Liquid and Dissolvable ADHD Medications
Methylphenidate oral solution (5 mg/5 mL or 10 mg/5 mL) is the FDA-approved liquid formulation for ADHD treatment in patients 6 years and older, dosed at 5 mg twice daily initially and titrated by 5-10 mg weekly up to a maximum of 60 mg daily. 1
FDA-Approved Liquid Formulation
- Methylphenidate hydrochloride oral solution is the only FDA-approved liquid stimulant medication for ADHD, available as a colorless, grape-flavored liquid in 5 mg/5 mL and 10 mg/5 mL concentrations 1
- For pediatric patients 6 years and older, start at 5 mg orally twice daily before breakfast and lunch (preferably 30-45 minutes before meals), increasing gradually in 5-10 mg weekly increments 1
- For adults, administer in divided doses 2-3 times daily, 30-45 minutes before meals, with a maximum daily dose of 60 mg and average effective dose of 20-30 mg daily 1
- Adults who experience sleep difficulties should take the last dose before 6 p.m. 1
Chewable Tablet Options
- QuilliChew ER (methylphenidate extended-release chewable tablet) provides once-daily dosing for patients who cannot swallow pills, using ion exchange technology with both immediate-release and extended-release components 2
- Chewable tablets must be chewed before swallowing and offer advantages in portability, ease of titration, and acceptability for certain patients 2
- Extended-release chewable formulations allow once-daily dosing, which improves medication adherence and reduces rebound effects compared to immediate-release preparations 3
Alternative Non-Swallowable Formulations
Beyond liquid and chewable options, several other delivery systems exist for patients with swallowing difficulties:
- Sprinkle capsule formulations allow the contents to be sprinkled on food, providing flexibility for patients who cannot swallow capsules 4
- Orally disintegrating tablets dissolve in the mouth without water, offering convenience and improved compliance 4
- Transdermal patches deliver methylphenidate through the skin, avoiding oral administration entirely 3, 4
Clinical Considerations for Formulation Selection
- Long-acting formulations are strongly preferred over short-acting preparations due to better medication adherence, lower risk of rebound effects, and more consistent symptom control throughout the day 3, 5
- Physicians should consider pharmacokinetic differences between formulations, particularly the rate at which peak levels are attained and decline, to match the patient's symptom profile and individual needs 3
- Methylphenidate oral solution has high abuse potential and requires careful monitoring, with assessment of each patient's risk for abuse, misuse, and addiction before prescribing 1
Monitoring Requirements
- Monitor blood pressure and pulse at baseline and regularly during treatment, as stimulants cause statistically significant increases that may be clinically relevant for patients with preexisting cardiovascular conditions 3
- Track height and weight regularly, as psychostimulants are associated with statistically significant reductions in height and weight gain, though effects are usually minor 3
- Common adverse effects include decreased appetite, sleep disturbances, increased blood pressure and pulse, headaches, irritability, and stomach pain 3
Contraindications and Warnings
- Methylphenidate oral solution is contraindicated in patients with known hypersensitivity to methylphenidate, those receiving MAOIs, or within 14 days of MAOI discontinuation due to hypertensive crisis risk 1
- Screen for cardiac disease (careful history, family history of sudden death or ventricular arrhythmia, physical exam) and evaluate for motor/verbal tics or Tourette's syndrome before initiating treatment 1
- Misuse and abuse can result in overdose and death, with increased risk at higher doses or unapproved administration methods such as snorting or injection 1