What is the equivalent dose of Ritalin (methylphenidate) when starting Concerta (methylphenidate extended-release)?

Dose Conversion from Ritalin to Concerta

When converting from immediate-release Ritalin (methylphenidate) to Concerta, the starting dose of Concerta should be approximately 20% higher than the total daily dose of Ritalin to account for the extended-release delivery system. 1

Conversion Algorithm

Standard Conversion Ratios

• If taking Ritalin 5 mg three times daily (15 mg/day total): Start Concerta 18 mg once daily 1
• If taking Ritalin 10 mg three times daily (30 mg/day total): Start Concerta 36 mg once daily 1
• If taking Ritalin 15 mg three times daily (45 mg/day total): Start Concerta 54 mg once daily 1

The 20% dose increase in Concerta compensates for the ascending rate of methylphenidate delivery required to provide continuous 12-hour coverage equivalent to three-times-daily immediate-release dosing. 1

Starting De Novo (No Prior Ritalin Use)

• Pediatric patients (6 years and older) and adults with no prior stimulant exposure: Begin with Concerta 18 mg once daily in the morning 2
• Adults with prior stimulant exposure: May start at Concerta 36 mg once daily 2

Pharmacokinetic Rationale

The conversion accounts for critical differences in drug delivery:

• Immediate-release Ritalin reaches peak plasma concentration in 1-3 hours with effects lasting approximately 4 hours, necessitating multiple daily doses 3
• Concerta uses an osmotic pump system (OROS technology) that provides 12 hours of clinical action, designed to mimic three-times-daily dosing of immediate-release methylphenidate 3, 4
• The starting dose of Concerta 18 mg produces significantly different clinical effects than Ritalin LA 20 mg in head-to-head comparisons, with Ritalin LA 20 mg showing superior morning control (AUC 0-4 hours) compared to Concerta 18 mg 5

Critical Caveats

OROS vs Non-OROS Formulations

• Only use authorized generic Concerta with OROS technology - non-OROS generic extended-release methylphenidate formulations show significantly inferior symptom control at equivalent doses, with mean T-score differences of 23 points on inattention scales 6
• The FDA has raised concerns about therapeutic equivalence of non-OROS generics 6

Titration After Conversion

• Assess response after 1 week at the initial Concerta dose before making adjustments 2
• Increase by 18 mg increments weekly if symptom control is inadequate and current dose is well-tolerated 2
• Maximum doses: 72 mg daily for adolescents and adults; 60 mg daily for children under 45 pounds 2

Extended Coverage Needs

• For coverage beyond 12 hours: Add 5-10 mg immediate-release methylphenidate in late afternoon rather than increasing Concerta dose 2
• This approach maintains the benefits of once-daily dosing while extending symptom control into evening hours 2

Monitoring Requirements

• Monitor for nausea during the first week, which occurs in up to 25% of patients starting methylphenidate 2
• Use standardized ADHD rating scales from multiple informants (parents, teachers, patient) to assess response 2
• Common side effects include decreased appetite and insomnia, which can be managed by dose adjustment or timing modifications 7