Extended-Release Methylphenidate Dosing
For extended-release methylphenidate formulations, start with 18-20 mg once daily in the morning and titrate upward based on response, with typical effective doses ranging from 18-54 mg daily for Concerta (OROS-methylphenidate) and 10-40 mg daily for Ritalin LA, both providing 10-12 hours of symptom control with once-daily administration. 1, 2, 3
Concerta (OROS-Methylphenidate) Dosing
- Initial dose: 18 mg once daily in the morning 1
- Available strengths: 18 mg, 36 mg, and 54 mg tablets 1
- Dose equivalency: 18 mg Concerta ≈ methylphenidate 5 mg three times daily 1
- Duration of action: Full 12-hour coverage with onset within 1-2 hours 1, 2
- Titration approach: Increase dose based on clinical response, with adults often requiring higher total daily doses than children due to longer workday coverage needs 1
The OROS technology delivers methylphenidate through an osmotic pump system that produces an ascending plasma drug level pattern throughout the day, which overcomes acute tolerance (tachyphylaxis) that limited earlier sustained-release formulations 2. This ascending profile matches the efficacy of immediate-release methylphenidate given three times daily but eliminates the need for multiple doses 2.
Ritalin LA (Extended-Release) Dosing
- Initial dose: 10-20 mg once daily in the morning 3
- Typical dose range: 10-40 mg once daily 4, 3
- Pharmacokinetic profile: Demonstrates two distinct peak plasma concentrations approximately 4 hours apart, mimicking immediate-release methylphenidate 10 mg given twice, 4 hours apart 3
- Duration of action: Provides coverage throughout the school/work day with once-daily administration 3, 5
Pediatric Considerations for Extended-Release Formulations
- In children with ADHD (ages 6-12): Extended-release methylphenidate 10-40 mg once daily was significantly more effective than placebo for both inattention and hyperactivity symptoms 3, 6
- In children with autism spectrum disorder and comorbid ADHD: Methylphenidate extended-release 10-40 mg each morning significantly decreased hyperactivity and inattention 4
- Onset of effect: 1 hour post-dose, with efficacy maintained through 12 hours 6
Adult Dosing Considerations
- Adults with ADHD often require higher total daily doses than children to maintain symptom coverage throughout a longer workday 1
- Doses above 72 mg may be needed in some adults, but this requires clear documentation that lower doses were inadequate and higher doses are not producing prohibitive side effects 1
- Response assessment: If no response occurs after 4 weeks at maximum tolerated dose, consider switching to an alternative stimulant 1
Key Advantages of Extended-Release Formulations
- Once-daily morning administration improves compliance and reduces risk of medication diversion, particularly in adolescents 1
- Eliminates need for school-based dosing, reducing stigma and logistical challenges 3, 5
- Concerta provides persistent efficacy into late afternoon/evening for homework completion 5
- Safety and tolerability profiles are consistent with immediate-release methylphenidate 3
Common Pitfalls to Avoid
- Do not expect immediate onset like immediate-release formulations; extended-release has more gradual onset over 1-2 hours 1
- Avoid evening administration to minimize sleep disturbances; morning dosing is recommended 1
- Do not assume all extended-release formulations are equivalent; Concerta's OROS technology provides different pharmacokinetics than Ritalin LA's bimodal release pattern 2, 3