Concerta CR Dosing Recommendations
Concerta CR (methylphenidate extended-release) should be administered once daily in the morning at a starting dose of 18 mg, with titration up to a maximum of 54-60 mg daily based on clinical response and tolerability.
Dosing Guidelines
Initial Dosing
- Start with 18 mg once daily in the morning
- Administer with or without food (food does not significantly affect drug absorption with Concerta CR) 1
- Take the tablet whole; do not crush, chew, or divide the tablet as this will disrupt the extended-release mechanism
Dose Titration
- Increase dose in 18 mg increments at weekly intervals if needed 2
- Typical dose progression: 18 mg → 36 mg → 54 mg
- Maximum recommended daily dose:
Dose Equivalence to Immediate-Release Methylphenidate
Concerta CR provides equivalent total daily exposure to immediate-release methylphenidate but with a different delivery profile 2:
- 18 mg Concerta CR ≈ 5 mg immediate-release methylphenidate three times daily
- 36 mg Concerta CR ≈ 10 mg immediate-release methylphenidate three times daily
- 54 mg Concerta CR ≈ 15 mg immediate-release methylphenidate three times daily
Clinical Considerations
Advantages of Concerta CR
- Once-daily dosing improves adherence and eliminates the need for in-school medication administration 4
- Provides continuous coverage for 12 hours using OROS technology 2
- Consistent drug delivery regardless of food intake 1
- Tamper-resistant formulation that reduces potential for misuse 2
Monitoring
- Assess effectiveness and side effects regularly
- Monitor vital signs, particularly blood pressure and heart rate 3
- In pediatric patients, monitor height and weight as stimulants may affect growth 3
Common Side Effects
- Decreased appetite
- Insomnia
- Headache
- Anxiety
- Tachycardia
- Dry mouth 3
Special Populations
Renal Impairment
- No specific dosage adjustments are recommended for patients with mild to moderate renal impairment
Cardiovascular Considerations
- Avoid use in patients with:
Clinical Pearls
- The OROS technology in Concerta CR provides an initial bolus release (22% of the dose) followed by a controlled ascending release pattern over 12 hours 4
- Morning symptom control may be better with other extended-release formulations (like Metadate CD), while Concerta provides better evening control 5
- Unlike some other extended-release stimulants, Concerta's absorption is not significantly affected by high-fat meals, providing more consistent day-to-day performance 1
- For patients requiring better morning symptom control with Concerta, consider using a higher dose or supplementing with a small dose of immediate-release methylphenidate in the morning
Remember that while Concerta CR provides consistent 12-hour coverage, individual responses vary, and some patients may require alternative formulations or dosing strategies based on their specific symptom patterns throughout the day.