Concerta Dosing Recommendations
For treatment-naïve children 6 years and older, start Concerta at 18 mg once daily in the morning, which is equivalent to methylphenidate 5 mg three times daily. 1
Pediatric Dosing (Ages 6 and Older)
Initial Dosing
- Start at 18 mg once daily in the morning for stimulant-naïve patients 1
- Concerta can be initiated directly without prior immediate-release methylphenidate trials 1
- Administer in the morning; timing with food does not affect absorption 2
Titration Schedule
- Increase in weekly increments if symptom control is inadequate 1
- Typical increases are by one capsule strength (18 mg, 27 mg, 36 mg, 54 mg) 1
- The titration phase typically requires 2-4 weeks 1
Maximum Dosing
- Maximum recommended dose is 54 mg daily for children 3
- The PDR states 60 mg/day as the upper limit for methylphenidate formulations, though Concerta-specific dosing typically caps at 54 mg 1
- Children weighing less than 25 kg should not receive single doses greater than 15 mg of immediate-release methylphenidate equivalent 1
Adolescent Dosing
- Concerta is particularly well-suited for adolescents due to its once-daily dosing, which maintains privacy and eliminates school-based administration 1
- The formulation is resistant to diversion (cannot be crushed or snorted) 1
- Dosing follows the same titration schedule as pediatric patients 1
- Can be supplemented with immediate-release stimulant in the afternoon before homework if needed 1
Adult Dosing
- Start at 18-36 mg once daily in the morning 3
- Maximum recommended daily dose is 60 mg 3
- Average effective dosage is 20-30 mg daily (methylphenidate equivalent) 3
- For adults unable to sleep if medication is taken late, ensure last dose is before 6 PM 3
Monitoring During Titration
Assessment Schedule
- Weekly contact (by telephone or in-person) during dose adjustments 1
- Once stabilized, follow-up appointments should occur at least monthly 1
Target Symptom Evaluation
- Obtain systematic ratings from parents and teachers at each adjustment 1
- Use standardized rating scales to supplement clinical assessment 1
- Self-ratings are essential for adolescents and adults 1
Side Effect Monitoring
- Systematically assess for insomnia, anorexia, headaches, social withdrawal, tics, and weight loss 1
- Weigh patient at each visit to objectively monitor appetite suppression 1
- Check blood pressure and pulse quarterly once on maintenance therapy 1
Key Clinical Advantages
Pharmacokinetic Profile
- Concerta produces an ascending plasma drug level pattern through its osmotic-release oral system (OROS) 1
- Provides 12-hour duration of effect with once-daily dosing 1, 4
- Food does not affect methylphenidate absorption from Concerta, providing consistent early drug exposure regardless of breakfast timing 2
Timing of Peak Effects
- Onset of action occurs approximately 90 minutes after ingestion 1
- Peak behavioral benefit occurs around 3 hours post-dose 1
- Maintains efficacy into early evening (up to 12 hours) 5
Important Caveats
- If no improvement occurs after appropriate dosage adjustment over one month, discontinue Concerta 3
- Plasma methylphenidate levels do not correlate with clinical response and should not guide dosing 1
- Weight-based dosing is not clinically useful due to high inter-individual variability in behavioral response 1, 6
- If paradoxical aggravation of symptoms occurs, reduce dosage or discontinue 3