Medication | United States trade name (generic availability) | Description of release and duration of action | Initial dose* | Dose advancement | Maximum dose (per day) |
Methylphenidate |
Methylphenidate ER | - Metadate ER (generic available)
| - Delayed onset with continuous release over 3 to 8 hours. May require twice daily dosing and/or use with immediate-release methylphenidate.
- Tablet must be swallowed whole.
| | - Increments of 10 mg per day every 3 to 7 days
| - ≤50 kg: 60 mg
- >50 kg: 100 mg¶
|
Methylphenidate ER chewable tablets - 20 mg (scored), 30 mg (scored), 40 mg (not scored)
| | - Continuous release over 6 to 8 hours with duration of action up to 13 hours.
| | - Increments of 10 mg, 15 mg, or 20 mg per day every 7 days
| |
Methylphenidate XR-ODT - 8.6, 17.3, 25.9 mg tablets as methylphenidate base (equivalent to 10, 20, 30 mg of methylphenidate hydrochloride)Δ
| | - 25% immediate-release and 75% extended-release for duration of action up to 12 hours.
- Whole tablet must be dissolved on tongue; should be taken consistently either with or without food.◊
| | - Increments of 8.6 to 17.3 mg per day every 7 days
| |
Methylphenidate ER (OROS) - 18, 27, 36, 54, 63, 72 mg tablets
| - Concerta, Relexxii (generics for Concerta with limited availability)
| - 20% immediate-release and 80% continuous-release over 10 to 12 hours by osmotic delivery.
- Tablet must be swallowed whole.
| | - Increments of 9 to 18 mg per dose every 3 to 7 days
| - <13 years: 54 mg
- ≥13 years: 72 mg
|
Methylphenidate LA - 10, 20, 30, 40 mg capsules
| - Ritalin LA (generic available except 10 mg)
| - 50% immediate-release and 50% delayed-release over 8 to 12 hours (bimodal).
- Capsule may be swallowed whole or opened and contents sprinkled over a spoonful of cold applesauce and swallowed immediately; capsule or contents should not be crushed or chewed.
| | - Increments of 10 or 20 mg per dose every 3 to 7 days
| - ≤50 kg: 60 mg
- >50 kg: 100 mg¶
|
Methylphenidate CD - 10, 20, 30, 40, 50, 60 mg capsules
| | - 30% immediate-release and 70% delayed-release over 8 to 12 hours (bimodal).
- Capsule may be swallowed whole or opened and contents sprinkled over a spoonful of cold applesauce and swallowed immediately; capsule or contents should not be crushed or chewed.
| | - Increments of 10 mg per dose every 3 to 7 days
| - ≤50 kg: 60 mg
- >50 kg: 100 mg¶
|
Methylphenidate XR - 10, 15, 20, 30, 40, 50, 60 mg capsules
| - Aptensio XR (generic available)
| - 40% immediate release and 60% controlled release for duration of action of 12 hours.
- Capsule may be swallowed whole or opened and contents sprinkled over a spoonful of cold applesauce and swallowed immediately; capsule or contents should not be crushed or chewed.
| | - Increments of 10 mg every 7 days
| |
Methylphenidate XR oral suspension | | - 20% immediate-release and 80% extended-release for duration of action up to 12 hours.
| | - Increments of 10 mg every 7 days
| |
Methylphenidate extended release capsules - 20, 40, 60, 80, 100 mg capsules
| | - <5% of total drug is available within the first 10 hours after administration.
- Peak concentration occurs 14 hours after dose with gradual decline thereafter.
- Capsules may be swallowed whole or opened and the contents sprinkled over a spoonful of cold applesauce; capsule or contents should not be crushed or chewed.
| - 20 mg per day in the evening (adjust timing to optimize tolerability and efficacy)
| - Increments of 20 mg per day every 7 days
| |
Methylphenidate patch§ | | - Onset 2 hours after application of patch and continuous release over 9 to 12 hours.
| | - Increments of 5 mg per dose every 3 to 7 days
| |
Dexmethylphenidate |
Dexmethylphenidate XR - 5, 10, 15, 20, 25, 30, 35, 40 mg capsules
| - Focalin XR (generic available)
| - 50% immediate-release and 50% delayed-release over 10 to 12 hours (bimodal).
- Capsule may be swallowed whole or opened and contents sprinkled over a spoonful of cold applesauce and swallowed immediately; capsule or contents should not be crushed or chewed.
| | - Increments of 5 mg per dose every 3 to 7 days
| |
Serdexmethylphenidate-dexmethylphenidate - 26.1/5.2, 39.2/7.8, 52.3/10.4 mg capsules
| | - 70% serdexmethylphenidate (dexmethylphenidate prodrug) and 30% dexmethylphenidate (immediate release).
