What is the recommended starting dose of Focalin (dexmethylphenidate) for a patient converting from Concerta (methylphenidate) 27mg?

Focalin Dosing When Converting from Concerta 27mg

When converting from Concerta 27mg to Focalin (dexmethylphenidate), start with Focalin XR 10mg once daily in the morning, as the FDA-approved conversion is to use half the total daily dose of methylphenidate. 1

Conversion Rationale

• The FDA label for dexmethylphenidate extended-release explicitly states that for patients currently on methylphenidate, the starting dose should be half (1/2) the current total daily dosage of methylphenidate. 1
• Concerta 27mg contains 27mg of racemic methylphenidate, so half of this is 13.5mg. 1
• Since Focalin XR is available in 5mg increments, round down to 10mg as the starting dose for safety. 1

Titration Protocol After Conversion

• Titrate weekly in increments of 5mg for pediatric patients or 10mg for adult patients until optimal symptom control is achieved. 1
• The maximum recommended daily dose is 30mg in pediatric patients and 40mg in adults. 1
• Systematic titration is necessary because dose response is highly variable and unpredictable between individuals—calculating dose based on mg/kg has not been helpful. 2

Expected Timeline and Effects

• Expect immediate therapeutic effects within 0.5 to 1 hour after the first dose of Focalin XR, with improvements in attention, decreased fidgeting, and reduced impulsivity. 2
• Dexmethylphenidate XR provides symptom control for up to 12 hours after administration, similar to the duration of Concerta. 3, 4
• The bimodal release profile of Focalin XR mimics two doses of immediate-release dexmethylphenidate given 4 hours apart, allowing once-daily administration. 3, 4

Critical Clinical Considerations

• Do not assume 10mg will be the final therapeutic dose—over 70% of patients require dose optimization beyond the starting dose to achieve maximum benefit. 2
• The goal of titration is reducing core ADHD symptoms to or close to the levels of individuals without ADHD, which typically requires doses higher than the initial starting dose. 2
• Discontinue Concerta abruptly without tapering when switching to Focalin XR, as no washout period is required between stimulant medications. 5

Administration Options

• Focalin XR capsules may be swallowed whole or opened and the entire contents sprinkled on applesauce for patients unable to swallow the capsule whole. 1
• Administer with or without food in the morning, though consistent administration timing is recommended. 1

Common Pitfall to Avoid

• The most common error is stopping titration at the starting dose of 10mg. The starting dose is designed for safety and tolerability assessment, not as a therapeutic endpoint. 2
• Ensure adequate titration to higher Focalin XR doses (15-20mg or higher) has been attempted before concluding the medication is ineffective. 2