Converting from Concerta 27mg to Focalin (Dexmethylphenidate)
Direct Conversion Strategy
Start Focalin XR at 10mg once daily in the morning, as there is no established direct dose equivalency between methylphenidate formulations and dexmethylphenidate, requiring a conservative restart approach. 1
Discontinuation Protocol
- Discontinue Concerta 27mg abruptly without tapering when switching to Focalin XR, as no washout period is required between stimulant medications 1
- The immediate cessation approach is safe because both medications are short-acting stimulants with rapid clearance 1
Initial Focalin Dosing
- Begin Focalin XR at 10mg once daily regardless of the previous Concerta dose 1
- This conservative starting dose accounts for the fact that dexmethylphenidate contains only the active d-enantiomer of methylphenidate, making it approximately twice as potent on a milligram-per-milligram basis 2, 3
- The 10mg starting dose provides immediate therapeutic effects within 0.5-1 hour after administration 2, 3
Titration Algorithm
Weekly Dose Adjustments
- Increase by 5mg weekly increments based on symptom response and tolerability 1
- Continue titration until optimal symptom control is achieved, intolerable side effects emerge, or maximum dose of 30mg daily (for Focalin XR) is reached 2
- Systematic titration is necessary because dose response is highly variable and unpredictable between individuals 4
Expected Timeline
- Expect immediate therapeutic effects within hours of the first Focalin XR dose, not weeks 1, 2
- Improvements in ADHD symptoms occur as early as 0.5 hours after administration and last up to 11-12 hours 2
- Peak plasma concentrations occur with the bimodal release profile that mimics two doses given 4 hours apart 2, 3
Critical Pharmacological Considerations
Why Direct Conversion Ratios Don't Apply
- Methylphenidate and dexmethylphenidate are different medication classes with distinct mechanisms and pharmacokinetics, making direct dose equivalency impossible 1
- Dexmethylphenidate contains only the pharmacologically active d-threo-enantiomer, while Concerta contains both d- and l-enantiomers 2, 3
- The bimodal release profile of Focalin XR differs fundamentally from Concerta's OROS osmotic pump delivery system 2, 5
Duration of Action Differences
- Focalin XR provides coverage for 11-12 hours with peak effects in the first half of the day 2
- Concerta's ascending delivery pattern provides 10-12 hours of coverage with more sustained late-day effects 5
- Assessments late in the day (10-12 hours post-dose) may favor Concerta over Focalin XR 2
Monitoring and Optimization
Assessment Points
- Evaluate symptom control in the morning, midday, and evening to determine if coverage is adequate throughout the day 4
- Monitor for improvements in attention, decreased fidgeting, and reduced impulsivity within the first hour 4
- Assess response variability and impulsive responding on cognitive tasks 4
Common Pitfalls to Avoid
- Do not assume 27mg Concerta equals any specific Focalin dose—the starting dose should always be 10mg regardless of previous methylphenidate exposure 1
- Do not undertitrate—over 70% of patients require dose optimization beyond the starting dose to achieve maximum benefit 4
- Do not calculate dose based on mg/kg—this approach has not been helpful for stimulant dosing 4
Administration Considerations
- Focalin XR capsules can be opened and sprinkled on applesauce for patients unable to swallow capsules whole 2
- Administer consistently with or without food, as high-fat meals can significantly reduce early drug exposure 1
- Once-daily administration eliminates the need for midday dosing at school 2