Version August 2025
| Medication | Starting dose | Usual effective dose range | Common side effects | Serious side effects |
| Stimulants | ||||
| Methylphenidate immediate release | 5 mg twice daily (before breakfast and before lunch) | 10 to 60 mg/day in 2 to 3 divided doses | Anorexia, poor growth or weight loss, sleep disturbance, jitteriness, emotional lability, tics | Psychosis, mania, seizures, cardiovascular effects¶, priapism, diversion or misuse |
| Methylphenidate ER or SR | 10 mg every morning | 20 to 60 mg every morning | ||
| Methylphenidate (Concerta) | 18 mg every morning | 18 to 54 mg every morning | ||
| Methylphenidate patch | 10 mg patch every morning | 10 to 30 mg every morning | ||
| Dextroamphetamine immediate release | 5 mg every morning | 5 to 40 mg/day in 1 to 2 divided doses | ||
| Amphetamine/dextroamphetamine immediate release | 5 mg every morning | 10 to 40 mg/day in 1 to 2 divided doses | ||
| Lisdexamfetamine | 20 mg every morning | 30 to 70 mg every morning | ||
| Wake-promoting agents | ||||
| Modafinil | 50 mg every morning | 50 to 200 mg/day in 1 to 2 divided doses | Headache, nervousness, nausea, insomnia | Severe rash, severe psychiatric events |
| Armodafinil | 50 mg every morning | 50 to 250 mg/day | ||
| Others | ||||
| Sodium oxybate immediate-releaseΔ | Doses are administered twice nightly, at bedtime and 2.5 to 4 hours later Recommended starting dose by weight:
| 2 to 9 grams in 2 divided doses at night Maximum recommended daily dose by weight:
| Morning sedation, nausea, weight loss, dizziness, enuresis, sleepwalking, tremor, worsening of OSA | Confusion, severe sedation, central sleep apnea, coma, diversion or misuseΔ |
| Sodium oxybate extended-releaseΔ | 4.5 grams at bedtime◊ | 4.5 to 9 grams at bedtime Maximum recommended daily dose by weight:
| Same as for sodium oxybate immediate- release | Same as for sodium oxybate immediate-release |
| Mixed-salt oxybate (calcium, magnesium, potassium, and sodium oxybates)Δ | Same as for sodium oxybate immediate-release | Same as for sodium oxybate immediate-release | Same as for sodium oxybate immediate-release | Same as for sodium oxybate immediate-release |
| Pitolisant§ | By weight:
| By weight:
| Headache, insomnia, nausea, anxiety | Severe rash, QT prolongation |
| Atomoxetine | 0.5 mg/kg/day (maximum 40 mg/day) | 0.5 to 1.2 mg/kg/day in 1 to 2 divided doses (maximum 100 mg/day) | Weight loss, abdominal pain, nausea, anorexia, headache | Suicidal ideation, psychosis, mania, cardiovascular events, priapism, hepatotoxicity |
ER: extended release; OSA: obstructive sleep apnea; SR: sustained release.
* Doses listed in table are appropriate for children ≥6 years and adolescents (except as noted).
¶ For additional information, refer to topic review of pharmacology of drugs used to treat attention deficit hyperactivity disorder children and adolescents, section on adverse effects.
Δ Dosing shown for children ≥7 years and adolescents; guidance for such children weighing <20 kg is provided in drug information included within UpToDate. Not recommended in children with narcolepsy type 2 (narcolepsy without cataplexy). In the United States, prescribers must register with the Risk Evaluation and Mitigation Strategies (REMS) program and follow specific safety and monitoring recommendations. Combined use with alcohol, sedatives, or hypnotics is specifically contraindicated in United States licensing information.
◊ If there is concern that a starting dose of 4.5 grams is too high for a patient, we advise starting with immediate-release sodium oxybate, which allows for lower and more flexible titration. As an example, the immediate-release formulation is recommended for children weighing <45 kg until the total nightly dose is ≥4.5 grams.
§ Dosing is expressed as pitolisant base and corresponds with tablet strengths available in the United States. International products may express dosing differently (eg, as pitolisant hydrochloride or approximate pitolisant base amount) depending on country. Refer to local product information.
