What is the recommended dose of Jornay (methylphenidate) for a patient with Attention Deficit Hyperactivity Disorder (ADHD) based on their weight?

Jornay Dosing and Weight-Based Considerations

Jornay (methylphenidate) dosing is not weight-based; instead, use a fixed-dose titration approach starting at 20 mg once daily in the evening, increasing by 20 mg weekly increments based on clinical response and tolerability, up to a maximum of 100 mg daily. 1

Starting Dose and Administration

• Begin with 20 mg once daily in the evening (approximately 6:30-9:30 PM), as Jornay is specifically designed as an evening-dosed, delayed-release formulation that provides symptom control the following morning 1
• The evening administration timing is critical because Jornay's unique formulation delays methylphenidate release for approximately 10-12 hours, providing coverage upon awakening 1

Titration Protocol

• Increase the dose by 20 mg increments weekly based on systematic assessment using standardized ADHD rating scales from both parents and teachers 2, 1
• Continue weekly titration until optimal symptom control is achieved without significant adverse effects 2, 1
• The maximum recommended daily dose is 100 mg for Jornay PM (note: this differs from immediate-release methylphenidate's 60 mg maximum) 1

Why Weight-Based Dosing Should NOT Be Used

Current evidence does not support weight-adjusted dosing for methylphenidate formulations, including Jornay. 3, 2

• Research shows little correlation between weight-adjusted methylphenidate doses and reduction of ADHD symptoms 3
• Weight-adjusted dose ranges may inappropriately restrict titration for some smaller children who require higher doses, or expose them to excessive doses 3
• Individual response to methylphenidate is highly variable and unpredictable, with dose requirements not reliably related to height or weight 2
• The fixed-dose titration method using whole pills reflects typical practice in the United States and is more practical than weight-based calculations 3

Target Therapeutic Range

• Most patients achieve optimal response between 40-80 mg daily of Jornay, though this varies considerably by individual 1
• More than 70% of children respond to methylphenidate when a full range of doses is administered through proper titration 2
• The average therapeutic dose for standard methylphenidate formulations is 20-30 mg daily total, but Jornay's unique pharmacokinetics may require different dosing 1, 4

Critical Monitoring Requirements

• Assess blood pressure, pulse, height, and weight at each visit to monitor for cardiovascular effects and growth suppression 2, 1
• Systematically evaluate for common side effects including insomnia, decreased appetite, headaches, tachycardia, and mood changes by asking specific questions at each visit 2, 1
• Obtain standardized ADHD rating scales with age- and gender-specific norms from both home and school settings before each dose adjustment 2
• Schedule follow-up appointments at least monthly after dose stabilization 2

Important Clinical Pitfalls to Avoid

• Do not stop titration prematurely at low doses before assessing response at higher doses, as many patients require 40-80 mg daily for optimal control with Jornay 2, 1
• Do not calculate doses based on mg/kg, as this approach is not supported by current evidence and may lead to suboptimal dosing 3, 2
• If adequate response is not achieved after trying the full dose range up to 100 mg daily, consider switching to an amphetamine-based stimulant, as more than 90% of patients respond when both methylphenidate and amphetamine classes are systematically tried 2
• Ensure patients understand that Jornay must be taken in the evening (not morning like other stimulants) to achieve proper therapeutic effect the following day 1

Pretreatment Screening

• Assess for cardiac disease by performing careful personal and family history of sudden death or ventricular arrhythmia, plus physical examination 1
• Evaluate family history and clinically assess for motor or verbal tics or Tourette's syndrome before initiating treatment 1
• Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmias, coronary artery disease, or other serious cardiac disease 1