Concerta Dosage Recommendations
For pediatric patients 6 years and older, start Concerta at 18 mg once daily in the morning, increasing by 18 mg weekly as needed up to a maximum of 54-72 mg daily; for adults, typical dosing ranges from 18-72 mg once daily, with most patients responding to 36-54 mg daily. 1
Pediatric Dosing (Ages 6 and Older)
Starting dose: 18 mg once daily taken in the morning 1
Titration schedule:
- Increase by 18 mg weekly increments based on clinical response and tolerability 1
- Maximum recommended daily dose is 54 mg for most children, though doses up to 72 mg have been studied 2, 3
- Daily dosages above 60 mg are generally not recommended per FDA labeling 1
Conversion from immediate-release methylphenidate (Ritalin):
- Concerta 18 mg once daily is equivalent to methylphenidate IR 5 mg three times daily (15 mg total daily dose) 4
- Concerta 36 mg once daily is equivalent to methylphenidate IR 10 mg three times daily (30 mg total daily dose) 2
- Concerta 54 mg once daily is equivalent to methylphenidate IR 15 mg three times daily (45 mg total daily dose) 2
- Important caveat: Concerta doses are approximately 20% higher on a daily basis than equivalent tid regimens of IR methylphenidate to achieve the ascending rate of delivery needed for continuous 12-hour coverage 2
Adult Dosing
Starting dose: 18-36 mg once daily in the morning 1
Titration:
- Increase by 18 mg weekly as tolerated 1
- Average effective dosage is 36-54 mg daily 1
- Maximum recommended daily dosage is 72 mg 1, 3
Administration Guidelines
Timing and food considerations:
- Administer once daily in the morning, preferably 30-45 minutes before breakfast 1
- Critical advantage: Unlike amphetamine-based extended-release formulations, Concerta provides consistent early drug exposure regardless of whether taken with or without food 5
- The osmotic-controlled OROS delivery system ensures reliable methylphenidate delivery independent of food intake 5
Duration of action:
- Provides therapeutic coverage for approximately 12 hours 2, 3
- Eliminates the need for midday dosing at school or work 3
Conversion Challenges and Solutions
When switching from immediate-release to Concerta, be aware that:
- More than 43% of patients may require additional doses of IR methylphenidate in the evening when Concerta's effect wears off 6
- Approximately 55% of patients need higher than the recommended equivalent doses of Concerta for successful conversion 6
- Clinical strategy: If standard equivalent dosing is insufficient, consider either increasing the Concerta dose above the calculated equivalent or adding a small evening dose of IR methylphenidate (typically 5-10 mg) 6
Special Populations and Monitoring
Renal impairment:
- Patients with renal impairment may experience more pronounced side effects as methylphenidate is primarily excreted through the kidneys 7
- Consider dose reduction and closer monitoring in this population 7
Pediatric growth monitoring:
- Closely monitor height and weight in pediatric patients throughout treatment 1
- Patients not growing or gaining weight as expected may need treatment interruption 1
Cardiovascular monitoring:
- Monitor blood pressure and pulse regularly 1
- Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmias, coronary artery disease, or other serious cardiac disease 1
Common Side Effects and Management
Most frequent adverse reactions:
- Decreased appetite, insomnia, headache, abdominal pain, nausea 1, 2
- Tachycardia, palpitations, anxiety, hyperhidrosis, weight loss 1
Nausea management specifically:
- Take with food in the morning to reduce nausea 7
- Nausea is typically more pronounced during initiation or dose increases, with tolerance developing within a few days 7
- If severe, consider temporary dose reduction followed by slower titration 7
Contraindications
Absolute contraindications: