Recommended Dosages for ADHD Medications
For optimal treatment of ADHD, methylphenidate should be started at 5 mg twice daily for children and titrated weekly by 5-10 mg increments to a maximum of 60 mg daily, while atomoxetine should be initiated at 0.5 mg/kg/day and titrated to 1.2-1.8 mg/kg/day with a maximum of 100 mg daily. 1
Stimulant Medications
Methylphenidate (MPH)
Children and Adolescents (6+ years)
- Starting dose: 5 mg twice daily (before breakfast and lunch) 1, 2
- Titration: Increase by 5-10 mg weekly based on response and side effects 1
- Maximum daily dose: 60 mg (not to exceed this amount regardless of formulation) 1, 2
- Children weighing less than 25 kg should generally not receive single doses greater than 15 mg 1
Adults
- Starting dose: 5-10 mg twice or three times daily 2
- Average dosage: 20-30 mg daily 2
- Maximum daily dose: 60 mg 2
- Administration: Preferably 30-45 minutes before meals 2
Amphetamine Formulations
Children and Adolescents
- Starting dose: 2.5 mg for dextroamphetamine/amphetamine 1
- Maximum daily dose: 40 mg for amphetamines 1
- For lisdexamfetamine: Titrate based on clinical response with maximum of 70 mg daily 1, 3
Adults
- Maximum daily dose: 40 mg for dextroamphetamine/amphetamine 3
- For lisdexamfetamine: Up to 70 mg daily 1
Non-Stimulant Medications
Atomoxetine
- Starting dose: 0.5 mg/kg/day 1
- Target dose: 1.2-1.8 mg/kg/day 1, 4
- Maximum daily dose: 100 mg in Malaysia and India, 120 mg in Japan 1
- Administration: Can be given as a single daily dose or split into two evenly divided doses 1, 5
- Duration: Treatment effects typically observed after 6-12 weeks of treatment 1
Clonidine
- Available dosages: 0.1 mg and 0.2 mg tablets 1
- Starting dose: 0.1 mg tablet at bedtime 1
- Titration: Increase to twice-daily administration with careful uptitration 1
- Maximum daily dose: 0.4 mg 1
- Duration: Treatment effects typically observed after 2-4 weeks 1
Guanfacine
- Available dosages: 1,2,3, and 4 mg tablets 1
- Dosing: Adjusted to body weight (approximately 0.1 mg/kg as a rule of thumb) 1
- Maximum daily dose: 6 mg 1
- Administration: Once-daily, preferably in the evening due to somnolence/fatigue side effects 1
- Duration: Treatment effects typically observed after 2-4 weeks 1
Monitoring and Titration Guidelines
- Titrate medication doses based on clinical response and presence of side effects 1, 3
- Use standardized rating scales from parents and teachers for children, and self-reports for adults 3
- Monitor vital signs including blood pressure, pulse, height, and weight at each visit 3, 2
- During initial titration, maintain weekly contact (can be by telephone) 1
- After stabilization, follow-up appointments should be at least monthly 1
Important Considerations
- Individual response to medications varies significantly; some patients may require higher or lower doses 1, 6
- Weight-adjusted dosing may not be reliable for all patients, as individual response varies 1
- Non-stimulants generally have smaller effect sizes compared to stimulants and are often considered second-line treatments 1
- Stimulants have a rapid onset of action (within hours), while non-stimulants take weeks to reach full effectiveness 1, 7
- Common side effects of stimulants include decreased appetite, insomnia, and increased heart rate/blood pressure 1, 2
- Common side effects of non-stimulants include somnolence, fatigue, and irritability for alpha-2 agonists (clonidine, guanfacine) 1