Starting Dose and Titration Schedule for Foquest in a 10-Year-Old Female
For a 10-year-old female, the recommended starting dose of Foquest is 25 mg once daily in the morning, with titration in 10-25 mg increments at weekly intervals based on clinical response and tolerability, up to a maximum of 70 mg daily.
Initial Dosing Considerations
Foquest (methylphenidate hydrochloride controlled-release capsules) is a long-acting stimulant medication used for ADHD treatment. When initiating treatment in pediatric patients, several factors must be considered:
- Age-appropriate dosing is critical for efficacy and safety
- Lower starting doses help minimize side effects
- Once-daily morning dosing is preferred due to the extended-release formulation
- Titration should be gradual to find the optimal therapeutic dose
Dosing Protocol
Starting Dose
- Begin with 25 mg once daily in the morning after breakfast
- Administer at a consistent time each day
- The extended-release formulation allows for once-daily dosing
Titration Schedule
- Increase dose in increments of 10-25 mg at weekly intervals
- Assess response using standardized rating scales from parents and teachers
- Monitor for side effects at each dose adjustment
- Continue titration until optimal symptom control is achieved or side effects become problematic
- Maximum recommended dose: 70 mg daily
Monitoring During Titration
During the initial titration phase (first 2-4 weeks), maintain weekly contact with the patient's caregivers to assess:
- Changes in target ADHD symptoms
- Potential side effects including:
- Appetite suppression
- Sleep disturbances
- Headaches
- Changes in mood or behavior
- Heart rate and blood pressure changes
- Weight should be measured at baseline and monitored regularly
Common Side Effect Management
- Insomnia: Ensure morning administration; avoid dosing after noon
- Appetite suppression: Monitor weight; encourage calorie-dense meals when appetite is better
- Headaches: Often transient; may require temporary dose reduction if severe
- Social withdrawal: May indicate dose is too high
Follow-up Schedule
- Weekly contact (in person or by phone) during initial titration
- Once stabilized on an effective dose, follow-up at least monthly until symptoms are well-controlled
- After stabilization, follow-up can be extended to every 2-3 months
Special Considerations
- If inadequate response is seen at the maximum dose, consider:
- Reassessing the diagnosis
- Evaluating for comorbid conditions
- Considering alternative medications
- Periodic drug holidays (e.g., during school breaks) may be considered to assess continued need for medication and to minimize potential growth effects
Practical Recommendations
- Use a consistent method of measuring response (standardized rating scales)
- Document baseline symptoms before starting medication
- Consider a fixed-dose titration trial where different doses are tried systematically to determine optimal response
- The maintenance phase begins once the optimal dose is established