What is the recommended dose of Concerta (methylphenidate) for adults?

Concerta Dosing for Adults

For adults with ADHD, start Concerta at 18 mg once daily in the morning and titrate weekly by 18 mg increments as needed, with a maximum recommended daily dose of 72 mg (equivalent to 60 mg of immediate-release methylphenidate). 1, 2

Starting Dose and Initial Administration

• Begin with 18 mg once daily in the morning, which can be initiated directly without prior immediate-release methylphenidate trials 1
• Administer in the morning; for patients who cannot sleep if medication is taken late in the day, ensure the dose is given well before evening 2
• The formulation provides approximately 12-hour duration of effect with onset of action around 90 minutes and peak behavioral benefit at 3 hours post-dose 1

Titration Schedule

• Increase weekly by one capsule strength (18 mg, 27 mg, 36 mg, 54 mg, up to 72 mg) if symptom control is inadequate 1
• The titration phase typically requires 2-4 weeks to reach optimal dosing 1
• Weekly contact (telephone or in-person) during dose adjustments is essential 1

Maximum Dosing

• Maximum daily dose is 72 mg for Concerta (extended-release formulation) 1
• This corresponds to the 60 mg maximum for immediate-release methylphenidate formulations 2
• The average effective dosage range is 20-30 mg daily of methylphenidate equivalent 2

Monitoring Requirements

• Self-ratings are essential for adults to assess treatment response 1
• Once stabilized, follow-up appointments should occur at least monthly 1
• Systematically assess for insomnia, anorexia, headaches, social withdrawal, and tics at each visit 1
• Check blood pressure and pulse quarterly once on maintenance therapy, as CNS stimulants increase blood pressure (mean 2-4 mmHg) and heart rate (mean 3-6 bpm) 2

Important Clinical Considerations

• Plasma methylphenidate levels do not correlate with clinical response and should not guide dosing decisions 1
• Weight-based dosing is not clinically useful due to high inter-individual variability in behavioral response 1, 3
• The formulation is resistant to diversion (cannot be crushed or snorted), making it appropriate for adults concerned about abuse potential 1
• Food does not significantly affect methylphenidate absorption from Concerta, providing consistent early drug exposure regardless of breakfast timing 4

Discontinuation Criteria

• If paradoxical aggravation of symptoms or adverse reactions occur, reduce dosage or discontinue 2
• If no improvement is observed after appropriate dosage adjustment over one month, discontinue Concerta 2

Contraindications and Precautions

• Contraindicated in patients with known hypersensitivity to methylphenidate, those receiving MAOIs, or within 14 days of MAOI discontinuation 2
• Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease 2
• Assess cardiac disease risk (careful history, family history of sudden death or ventricular arrhythmia, physical exam) before initiating treatment 2