What is the recommended dose of Conserta (methylphenidate) for Attention Deficit Hyperactivity Disorder (ADHD)?

Concerta Dosing for ADHD

For treatment-naïve patients, start Concerta 18 mg once daily in the morning, which is equivalent to methylphenidate 5 mg three times daily. 1

Initial Dosing

• Treatment-naïve patients (children and adults): Begin with Concerta 18 mg once daily in the morning 1
• Patients currently on immediate-release methylphenidate: Convert based on current total daily dose:
  • If taking methylphenidate 5 mg three times daily (15 mg/day total), start Concerta 18 mg 1
  • If taking methylphenidate 10 mg twice or three times daily (20-30 mg/day total), start Concerta 36 mg 1

Titration Schedule

• Pediatric patients (6 years and older): Start at 5 mg twice daily (before breakfast and lunch) for immediate-release formulations, or 18 mg once daily for Concerta 2
• Increase by 5-10 mg weekly until optimal symptom control is achieved 2
• Maximum daily dose: 60 mg regardless of formulation 2, 3
• For children weighing less than 25 kg: Single doses should not exceed 15 mg 4

Adult Dosing

• Starting dose: 18 mg once daily in the morning for Concerta 1
• Average effective dose: 20-30 mg daily (for immediate-release formulations administered 2-3 times daily) 2
• Maximum recommended dose: 60 mg daily 2
• Administer preferably 30-45 minutes before meals when using immediate-release formulations 2

Monitoring Requirements

• Assess vital signs (blood pressure and pulse) at baseline and with each dose increase 4
• Use standardized ADHD rating scales to guide dose adjustments 4
• Schedule follow-up appointments at least monthly until symptoms are stabilized 4
• Monitor for side effects including agitation, insomnia, decreased appetite, and cardiovascular changes 1

Key Clinical Considerations

Concerta's unique pharmacokinetic profile: The osmotic-release oral system (OROS) produces an ascending plasma drug level pattern throughout the day, with 22% delivered as an immediate-release overcoat and the remainder released gradually 1, 5

Duration of action: Concerta provides approximately 12 hours of symptom control, compared to 8 hours for other extended-release formulations like Metadate CD or Ritalin LA 3, 5

Timing of peak effects: Concerta demonstrates superiority in the early evening (maintaining efficacy during homework time), while other formulations may show earlier morning peaks 5, 6

Common Pitfalls to Avoid

• Do not exceed 60 mg daily dose regardless of patient weight or severity of symptoms 2, 3
• Avoid administering late in the day to minimize insomnia risk 1
• Do not use plasma levels to guide dosing as they do not correlate with clinical response 1
• Screen for cardiac abnormalities before initiating treatment and avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious arrhythmias, or coronary artery disease 2
• Assess for psychiatric comorbidities including risk factors for mania, as new psychotic or manic symptoms may require discontinuation 2

Contraindications

• Absolute contraindications: Known hypersensitivity to methylphenidate, concurrent MAOI use, or MAOI use within 14 days 2
• Relative contraindications: Uncontrolled hypertension, underlying coronary artery disease, tachyarrhythmias 1

Side Effect Management

Most common adverse effects: Tachycardia, palpitations, headache, insomnia, anxiety, hyperhidrosis, weight loss, decreased appetite, dry mouth, nausea, and abdominal pain 2

• For insomnia: Reduce dose or administer earlier in the day 1
• For appetite suppression: Consider drug holidays on weekends or school breaks if growth suppression occurs 2
• Monitor growth parameters closely in pediatric patients, as treatment interruption may be needed if not growing as expected 2