Equivalent Focalin Dose for Concerta 56mg
For a patient taking Concerta 56mg, the equivalent Focalin (dexmethylphenidate) dose is approximately 28mg total daily, which can be given as 14mg twice daily or 28mg once daily if using the extended-release formulation. 1
Conversion Rationale
The conversion between these medications follows a straightforward 2:1 ratio (Concerta:Focalin) based on the pharmacological principle that dexmethylphenidate is the isolated active d-isomer of methylphenidate, making it approximately twice as potent per milligram. 1, 2
Dexmethylphenidate provides effective ADHD management at half the dose of racemic methylphenidate because it contains only the therapeutically active d-threo-enantiomer, eliminating the inactive l-isomer present in standard methylphenidate formulations. 2
The FDA-approved dosing guidance confirms that when converting from methylphenidate to dexmethylphenidate, the dexmethylphenidate dose should be half the total daily methylphenidate dose. 3
Practical Dosing Options
For Concerta 56mg (which is not a standard manufacturer dose but may represent combination dosing), you have two main approaches:
Immediate-release Focalin: 14mg twice daily (morning and midday), totaling 28mg daily 3
Extended-release Focalin XR: 28mg once daily in the morning, which provides bimodal release mimicking two doses given 4 hours apart 4
The extended-release formulation offers the advantage of once-daily dosing, eliminating the need for a midday school dose and potentially improving adherence, particularly in adolescents. 1, 4
Transition Protocol
An immediate transition can be made without a washout period. 1
Start the equivalent Focalin dose (28mg total daily) on the day after the last Concerta dose 1
Monitor for nausea, which occurs in up to 25% of patients starting methylphenidate-based medications; taking medication with food in the morning may reduce this side effect 1
Titrate in 5mg increments weekly if needed, with a maximum recommended dose of 30mg daily in pediatric patients and 40mg daily in adults 3
Important Clinical Considerations
Dose adjustments should be based on clinical response rather than strict mathematical conversion, as plasma methylphenidate levels do not correlate well with therapeutic effect. 5
The bimodal release profile of Focalin XR provides rapid onset (within 0.5 hours) with duration of action lasting 11-12 hours post-administration 4
If oral tics develop after transition, consider adding alpha-agonists (clonidine or guanfacine) as adjunctive therapy rather than discontinuing the stimulant 1
Focalin XR capsules can be opened and sprinkled on applesauce for patients unable to swallow capsules whole 3
Abuse Potential Advantage
Concerta's OROS delivery system provides some abuse deterrence as the medication is in a paste form that cannot be easily crushed or snorted, though this advantage is lost when switching to immediate-release Focalin. 1 Extended-release Focalin XR maintains lower abuse potential compared to immediate-release formulations. 4