

Data not available.

Other Comments

Administration Advice:
-Individualize dose titration and final dosage (plus wear time for transdermal patch users) according to the needs and response of each patient.
-In the treatment of ADHD, try to time drug administration with periods of greatest academic, behavioral, or social difficulties for the patient.
-Advise patients to swallow drug tablets whole with the aid of liquids, and not to crush, divide, or chew them.
-Immediate-Release Tablet and Extended-Release Capsule: Advise patients to standardize dosing in relation to food to ensure consistency of drug effect; absorption rate and onset of action is affected when taken with food.
-Extended-Release Capsule: Instruct patients that the capsule may be swallowed whole or the capsule contents may be sprinkled onto a small amount of applesauce and then consumed immediately (and not stored for future use); consult the manufacturer product information for specific instructions.
-Extended-Release Suspension: Before administration, vigorously shake the bottle for at least 10 seconds to ensure the proper dose is given.
-Transdermal Patch: Apply the patch immediately upon removal from the individual protective pouch; use patch within 2 months once the sealed tray or outer pouch is opened.

Storage Requirements:
-Consult the manufacturer product information.

Reconstitution/Preparation Techniques:
-XR Suspension: This formulation is supplied as a powder and should be reconstituted by a pharmacist (not by a patient or caregiver) with water prior to dispensing; consult the manufacturer product information for preparation instructions.

General:
-This drug should not be used for the prevention or treatment of normal fatigue stress.
-This drug is a racemic mixture comprised of the d- and l-isomers; the d-isomer is more pharmacologically active than the l-isomer.
-Transdermal Patch: Exposure to the l-isomer is nearly as high as to the d-isomer whereas little to none of the l-isomer is systemically available after oral administration due to first pass metabolism.
-Extended-Release Chewable Tablet: Do not substitute for other methylphenidate products on a milligram-per-milligram basis because of different methylphenidate base compositions and differing pharmacokinetic profiles.
-Overdosage: Efficacy of peritoneal dialysis and extracorporeal hemodialysis has not been established; consult the manufacturer product information for possible treatment options.

Monitoring:
-CARDIOVASCULAR: heart rate, blood pressure, presence of cardiac disease, digital changes
-DERMATOLOGIC: Signs of skin depigmentation
-GENERAL: Risk of misuse, abuse, and diversion
-HEMATOLOGIC: CBC, differential, and platelet counts
-NERVOUS SYSTEM: Neurological symptoms that are consistent with cerebral ischemia
-OTHER: Growth (height, weight, appetite) in patients under 18 years of age
-PSYCHIATRIC: Clinical evaluation for tics or Tourette's syndrome, emergence or worsening of psychiatric symptoms, risk for bipolar disorder, psychotic or manic symptoms, emergent suicidal ideation/behavior

Patient Advice:
-Avoid alcohol while taking this drug.
-Avoid potentially dangerous activities such as driving and operating machinery until you know how this drug affects you.
-Contact your healthcare provider immediately with any signs of unexplained wounds appearing on fingers or toes while taking this drug.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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