Biphentin Dosing for ADHD
Starting Doses by Age Group
Begin Biphentin at 10 mg once daily in the morning for children aged 6 years and older, adolescents, and adults, then titrate systematically based on clinical response rather than body weight. 1
- Children (6-12 years): Start with 10 mg once daily in the morning 1, 2
- Adolescents (≥13 years): Start with 10 mg once daily in the morning 1, 2
- Adults: Start with 10 mg once daily in the morning 1, 2
Titration Schedule
Increase the dose by 10 mg increments at weekly intervals until optimal symptom control is achieved without intolerable adverse effects. 1, 3
- Allow a minimum of 7 days between dose adjustments to adequately assess response 1, 3
- In urgent clinical situations, titration intervals may be shortened to 3 days, though this is not preferred 1, 3
- Continue titration until maximum therapeutic benefit is reached or adverse effects become limiting 1, 3
- The full titration process typically requires several weeks to months 1, 3
Maximum Doses
The usual maximum dose is 60 mg per day, though higher doses may be used when clinically justified with careful monitoring. 1, 4
- Maximum doses in clinical trials have ranged from 0.8 to 1.8 mg/kg/day 4
- Dose should be determined by clinical response rather than strict mg/kg calculations 1, 4
- Life-threatening adverse events at higher doses are absent in the literature 4
Monitoring Requirements During Titration
Collect standardized ADHD rating scales from both parents and teachers before each dose increase to objectively assess response. 1, 3
- Measure blood pressure and pulse at each dose adjustment 3
- Monitor for common adverse effects including insomnia, decreased appetite, headache, and abdominal pain 4
- Assess weight at every visit as an objective measure of appetite suppression 1
- Conduct weekly telephone or in-person contacts during active titration 1
Critical Pitfalls to Avoid
Do not calculate doses based on body weight or assume that lower doses will be sufficient without proper systematic titration. 1, 3
- Individual response to methylphenidate is highly variable and unpredictable—approximately 70% of children respond to methylphenidate when a full range of doses is tried 1
- Avoid arbitrary dose limitations that may prevent achieving optimal symptom control 4
- Do not assume equivalence between different methylphenidate formulations without retitration 5
- Ensure adequate monitoring frequency—community treatment with less frequent monitoring produces inferior outcomes compared to optimal medication management 1
Expected Response Patterns
Behavioral effects of methylphenidate appear rapidly, with maximum effects occurring 1-3 hours after administration when plasma concentrations are rising. 2, 6
- Biphentin, as an extended-release formulation, provides duration of action of 8-12 hours 2, 7
- More than 90% of patients will respond to one stimulant class (methylphenidate or amphetamine) when both are systematically tried 1
- Response to one stimulant does not predict response to another 3
Maintenance Phase Monitoring
Once optimal dosing is established, continue monthly follow-up appointments until symptoms are stable, then transition to quarterly monitoring. 1