Recommended Dosages for ADHD Medications
The recommended dosages for ADHD medications include starting methylphenidate at 5 mg twice daily for immediate-release and 10 mg once daily for extended-release (maximum 1.0 mg/kg/day), amphetamine/Adderall at 5-10 mg daily (maximum 50 mg daily), and atomoxetine at 1.2 mg/kg/day. 1
Methylphenidate Dosing
Immediate-Release Methylphenidate
- Starting dose: 5 mg twice daily (before breakfast and lunch) 1
- Effects typically last about 4 hours, requiring multiple daily doses 1, 2
- Maximum daily dose: up to 1.0 mg/kg/day 1
- Titration: Increase by 5-10 mg weekly increments based on symptom control 1
Extended-Release Methylphenidate
- Starting dose: 10 mg once daily in the morning 1
- Maximum daily dose: up to 1.0 mg/kg/day 1
- Administration: Give in the morning to prevent sleep disturbances 1
- Various formulations available (Concerta, Ritalin LA, etc.) with different durations of action (8-12 hours) 2
Amphetamine-Based Medications
Adderall (Mixed Amphetamine Salts)
- Starting dose: 5-10 mg daily 1
- Maximum daily dose: up to 50 mg daily 1
- Titration: Adjust based on clinical response and side effects
Lisdexamfetamine (Vyvanse)
- Starting dose: 20-30 mg once daily in the morning 3
- Titration: Increase by 10 mg weekly 3
- Maximum daily dose: 70 mg daily 3
Non-Stimulant Medications
Atomoxetine (Strattera)
- Recommended dose: 1.2 mg/kg/day 1
- Clinical studies showed efficacy at doses between 1.2-1.8 mg/kg/day 4
- Can be administered as a single daily dose or split into two evenly divided doses 5
- For children: Starting dose typically lower with gradual titration to target dose
- Maximum recommended dose: 1.4-1.8 mg/kg/day or 100 mg daily (whichever is less) 4
Alpha-2 Adrenergic Agonists
- Guanfacine and Clonidine can be used as monotherapy or adjunctive therapy with stimulants 1
- These medications have minimal effects on appetite compared to stimulants 1
Dosing Considerations and Monitoring
Individualized Titration
- Start at the lower end of the dosing range and titrate upward based on response
- Assess target ADHD symptoms using standardized rating scales 1
- Monitor for common side effects: sleep difficulties, reduced appetite, weight changes, headaches, stomach discomfort 1
Special Populations
- For patients with tics: Methylphenidate, clonidine, guanfacine, and atomoxetine have been shown to reduce ADHD symptoms without necessarily worsening tics 6
- For patients with comorbid anxiety: Atomoxetine may be particularly beneficial 4
- For adults with ADHD: Similar dosing principles apply, though adult studies have used mean daily doses of approximately 35.8 mg of methylphenidate 7
Monitoring Requirements
- Regular assessment of symptom control
- Weight monitoring, especially with stimulants
- Vital signs checks: annually in children and quarterly in adults 1
- Follow-up within 2-4 weeks after dose adjustment 1
Important Considerations
- Immediate-release methylphenidate effects typically last 4 hours, requiring multiple daily doses 2
- Extended-release formulations help address adherence challenges during school hours 2
- Atomoxetine has a negligible risk of abuse and is not a controlled substance, making it useful for patients at risk of substance abuse 5
- Individual responses to medications vary significantly, necessitating careful dose titration 2
- Plasma concentration monitoring is not clinically useful for methylphenidate dosing 2
Remember that medication should be part of a comprehensive treatment approach that may include behavioral interventions for optimal outcomes.