Available Dosing Options for Metadate CD
Metadate CD (methylphenidate controlled-delivery capsules) is available in 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg capsule strengths for once-daily oral administration in pediatric patients 6 years and older with ADHD. 1, 2
Starting Dose and Titration Schedule
- Begin with 20 mg once daily in the morning for most children and adolescents aged 6 years and older 3
- The capsule should be administered before breakfast, as methylphenidate is optimally dosed 30 to 45 minutes before meals 4
- Increase the dose in weekly increments of 10 mg to 20 mg based on symptom response and tolerability 3
- Rating scales from teachers and parents should guide dose adjustments at each weekly interval 3
Maximum Dosing Limits
- The maximum recommended daily dose is 60 mg for all pediatric patients 4, 1
- For children weighing less than 25 kg (approximately 55 pounds), exercise particular caution and generally do not exceed single doses of 15 mg or total daily doses of 35 mg 3
- The 60 mg maximum applies regardless of body weight in older children and adolescents 3
Dose Selection Based on Clinical Needs
Metadate CD's unique pharmacokinetic profile delivers 30% of the dose immediately and 70% in a delayed-release manner, providing bimodal peaks that simulate twice-daily immediate-release methylphenidate dosing 1, 2, 5. This translates to:
- Superior symptom control during morning and midday hours (1.5 to 6 hours post-dose) compared to other extended-release formulations like Concerta 6
- Effective coverage throughout the typical school day with symptom control maintained for approximately 8 hours 1, 2
- Less robust evening coverage (after 7.5 hours post-dose) compared to formulations like Concerta 6
Practical Dosing Algorithm
For children requiring primarily school-day coverage:
- Start with Metadate CD 20 mg once daily in the morning 3, 1
- Titrate weekly by 10-20 mg increments based on teacher ratings 3
- Target dose range is typically 20-40 mg daily for most children 6
- Maximum dose is 60 mg daily 4
For children requiring extended afternoon/evening coverage:
- Consider that Metadate CD 40-60 mg provides comparable morning control to lower doses but with improved late-day coverage 6
- Alternatively, augment with immediate-release methylphenidate 5-10 mg in late afternoon (approximately 30-50% of the morning dose) 7
Critical Monitoring Requirements
- Obtain baseline blood pressure, pulse, height, and weight before initiating treatment 3, 8
- Monitor these parameters at each dose adjustment and monthly during maintenance 3
- Assess for common adverse effects including decreased appetite (occurs in 266% more children than placebo), sleep disturbances (60% increased risk), headaches, and abdominal pain 9, 8
- Screen adolescents for substance abuse risk before prescribing, as diversion is a particular concern in this age group 7
Common Pitfalls to Avoid
- Do not start with doses lower than 20 mg unless the child weighs less than 25 kg, as this may provide insufficient symptom control and delay optimal treatment 3, 6
- Do not exceed 60 mg daily even if symptoms persist, as higher doses are not recommended and may indicate need for alternative treatment strategies 3, 4
- Do not administer Metadate CD late in the day if evening coverage is needed; instead, add a separate immediate-release dose rather than shifting the timing of the extended-release formulation 7
- Do not assume lack of response means methylphenidate failure—approximately 70% respond to methylphenidate, but if Metadate CD is ineffective, trial an amphetamine-based stimulant before abandoning stimulant treatment entirely 3, 7