What is the maximum recommended dose of Focalin (dexmethylphenidate) for Attention Deficit Hyperactivity Disorder (ADHD)?

Maximum Dose of Focalin (Dexmethylphenidate)

The maximum recommended dose of Focalin is 30 mg/day for pediatric patients and 40 mg/day for adult patients, as daily doses above these levels have not been studied and are not recommended. 1

Pediatric Patients (Ages 6-17 Years)

• Maximum dose: 30 mg once daily 1
• Start with 5 mg once daily in the morning for patients new to methylphenidate 1
• Titrate weekly in increments of 5 mg based on symptom control and tolerability 1
• Children weighing less than 25 kg generally should not receive single doses greater than 15 mg 2
• The extended-release formulation provides symptom control for up to 12 hours after administration 3, 4

Adult Patients (Ages 18 and Older)

• Maximum dose: 40 mg once daily 1
• Start with 10 mg once daily in the morning for patients new to methylphenidate 1
• Titrate weekly in increments of 10 mg based on response 1
• Older adults may require more conservative titration (5 mg every 2 weeks instead of weekly) due to increased sensitivity to both therapeutic and adverse effects 2

Conversion from Other Methylphenidate Formulations

• For patients switching from racemic methylphenidate (d,l-MPH), start with half the total daily dose of the racemic formulation 1
• For patients already on immediate-release dexmethylphenidate, use the same total daily dose when converting to extended-release 1
• This 2:1 potency ratio reflects that dexmethylphenidate contains only the active d-enantiomer 5

Monitoring During Titration

• Assess blood pressure and pulse at baseline and with each dose increase 2
• Use standardized ADHD rating scales (such as ADHD-RS-IV or Conners' scales) from both parents and teachers before each dose increase 2, 3
• Schedule follow-up appointments at least monthly until symptoms are stabilized 2
• Evaluate both therapeutic effects and side effects before each dose increase 2

Important Caveats

• Doses above the maximum have not been studied and carry unknown risks 1
• If improvement is not observed after appropriate dosage adjustment over a one-month period, discontinue the medication 1
• The extended-release formulation should not be divided—patients must take the entire capsule contents 1
• Consider switching to alternative stimulants or adding non-stimulant medications if maximum dose provides inadequate symptom control 6