Focalin Starting Dose for ADHD
Recommended Starting Doses
For pediatric patients (ages 6-17) who are new to methylphenidate, start Focalin (dexmethylphenidate) extended-release at 5 mg once daily in the morning, while adults should start at 10 mg once daily in the morning. 1
Dosing Based on Prior Methylphenidate Use
Patients Already Taking Methylphenidate
- If the patient is currently taking racemic methylphenidate (standard methylphenidate), start Focalin at half (1/2) the total daily dose of their current methylphenidate regimen 1
- This conversion accounts for the fact that dexmethylphenidate contains only the active d-isomer, making it approximately twice as potent as racemic methylphenidate 2
Patients Already Taking Immediate-Release Dexmethylphenidate
- If switching from immediate-release dexmethylphenidate tablets to extended-release capsules, use the same total daily dose 1
Titration Schedule
- Pediatric patients: Increase by 5 mg increments weekly based on clinical response and tolerability 1
- Adult patients: Increase by 10 mg increments weekly based on clinical response and tolerability 1
Maximum Doses
- Pediatric patients: 30 mg daily (doses above this have not been studied and are not recommended) 1
- Adult patients: 40 mg daily (doses above this have not been studied and are not recommended) 1
Administration Details
- Administer once daily in the morning, with or without food 1
- Capsules may be swallowed whole OR opened and sprinkled on applesauce (consume immediately without chewing; do not store) 1
- The bimodal release profile mimics two doses given 4 hours apart, providing symptom control throughout the day 3
Clinical Monitoring During Titration
The FDA label emphasizes pretreatment screening for cardiac disease through careful history, family history of sudden death or ventricular arrhythmia, and physical examination 1. Additionally, assess family history and clinically evaluate for motor or verbal tics or Tourette's syndrome before initiating treatment 1.
Evidence for Efficacy
Clinical trials demonstrate that all three doses (10,20, and 30 mg once daily) are significantly more effective than placebo in improving ADHD symptoms, with effects lasting 6-12 hours post-dose 4, 2. The 30 mg dose provides superior late-day symptom control (10-12 hours post-dose) compared to 20 mg in children previously stabilized on higher methylphenidate doses 5.
Common Pitfalls to Avoid
- Do not start at too high a dose in treatment-naive patients, as this increases unnecessary side effects and decreases medication adherence 6
- Do not forget the 2:1 conversion ratio when switching from racemic methylphenidate to dexmethylphenidate 1, 2
- Do not divide capsule contents—patients must take the entire capsule dose 1