What are the recommended dosing guidelines for Foquest (controlled‑release methylphenidate) in children (6‑17 years) and adults (≥18 years), including starting dose, titration increments, maximum dose, administration method, and missed‑dose instructions?

Foquest Dosing Guidelines for ADHD

Foquest (controlled-release methylphenidate) should be initiated at 18 mg once daily in the morning for children ≥6 years, adolescents, and adults, with weekly titration by 18 mg increments until optimal symptom control is achieved, up to a usual maximum of 60 mg daily. 1

Starting Dose

• Begin with 18 mg once daily in the morning for all patients aged 6 years and older, regardless of body weight. 1
• Do not calculate doses based on mg/kg; systematic titration to clinical response is superior to weight-based dosing. 1, 2

Titration Schedule

• Increase by 18 mg increments at weekly intervals (e.g., 18 mg → 36 mg → 54 mg) based on symptom response and tolerability. 1
• Maintain a minimum of 7 days between dose adjustments to allow adequate assessment of therapeutic effect. 1
• In urgent clinical situations, the interval may be shortened to 3 days, though this is not the preferred approach. 1
• Continue titration until maximum therapeutic benefit is reached or adverse effects become dose-limiting. 1
• The full titration process typically spans several weeks to months. 1

Maximum Dose

• The usual maximum dose is 60 mg per day; higher doses may be employed when clinically justified with careful monitoring. 1, 3
• Approximately 70% of patients respond optimally when the full dose range is systematically trialed. 1

Administration Method

• Administer once daily in the morning to provide 12-hour symptom coverage throughout the school/work day. 4, 5
• Foquest uses an osmotic-pump delivery system (OROS technology) that provides continuous drug release over 12 hours, mimicking three doses of immediate-release methylphenidate. 4, 5
• The capsule may be swallowed whole; if unable to swallow, consult product-specific instructions (some extended-release methylphenidate formulations allow sprinkling on applesauce, though this must be verified for Foquest specifically). 6

Baseline Assessment Before Initiation

• Measure blood pressure and pulse as part of the initial cardiovascular safety evaluation. 1
• Obtain a detailed cardiac history including syncope, chest pain, palpitations, and family history of premature cardiovascular death or arrhythmias. 7
• Record baseline height and weight, particularly in pediatric patients. 1
• Document all prior ADHD treatments, doses, duration, response, and side effects. 7

Monitoring During Titration

• Collect standardized ADHD rating scales from parents and teachers before each dose increase to objectively assess response. 1
• Measure blood pressure and pulse at each dose adjustment visit. 1
• Assess weight at every visit as an objective indicator of appetite suppression. 1
• Conduct weekly telephone or in-person contacts during active titration to monitor progress and side effects. 1
• Evaluate for common adverse effects including appetite suppression, insomnia, headache, and abdominal pain. 3

Maintenance Phase Monitoring

• After establishing the optimal dose, schedule monthly follow-up appointments until symptoms are stable, then transition to quarterly monitoring. 1
• Adults: check blood pressure and pulse quarterly. 7
• Children/Adolescents: perform annual vital-sign assessments during routine examinations. 7
• Measure height and weight at every visit to monitor growth effects in pediatric patients. 7, 1
• Reassess medication efficacy at regular intervals using standardized rating scales. 1

Missed-Dose Instructions

• If a morning dose is missed, it may be taken as soon as remembered if it is still early in the day (generally before noon). 3
• Do not take a missed dose late in the day, as this may cause insomnia. 3
• Do not double the next dose to make up for a missed dose. 3
• Resume the regular once-daily morning schedule the following day. 3

Critical Pitfalls to Avoid

• Do not underdose—community treatment programs using lower doses and infrequent monitoring produce inferior outcomes compared with optimal medication management. 1
• Do not assume very low doses are sufficient; approximately 70% of children respond to methylphenidate when the full dose range (up to 60 mg) is systematically tried. 1
• Do not base dosing on body weight—marked individual variability in dose-response exists, requiring individualized titration rather than mg/kg calculations. 1, 2
• More than 90% of patients will respond to at least one stimulant class (methylphenidate or amphetamine) when both are systematically trialed; response to one does not predict response to another. 1

Expected Response Timeline

• Therapeutic effects appear within days of starting or adjusting the dose, allowing rapid assessment of efficacy. 8, 2
• Maximum behavioral effects occur 1–3 hours post-dose when plasma concentrations are rising. 3, 2
• The OROS formulation provides continuous symptom control for 12 hours, preventing behavioral deterioration throughout the day. 4, 5

Contraindications

• Symptomatic cardiovascular disease or uncontrolled hypertension. 7
• Active psychosis or mania. 7
• Concurrent use of MAO inhibitors or within 14 days of discontinuation. 7
• Glaucoma, hyperthyroidism, or known hypersensitivity to methylphenidate. 7