What is the recommended starting dose for Quillichew (methylphenidate)?

Quillichew Starting Dose for ADHD

The recommended starting dose of Quillichew ER (methylphenidate extended-release chewable tablets) is 20 mg once daily in the morning, which can be titrated weekly in increments of 10-15 mg to a maximum of 60 mg per day. 1

Initial Dosing Strategy

• Start with 20 mg once daily in the morning for most patients 6 years and older 1
• The tablet must be chewed thoroughly before swallowing; it cannot be swallowed whole 2
• Administer with or without food, though consistency in administration timing relative to meals is recommended 1

Dose Titration Protocol

• Increase by 10-15 mg weekly based on clinical response and tolerability 1
• Assess efficacy using standardized ADHD rating scales when possible 3
• The maximum recommended daily dose is 60 mg 1
• If inadequate response occurs at maximum dose, consider switching to an alternative stimulant rather than exceeding 60 mg 3

Special Populations Requiring Lower Starting Doses

• Pediatric patients weighing less than 25 kg: Consider starting with lower doses, as single doses generally should not exceed 15 mg in this population 3
• Older or frail patients: May require starting doses as low as 2.5-5 mg, though this would necessitate using immediate-release formulations that can be split 3

Monitoring Requirements

• Check blood pressure and pulse before initiating treatment and regularly during dose titration 1
• Monitor for cardiovascular symptoms, particularly in patients with any cardiac history 1
• Assess height and weight in pediatric patients at baseline and regularly during treatment, as growth suppression can occur 1
• Screen for psychiatric risk factors (history of psychosis, bipolar disorder, family history of suicide) before initiating treatment 1

Clinical Considerations

• Quillichew ER uses ion exchange technology providing both immediate-release and extended-release components, with effects lasting approximately 8 hours 2, 4
• The chewable formulation improves convenience and may enhance adherence compared to tablets that must be swallowed whole 2, 4
• Peak plasma concentration occurs approximately 3-4 hours after administration 4
• The pharmacokinetic half-life of methylphenidate is 2-3 hours, but the extended-release formulation provides duration of action of 8-12 hours 5

Common Pitfalls to Avoid

• Do not start at doses higher than 20 mg unless the patient is already on another methylphenidate formulation and being switched 1
• Do not exceed 60 mg daily, as doses above this threshold are not recommended and increase risk of adverse effects without additional benefit 1
• Ensure patients understand the tablet must be chewed, not swallowed whole, as this affects the drug delivery system 2
• Avoid use in patients with structural cardiac abnormalities, cardiomyopathy, serious arrhythmias, or coronary artery disease 1
• Do not use within 14 days of MAOI therapy due to risk of hypertensive crisis 1

Abuse Potential and Storage

• Methylphenidate has high potential for abuse and misuse, which can lead to substance use disorder 1
• Educate patients and families about proper storage and disposal of unused medication 1
• Monitor regularly for signs of abuse, misuse, or diversion throughout treatment 1
• The chewable formulation may have reduced abuse potential compared to immediate-release tablets, as it cannot be easily crushed for intranasal or intravenous use 4