Concerta 27mg to Focalin Conversion
When converting from Concerta 27mg to Focalin (dexmethylphenidate), start with Focalin XR 10mg once daily in the morning, as dexmethylphenidate is approximately twice as potent as racemic methylphenidate on a milligram basis. 1
Conversion Rationale
Dexmethylphenidate contains only the d-threo-enantiomer of methylphenidate, which is the pharmacologically active component, making it approximately 2:1 more potent than racemic methylphenidate (found in Concerta) 1
Concerta 27mg delivers methylphenidate through an osmotic pump system with 22% immediate release, providing coverage for 10-12 hours 2, 3
The appropriate starting dose of Focalin XR when converting from Concerta 27mg is 10mg once daily, which accounts for the doubled potency of the d-enantiomer 1
Switching Protocol
Discontinue Concerta and start Focalin XR the next morning without any washout period, as both medications have short half-lives and direct transition is safe 4
Focalin XR has a bimodal release profile mimicking two doses of immediate-release dexmethylphenidate given 4 hours apart, allowing once-daily administration 1
Expect therapeutic effects within 0.5-1 hours of administration, with duration of action lasting approximately 11-12 hours 1
Titration Strategy
Assess response after 1 week at the initial 10mg dose before making adjustments 5
If symptom control is inadequate after 1 week, increase by 5mg increments weekly based on clinical response 1
Allow at least 4 weeks at a therapeutic dose before determining treatment failure 5
Maximum recommended dose is typically 20mg daily for Focalin XR 1
Administration Considerations
Focalin XR capsules can be opened and sprinkled on applesauce for patients unable to swallow capsules whole, maintaining the extended-release properties 1
Administer consistently with or without food, as high-fat meals may affect absorption kinetics 4
Monitoring Parameters
Monitor cardiovascular parameters including pulse and blood pressure at baseline and during treatment 5
Watch for appetite suppression and sleep disturbances, which are common with all methylphenidate formulations 3
Continue height and weight monitoring, as stimulants are associated with reductions in growth velocity 5
Common Pitfall to Avoid
- Do not use a 1:1 milligram conversion between Concerta and Focalin, as this would result in overdosing due to the doubled potency of dexmethylphenidate 1. The correct conversion accounts for dexmethylphenidate being the isolated active enantiomer, requiring approximately half the milligram dose to achieve equivalent therapeutic effect.