Metadate CD Dosing
Start Metadate CD at 20 mg once daily in the morning before breakfast, titrate in weekly increments of 10-20 mg based on clinical response, up to a maximum of 60 mg per day. 1
Starting Dose and Administration
- Initial dose: 20 mg once daily 1
- Timing: Morning, before breakfast 1
- Administration options:
- Swallow capsule whole with liquids, OR
- Open capsule and sprinkle contents on a tablespoon of applesauce (give immediately, do not store)
- Never crush or chew the capsule or contents 1
Titration Protocol
- Adjustment interval: Weekly 1
- Increment size: 10-20 mg increases 1
- Maximum dose: 60 mg per day 1
- Dosage must be individualized based on patient needs and clinical response 1
Available Strengths
Metadate CD comes in 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg capsules 1, allowing flexible titration to optimize symptom control throughout the day.
When to Adjust or Discontinue
- Reduce or discontinue if paradoxical aggravation of symptoms or adverse reactions occur 1
- Discontinue if no improvement after appropriate dosage adjustment over one month 1
Important Prescribing Considerations
Pretreatment Screening Required:
- Assess for cardiac disease (careful history, family history of sudden death/ventricular arrhythmia, physical exam) 1
- Evaluate family history and clinically assess for motor/verbal tics or Tourette's syndrome 1
Age Restrictions:
- Approved for ages 6-15 years 1
- Not recommended under age 6 due to higher plasma exposure and increased adverse reactions (particularly weight loss) at equivalent doses 1
Common Pitfalls
The FDA label specifies weekly titration intervals, but research suggests that maximum doses can range from 0.8-1.8 mg/kg/day across studies 2. While the FDA maximum is 60 mg/day regardless of weight 1, some patients may require doses at the higher end of this range for optimal symptom control. The key is titrating based on clinical response rather than arbitrary weight-based calculations, while staying within the 60 mg/day ceiling.
Monitor closely for abuse potential - Metadate CD carries a boxed warning for high abuse and misuse potential 1. Assess each patient's risk before prescribing and monitor throughout treatment for signs of diversion or misuse 1.