Converting from Adderall XR 30mg + Adderall IR 10mg to Focalin
Direct Conversion Recommendation
Convert the total daily Adderall dose of 40mg (30mg XR + 10mg IR) to Focalin XR 20mg once daily in the morning, using a 2:1 conversion ratio that accounts for dexmethylphenidate's greater potency as the isolated d-enantiomer. 1
Conversion Rationale and Pharmacology
The 2:1 conversion ratio (Adderall to Focalin) is based on the pharmacological principle that dexmethylphenidate (Focalin) contains only the d-threo enantiomer of methylphenidate, which is the more pharmacologically active isomer. 1 This makes it approximately twice as potent per milligram compared to mixed amphetamine salts. 1
Key Conversion Steps:
Calculate total daily Adderall dose: 30mg XR + 10mg IR = 40mg total daily dose 2
Apply 2:1 conversion ratio: 40mg Adderall ÷ 2 = 20mg Focalin XR as starting dose 1
Choose extended-release formulation: Use Focalin XR rather than IR to replicate the coverage provided by the combination of Adderall XR and IR 1, 3
Titration Protocol After Conversion
Allow at least one week at the initial Focalin XR 20mg dose before making any adjustments to assess tolerability and therapeutic response. 4
If symptom control is inadequate after one week, increase by 5mg increments weekly up to a maximum of 40mg daily 1
The maximum recommended daily dose of Focalin XR is 40mg, which should not be exceeded 1, 2
Monitor for both efficacy and side effects at each dose adjustment using standardized ADHD rating scales 1
Critical Monitoring Requirements
Schedule follow-up within 2-4 weeks post-conversion to systematically assess response and tolerability. 5
Essential monitoring parameters include:
Cardiovascular monitoring: Check blood pressure and pulse at the first follow-up visit and quarterly thereafter 2, 1
Symptom assessment: Use standardized ADHD rating scales to objectively measure changes in core symptoms 1
Weight monitoring: Weigh patient at each visit to detect appetite suppression, a common stimulant side effect 4
Side effect surveillance: Assess for insomnia, decreased appetite, irritability, and cardiovascular effects 5, 1
Important Clinical Pitfalls to Avoid
Do not use a 1:1 conversion ratio, as this would result in overdosing given dexmethylphenidate's greater potency. 1
Avoid making dose adjustments more frequently than weekly, as insufficient time between changes prevents accurate assessment of therapeutic response 5
Do not crush or open Focalin XR capsules, as this destroys the extended-release mechanism and can cause dangerous immediate release of the full dose 2
If the patient was taking the Adderall IR 10mg dose in the afternoon for symptom coverage, ensure the Focalin XR provides adequate duration (typically 10-12 hours) 6, 3
Consider that some patients may require afternoon supplementation with Focalin IR 5mg if extended-release coverage is insufficient 1
Alternative Approach if Conversion Fails
If Focalin XR 20-40mg fails to provide adequate symptom control, switch to an alternative stimulant class rather than exceeding maximum recommended doses. 2
Consider returning to methylphenidate-based products (Concerta, Ritalin LA) if dexmethylphenidate is not well-tolerated 1
Non-stimulant options like atomoxetine or viloxazine may be appropriate if stimulant side effects are problematic 5, 7
The clinical team should reassess the diagnosis and consider comorbid conditions if multiple stimulant trials fail 1