Concerta (Methylphenidate) Dosage and Usage for ADHD
For the treatment of ADHD, Concerta (extended-release methylphenidate) should be initiated at 18 mg once daily in the morning for both children (6+ years) and adults, with gradual weekly increases of 18 mg until optimal response is achieved, not exceeding 54 mg/day for children or 72 mg/day for adults. 1
Dosing Guidelines by Age Group
Children and Adolescents (6-17 years)
- Initial dose: 18 mg once daily in the morning
- Titration: Increase by 18 mg weekly based on response
- Maximum dose: 54 mg daily
- Administration: Take in the morning with or without food, swallow whole (do not crush or chew)
Adults (18+ years)
- Initial dose: 18-36 mg once daily in the morning
- Titration: Increase by 18 mg weekly based on response
- Maximum dose: 72 mg daily
- Administration: Take in the morning, at least 30-45 minutes before meals
Monitoring Parameters During Treatment
- Vital signs: Regular monitoring of blood pressure and heart rate
- Growth: Height and weight monitoring in pediatric patients
- Psychiatric symptoms: Monitor for emergence of new psychotic or manic symptoms
- Cardiovascular: Assess for signs of cardiac disease before initiating therapy 2
Special Considerations
Preschool Children (4-5 years)
- Methylphenidate should be used with caution in preschool children
- Only consider for moderate-to-severe ADHD when behavioral therapy has failed
- Start with lower doses and increase more gradually 2
- Maximum doses have not been adequately studied in this age group
Adolescents
- Consider risk of diversion and substance abuse
- Monitor prescription refill patterns
- Consider once-daily extended-release formulations like Concerta to maintain privacy at school and improve adherence 2
- Ensure medication coverage during driving hours to reduce accident risk 2
Advantages of Concerta Over Immediate-Release Methylphenidate
- Duration of action: 10-12 hours of coverage with once-daily dosing
- Adherence: Significantly fewer gaps in therapy (85% vs 97% had 15-day gaps) 3
- Persistence: Longer duration on therapy (199 vs 108 mean days) 3
- Reduced hospitalizations: 33% lower odds of hospitalization compared to three-times-daily immediate-release methylphenidate 3
- Convenience: No need for midday dosing at school
Common Adverse Effects to Monitor
- Decreased appetite
- Sleep disturbances
- Increased blood pressure and pulse
- Headaches
- Stomach pain
- Irritability 2
Important Precautions
- Abuse potential: Assess risk for abuse, misuse, and addiction before prescribing 1
- Cardiovascular risk: Avoid in patients with structural cardiac abnormalities or serious cardiac disease 1
- Growth suppression: Monitor height and weight in pediatric patients; consider drug holidays if growth suppression occurs 1
- Psychiatric effects: Screen for risk factors for developing manic episodes before initiating therapy 1
- Tics/Tourette's: Assess family history and monitor for emergence or worsening of tics 1
Treatment Algorithm
- Confirm ADHD diagnosis using standardized criteria
- Start with Concerta 18 mg once daily in the morning
- Evaluate response after 1 week:
- If inadequate response with minimal side effects → increase by 18 mg
- If partial response with side effects → maintain dose for another week
- If significant side effects → consider lower dose or alternative medication
- Continue weekly titration until optimal balance between symptom control and side effects
- Once stabilized, monitor every 3-6 months for continued efficacy and adverse effects
- If inadequate response after reaching maximum dose, consider switching to another stimulant or non-stimulant medication
Concerta's extended-release formulation provides significant advantages in treatment adherence and clinical outcomes compared to immediate-release methylphenidate, making it an excellent choice for improving morbidity, mortality, and quality of life in patients with ADHD.