Recommended Dosage and Usage of Concerta (Methylphenidate) for ADHD
The recommended starting dose of Concerta (methylphenidate) for ADHD is 18 mg once daily in the morning for both children (6 years and older) and adults, with gradual titration in 18 mg increments at weekly intervals to a maximum of 54 mg daily for children and 72 mg daily for adults. 1
Dosage Guidelines by Age Group
Children (6 years and older):
- Starting dose: 18 mg once daily in the morning
- Titration: Increase by 18 mg increments at weekly intervals
- Maximum dose: 54 mg daily
- Administration: Take 30-45 minutes before breakfast
Adults:
- Starting dose: 18 mg once daily in the morning
- Titration: Increase by 18 mg increments at weekly intervals
- Average dose: 20-30 mg daily
- Maximum dose: 72 mg daily
- Administration: Take in the morning, preferably before 6 pm to avoid sleep disturbances
Administration Considerations
- Concerta should be taken once daily in the morning
- The tablet should be swallowed whole with water and not crushed, chewed, or divided
- The osmotic-release oral system (OROS) technology provides controlled delivery over a 12-hour period 2
- For adults who experience insomnia, the medication should be taken before 6 pm 1
Monitoring and Dose Adjustments
- Assess response and side effects 1-2 weeks after each dose increase 3
- Monitor vital signs, particularly blood pressure and heart rate, at each visit
- Evaluate growth (height and weight) in pediatric patients regularly
- If paradoxical aggravation of symptoms occurs, reduce dosage or discontinue if necessary 1
- If no improvement is observed after appropriate dosage adjustments over a one-month period, consider discontinuing Concerta 1
Special Considerations
Contraindications:
- Known hypersensitivity to methylphenidate
- Concurrent treatment with MAOIs or within 14 days of MAOI discontinuation
- Glaucoma
- Severe cardiovascular disease
- Hyperthyroidism or hypertension 1
Precautions:
- Abuse and Misuse Potential: Concerta has high potential for abuse and misuse, which can lead to substance use disorder 1
- Cardiovascular Risk: Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious arrhythmias, or coronary artery disease 1
- Psychiatric Effects: Screen for risk factors for developing manic episodes before initiating treatment 1
- Growth Suppression: Monitor height and weight in pediatric patients; consider interrupting treatment if growth is affected 1
Efficacy and Duration of Action
Concerta's OROS formulation provides:
- Continuous action over a 12-hour period
- Similar efficacy to immediate-release methylphenidate dosed three times daily
- Better coverage for symptom control throughout the day, including during driving for adolescents 4, 2
Common Side Effects
- Decreased appetite
- Weight loss
- Insomnia
- Tachycardia
- Increased blood pressure
- Headache
- Anxiety
- Dry mouth
- Nausea
- Abdominal pain 1
Practical Considerations
- Assess for substance use before initiating treatment in adolescents
- Monitor for signs of misuse or diversion, especially in adolescents
- Consider nonstimulant alternatives if there are concerns about abuse potential
- Provide comprehensive treatment that includes behavioral therapy alongside medication 4, 3
Concerta's once-daily dosing provides convenience and may improve adherence compared to multiple daily doses of immediate-release methylphenidate, while maintaining similar efficacy and safety profiles.