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. Author manuscript; available in PMC: 2015 Jan 16.
Published in final edited form as: Curr Psychiatr. 2013 Dec;12(12):20–29.

Table 2.

Dosing and Duration of Action for Specific U.S. Food and Drug Administration (FDA)-Approved ADHD Medications2, 24, 31

Medication
Class		 Medication
(Brand Names) 		Starting Dose Typical Total
Daily
Maximum
Dose† 		Dosing Interval Duration of
Action		 Comments
Stimulant Short-acting methylphenidate (Ritalin§, Methylin, Methylin Chewable, Methylin Solution) 5mg 60mg BID-TID (q4 hours) 3–5 hours
  • -

    For those who do not swallow pills, Methylin has liquid and chewable preparations.

  • -

    Methylin solution is available in 5mg/5ml and 10mg/5ml concentrations.
Stimulant Intermediate-acting methylphenidate (Metadate CD, Metadate ER, Methylin ER, Ritalin LA, Ritalin SR§) 10 mg (for all but Ritalin SR [20mg]) 60mg Once daily 3–8 hours
  • -

    For those who do not swallow pills, Metadate CD and Ritalin LA capsules can be opened and microbeads sprinkled on and ingested with food.
Stimulant Extended release methylphenidate, osmotic-release oral system [OROS] (Concerta§) 18 mg 54 mg (<13 years old) or 72 mg (≥13 years old) Once daily 12 hours
  • -

    Must be swallowed whole. Opening or crushing capsule damages the osmotic pump delivery system.

  • -

    Has less abuse liability because osmotic pump delivery system makes it difficult to extract the methylphenidate for snorting or intravenous injection.
Stimulant Extended release methylphenidate, oral suspension (Quillivant XR) 20mg 60mg Once daily 12 hours
  • -

    Available in 25mg/5ml concentration.
Stimulant Extended release methylphenidate, dermal (Daytrana) 10mg 30mg Once daily, Apply for up to 9 hours 3 hours after patch removal (up to maximum of 15 hours)
  • -

    Greater absorption occurs when applied to the buttocks rather than the subscapular area.

  • -

    Dosages for patch are not equivalent to dosages of oral methylphenidate preparations.

  • -

    Has less abuse liability because intradermal delivery system makes it difficult to extract the methylphenidate for snorting or intravenous injection.
Stimulant Short-acting dexmethylphenidate (Focalin§) 2.5mg 20mg BID 4–6 hours
  • -

    1 mg dexmethylphenidate is equivalent to 2 mg oral methylphenidate
Stimulant Extended-release dexmethylphenidate (Focalin XR) 5mg 30mg Once daily 8–12 hours
  • -

    For those who do not swallow pills, capsules can be opened and microbeads sprinkled on and ingested with food.

  • -

    1 mg dexmethylphenidate is equivalent to 2 mg oral methylphenidate
Stimulant Short-acting mixed amphetamine salts (Adderall§) 2.5–5mg 40mg Once daily-BID 6 hours
  • -

    1 mg amphetamine is equivalent to 2 mg oral methylphenidate
Stimulant Extended release mixed amphetamine salts (Adderall XR) 5mg 40mg Once daily 10 hours
  • -

    For those who do not swallow pills, capsules can be opened and microbeads sprinkled on and ingested with food.

  • -

    1 mg amphetamine is equivalent to 2 mg oral methylphenidate
Stimulant Short-acting dextroamphetamine (Dexedrine§, DextroStat, ProCentra) 2.5mg 40mg BID-TID 4–6 hours
  • -

    For those who do not swallow pills, ProCentra oral suspension (5mg/5ml) can be used.

  • -

    1 mg dextroamphetamine is equivalent to 2 mg oral methylphenidate
Stimulant Intermediate-acting dextroamphetamine (Dexedrine SR§) 5mg 40mg Once daily-BID ≥ 6hrs
  • -

    For those who do not swallow pills, capsules can be opened and microbeads sprinkled on and ingested with food.

  • -

    1 mg dextroamphetamine is equivalent to 2 mg oral methylphenidate
Stimulant prodrug Lisdexamfetamine (Vyvanse) 20mg 70mg Once daily 10–12 hours
  • -

    For those who do not swallow pills, capsules can be opened and contents mixed with water, then ingested (efficacy when mixed with other liquids has not been ascertained).

  • -

    Has less abuse liability because prodrug form makes it difficult to extract the stimulant for snorting (cleavage of lysine is necessary to convert lisdexamfetamine to the active dextroamphetamine form).

  • -

    Dosages not equivalent to dextroamphetamine dosages, data on methylphenidate dosage equivalents not available.
Norepinephrine Reuptake Inhibitor Atomoxetine (Strattera) Patients <70 kg: 0.5 mg/kg/day for 1 week, then increase to 1.2mg/kg/day. Patients ≥70 kg: 40mg, then increase to 100mg/day Patients <70 kg: 1.4 mg/kg/day. Patients ≥70 kg: 100mg/day Once daily-BID 18–24 hours
  • -

    BID dosing (early AM and evening) may improve efficacy and decrease side effects

  • -

    Does not have abuse liability.
α2 Adrenergic Agonist Guanfacine ER (Intuniv) 1 mg 4 mg Once daily ~24 hours
  • -

    Does not have abuse liability.
α2 Adrenergic Agonist Clonidine ER (Kapvay) 0.1 mg 0.4 mg Once daily -BID 12–24 hours
  • -

    Does not have abuse liability.
§

Available in generic form

†

Certain patients may require higher than the average recommended dosing of stimulant medication due to limited response to lower doses or the combination of medication classes. There is extant literature on this matter,32 as well as ample empirical evidence of child psychiatrists having patients on total daily doses of stimulants above the typical maximum. Careful attention to cardiovascular considerations and other adverse effects is recommended in these situations. Flexibility and alliance with primary care physician and family is also crucial, as it permits the child psychiatrist to gather data about the tolerability and effectiveness of the chosen medication in order to make an informed clinical decision.