Maximum Dose of Concerta for a 17-Year-Old
The maximum recommended daily dose of Concerta (methylphenidate) for a 17-year-old is 72 mg per day. 1
Dosing Guidelines for Concerta in Adolescents
Concerta (methylphenidate extended-release) dosing for adolescents follows a structured approach:
- Initial dosing: Start with 18 mg once daily in the morning
- Titration: Increase by 18 mg increments at weekly intervals
- Maximum dose: 72 mg daily for adolescents (17-year-olds are dosed as adults)
The American Academy of Child and Adolescent Psychiatry recommends a maximum total daily dose of 60-65 mg for methylphenidate in general, but the specific extended-release formulation of Concerta allows for slightly higher dosing due to its unique delivery system 1.
Pharmacokinetic Considerations
Concerta uses an osmotic pump delivery system (OROS) that provides a more gradual release profile compared to immediate-release methylphenidate:
- Delivers medication over approximately 12 hours 2
- Provides more consistent coverage throughout the day
- Requires only once-daily dosing, improving adherence
This extended-release profile means that a 72 mg dose of Concerta provides more consistent blood levels rather than the peaks and valleys seen with multiple daily doses of immediate-release methylphenidate 3.
Safety Considerations at Maximum Dose
When prescribing the maximum dose of Concerta, monitor for:
- Cardiovascular effects: Regular monitoring of blood pressure and heart rate is essential
- Sleep disturbances: Insomnia is common, especially at higher doses
- Appetite suppression: May affect growth and development
- Mood changes: Monitor for irritability, anxiety, or mood instability
Clinical Decision Algorithm
- Start low: Begin with 18 mg once daily in the morning
- Evaluate response: Assess symptom control after 7 days
- Titrate as needed: Increase by 18 mg increments weekly if symptom control is inadequate
- Maximum dose: Do not exceed 72 mg daily for a 17-year-old
- Consider alternatives: If maximum dose does not provide adequate control, consider:
- Alternative ADHD medications
- Combination therapy
- Non-pharmacological interventions
Common Pitfalls to Avoid
- Exceeding maximum dose: Doses above 72 mg have not been studied in adolescents and may increase risk of adverse effects
- Rapid titration: Increasing dose too quickly can lead to unnecessary side effects
- Ignoring side effects: Regular monitoring for adverse effects is essential, especially at higher doses
- Dividing Concerta tablets: The osmotic delivery system requires the tablet to be swallowed whole; cutting or crushing destroys the extended-release mechanism
If the maximum dose of Concerta is not providing adequate symptom control, reevaluate the diagnosis and consider alternative or adjunctive treatments rather than exceeding the recommended maximum dose.