Concerta Dosing for ADHD
For stimulant-naïve children and adolescents with ADHD, 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)
- Starting dose: 18 mg once daily in the morning for stimulant-naïve patients 1
- Titration: Increase by 18 mg weekly increments based on response and tolerability 2
- Dose range: 18-54 mg once daily 1, 3
- Maximum dose: 54 mg daily (equivalent to methylphenidate 15 mg three times daily) in most clinical trials 3, 4
- FDA-approved maximum: Up to 60 mg daily, though doses above 60 mg are not recommended 2
The 18 mg starting dose provides coverage throughout the 12-hour day with an ascending plasma concentration profile due to Concerta's osmotic-controlled release system (OROS). 1
Adult Dosing
- Typical range: 18-72 mg once daily in the morning 1
- Starting approach: Begin with 18-36 mg once daily and titrate based on response 1
- Target dose: Most adults respond to 36-54 mg daily 1
- Maximum recommended: 72 mg daily in standard practice, though the FDA label indicates 60 mg as the maximum 2
Adults with ADHD may require higher total daily doses (up to 1 mg/kg) compared to children to achieve optimal symptom control. 1
Dose Equivalency
Concerta doses are approximately 20% higher on a total daily basis than immediate-release methylphenidate given three times daily to achieve equivalent symptom control throughout the day: 1, 3
- 18 mg Concerta = 5 mg immediate-release methylphenidate three times daily
- 36 mg Concerta = 10 mg immediate-release methylphenidate three times daily
- 54 mg Concerta = 15 mg immediate-release methylphenidate three times daily
Key Clinical Considerations
Duration of action: Concerta provides 12 hours of symptom control with once-daily morning dosing, making it superior to older sustained-release formulations that only lasted 6-8 hours. 1, 3, 5
Food effects: Unlike amphetamine-based extended-release formulations, Concerta provides consistent early drug exposure regardless of whether taken with or without food, making it more reliable for morning symptom control. 6
Adolescent advantages: Concerta is particularly well-suited for adolescents because it eliminates school-day dosing, maintains privacy, and is resistant to diversion (cannot be crushed or snorted). 1
Monitoring requirements: Monitor blood pressure, heart rate, growth parameters (height and weight), and psychiatric symptoms throughout treatment. 2
Common Pitfalls to Avoid
- Underdosing: Do not assume the 18 mg starting dose is therapeutic—most patients require titration to 36-54 mg for optimal response 3, 4
- Premature discontinuation: Allow at least one week at each dose level before increasing to assess full therapeutic effect 2
- Evening coverage: If symptoms return in late evening, consider adding a small immediate-release methylphenidate dose (5-10 mg) in the late afternoon rather than increasing Concerta dose 1
- Cardiac screening: Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious arrhythmias, or coronary artery disease 2