- Peak dexmethylphenidate concentration occurs approximately 2 hours after the dose (onset of action within 1 hour), with gradual decline thereafter for duration of action of up to 13 hours.
- Capsule may be swallowed whole or opened and contents sprinkled over 2 tablespoons of applesauce or into 50 mL of water and consumed within 10 minutes of mixing.
| Age 6 to 12 years: | - Increase or decrease by 13.1/2.6 mg after one week
| |
Age ≥13 years: | - Increase to 52.3/10.4 after 1 week
|
Amphetamines |
Dextroamphetamine-amphetamine ER - 5, 10, 15, 20, 25, 30 mg capsules¥
| - Adderall XR (generic available)
| - Combination of immediate- and continuous-release over 10 to 12 hours.
| | - Increments of 5 mg per dose every 3 to 7 days
| - ≤50 kg: 40 mg
- >50 kg: 60 mg‡
|
Dextroamphetamine-amphetamine ER - 12.5, 25, 37.5, 50 mg capsules¥†
| | - Combination of immediate- and two different delayed-release beads for duration up to 16 hours.
- Capsule may be swallowed whole or sprinkled over a spoonful of cold applesauce and swallowed immediately; capsule or contents should not be crushed or chewed.
| | - Increments of 12.5 mg every 7 days
| - 13 through 17 years: 25 mg
- ≥18 years: 50 mg
|
Amphetamine ER - Oral suspension 2.5 mg amphetamine as base per mL¥
- 5, 10, 15, and 20 mg tablets
| | - Combination of immediate- and extended-release for duration of action up to 13 hours.
- Tablets may be chewed or swallowed whole.
| | - Increments of 2.5 to 10 mg per day every 4 to 7 days
| |
Amphetamine ER - ODT 3.1, 6.3, 9.4, 12.5, 15.7, 18.8 mg as base¥
| | - Combination of 50% immediate- and 50% extended-release; levels are comparable to dextroamphetamine-amphetamine ER capsules when equivalent doses are used.¥
| | - Increments of 3.1 or 6.3 mg per day every 7 days
| - 6 to 12 years: 18.8 mg
- ≥13 years: 12.5 mg
|
Dextroamphetamine SR | - Generic extended release available (Dexedrine Spansule brand is no longer available)
| - Combination of immediate- and continuous-release over 8 to 12 hours.
- May require dividing dose twice daily.
| | - Increments of 5 mg per day every 3 to 7 days
| - ≤50 kg: 40 mg
- >50 kg: 60 mg‡
|
Dextroamphetamine patch§ - 4.5, 9, 13.5, 18 mg per 9 hour patches
| | - Strength is amount of dextroamphetamine released from patch over 9 hours.
- Onset 2 hours after application of patch; continuous release from application site over 9 to 12 hours.
| | - Increments of 4.5 mg per day every 7 days
| |
Lisdexamfetamine - 10, 20, 30, 40, 50, 60, 70 mg capsules
- 10, 20, 30, 40, 50, 60 mg chewable tablets
| | - Prodrug converted to dextroamphetamine in bloodstream with an effect over approximately 10 hours.
- Capsule may be opened and dissolved in water or juice for immediate use.
- Chewable tablets must be chewed completely before swallowing.
| | - Increments of 10 or 20 mg per day every 3 to 7 days
| |
Nonstimulants |
Selective norepinephrine reuptake inhibitors |
Atomoxetine - 10, 18, 25, 40, 60, 80, 100 mg capsules
| - Strattera (generic available)
| | - 0.5 mg/kg per day for minimum of 3 days
| - Increase to 1.2 mg/kg per day after a minimum of 3 days (maximum 100 mg per day)
| - Lesser of 1.4 mg/kg or 100 mg
|
Viloxazine ER - 100, 150, 200 mg capsules
| | - Lasts throughout the day.
- Capsule may be swallowed whole or opened and contents sprinkled over a teaspoonful of applesauce and swallowed immediately and without chewing; neither the capsule nor contents should be crushed or chewed.
| Age 6 to 11: | - Increments of 100 mg weekly
| |
Age 12 to 17: | - Increments of 200 mg weekly
|
Alpha-2 adrenergic agonists |
Guanfacine ER** | - Intuniv (generic available)
| | | - Increments of 1 mg per day at no less than weekly intervals
| - ≤12 years: 4 mg
- >12 years: 7 mg¶¶
|
Clonidine ER** | - Kapvay (generic available)
| | | - Increments of 0.1 mg per day every 7 days; doses >0.1 mg per day are divided twice daily (either split equally or with higher dose administered at bedtime)
| |