Aptensio XR (Methylphenidate) Dosing Recommendations
The recommended starting dosage for Aptensio XR (methylphenidate hydrochloride extended-release capsules) is 10 mg once daily in the morning for pediatric patients 6 years and older, with gradual dose increases of 5-10 mg weekly as needed, not exceeding 60 mg daily. 1
Dosing Guidelines by Age Group
Children 6 Years and Older
- Starting dose: 10 mg once daily in the morning
- Titration: Increase by 5-10 mg weekly based on response and tolerability
- Maximum daily dose: 60 mg 1
- Administer preferably 30-45 minutes before breakfast
Adults
- Starting dose: 10 mg once daily in the morning
- Titration: Increase gradually in 5-10 mg increments weekly
- Average effective dose: 20-30 mg daily
- Maximum daily dose: 60 mg 1
- Administer the last dose before 6 p.m. to avoid sleep disturbances
Titration Process
- Begin with 10 mg once daily
- Assess response after 1 week using standardized rating scales
- If inadequate response with minimal side effects, increase by 5-10 mg
- Continue weekly adjustments until optimal response is achieved
- Monitor for side effects at each dose increase
Special Considerations
Pretreatment Screening
Before initiating Aptensio XR, assess for:
- Cardiac disease (history, family history of sudden death, physical exam) 1
- History of motor or verbal tics or Tourette's syndrome
- Risk of abuse, misuse, or addiction
Dose Reduction and Discontinuation
- If paradoxical aggravation of symptoms occurs, reduce dose or discontinue 1
- If no improvement is observed after appropriate dose adjustments over one month, discontinue treatment
Safety Monitoring
- Monitor blood pressure and heart rate regularly, as methylphenidate can increase both 1
- Watch for signs of abuse, misuse, or addiction throughout treatment
- Monitor growth in pediatric patients
Common Pitfalls to Avoid
- Underdosing: Research shows flexible titration to optimal doses improves both efficacy and acceptability 2
- Inadequate monitoring: Failure to assess both therapeutic response and side effects can lead to suboptimal outcomes
- Abrupt discontinuation: This may lead to withdrawal symptoms; taper gradually when discontinuing
- Evening dosing: Administering doses too late in the day can cause insomnia
Toxicity Concerns
- Ingestion of more than 2 mg/kg or 60 mg (whichever is less) of immediate-release formulations requires emergency department referral 3
- For extended-release formulations like Aptensio XR, emergency referral is recommended for ingestions exceeding 4 mg/kg or 120 mg 3
Remember that Aptensio XR is a controlled substance with potential for abuse and misuse. Proper patient education regarding safe storage and proper disposal is essential to minimize these risks 1.