From the Guidelines
Concerta is a highly effective treatment for attention deficit hyperactivity disorder (ADHD) in children and adults, and its use should be prioritized due to its proven efficacy and safety profile, as demonstrated in the most recent and highest quality study 1.
Key Points
- Concerta, a brand name for methylphenidate, is a central nervous system stimulant medication that works by increasing the levels of dopamine and norepinephrine in the brain, which helps improve attention, focus, and behavioral control.
- It is available in extended-release tablets of 18mg, 27mg, 36mg, and 54mg strengths, designed to work gradually over 10-12 hours with once-daily dosing.
- For adults with ADHD, treatment typically starts at 18mg or 36mg once daily in the morning, with possible adjustments up to a maximum of 72mg daily, as supported by the evidence-based pharmacological treatment options for ADHD in children and adolescents 1.
- Children usually start at 18mg daily, with adjustments based on response, and the MTA study suggests that more than 70% of children and adolescents with ADHD are methylphenidate responders 1.
Side Effects and Monitoring
- Common side effects include decreased appetite, sleep problems, headache, and increased blood pressure, which are generally mild and/or temporary, but may require careful monitoring, especially in patients with preexisting cardiovascular diseases 1.
- Concerta should be taken in the morning to avoid sleep disturbances and should not be crushed or chewed as this disrupts the extended-release mechanism.
- It's a controlled substance due to potential for abuse and should be used exactly as prescribed, with regular monitoring by a healthcare provider to assess effectiveness and manage side effects.
Treatment Approach
- A child’s response to stimulants is variable and unpredictable, and it is recommended to titrate from a low dose to one that achieves a maximum, optimal effect in controlling symptoms without adverse effects, as suggested by the clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents 1.
- Parent and child education is an important component in the chronic illness model to ensure cooperation in efforts to achieve appropriate titration and monitoring.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Overview of Concerta
- Concerta, also known as OROS methylphenidate, is a medication used to treat attention-deficit/hyperactivity disorder (ADHD) 2.
- It is a long-acting formulation of methylphenidate, which provides benefits long after school and work, and increases the likelihood of once-daily dosing 2.
Efficacy of Concerta
- Studies have shown that Concerta is effective in reducing symptoms of ADHD in children, adolescents, and adults 2, 3, 4.
- A clinical case series found that patients who switched from non-OROS to OROS methylphenidate ER (Concerta) at the same dosage showed a significant reduction in ADHD symptoms 3.
- A head-to-head clinical trial found that osmotic-release oral system methylphenidate (OROS-methylphenidate) and atomoxetine were both effective in improving emotional and behavioral problems in youths with ADHD, with OROS-methylphenidate showing greater improvement in aggressive behavior and somatic complaints 4.
Comparison with Other Medications
- A study compared the efficacy of methylphenidate and atomoxetine in adults with ADHD, and found that both medications were effective in improving symptoms, social functions, and quality of life, with no significant difference in the slope of improvements over time 5.
- Another study found that combined methylphenidate and atomoxetine pharmacotherapy was effective and well-tolerated in patients with ADHD, with significant improvement in symptoms and functional impairments 6.
Safety and Tolerability
- Common side effects of Concerta include irritability, appetite reduction, palpitations, and headache 6.
- A study found that both immediate-release methylphenidate and atomoxetine were well-tolerated in ethnic Chinese adults with ADHD, with no significant group difference in the rates of adverse effects 5.