Methylphenidate

Stimulant (dopamine-norepinephrine reuptake inhibitor and releaser; serotonin reuptake inhibition)

Dosing

Dexmethylphenidate is the active isomer (levo is inactive). For methylphenidate, max daily dose 60-85 depending on form (Concerta 72mg). For dexmethylphenidate, cut that dose in half.

Methylphenidate

FORMS: Methylphenidate IR (3-5 hr), SR (4-8 hr), LA (6-9 hr), Metadate CD (8-9 hr), QuilliChew ER (8 hr), Quillivant XR (12 hr), Cotempla (12 hr), Daytrana (12 hr), Aptensio (12 hr), Jornay (9-12 hr), Adhansia (13-16 hr)

To convert to methylphenidate from another stimulant multiply by number in parentheses: Dexmethylphenidate (2.0), Adderall (2.0), Dextroamphetamine (2.4), Vyvanse (1.0), Evekeo (1.5). Some methylphen formulations have unusual dosing ranges (Daytrana patch, Contempla, Jornay). Avoid Daytrana (can permanently discolor skin).

Jornay is taken at night and delays onset to morning.

Dexmethylpheniate

FORMS: Focalin XR lasts about 10-12 hours and has 2 biphasic peaks; instant release lasts 3-5 hours (max dose 40 mg). Serdexmethylphenidate (Azstarys) is an abuse-deterrant prodrug version that contains 30% regular dexmethylphenidate. Azstarys has smoother, steadier blood levels than Focalin XR, duration is 10-12 hours.

To convert to dexmethylphenidate from another stimulant multiply by number in parentheses: Methylphenidate (0.5), Adderall (1.0), Dextroamphetamine (1.2), Vyvanse (0.5), Evekeo (0.75).  

Management

Methylphenidate is preferred over amphetamines particularly in children and those with psychiatric comorbidities. Concerta is ideal among generics, but has slower onset (1-2 hr). Astarys is abuse deterrent so ideal but brand-only. Lowest cost out of pocket is Ritalin SR ($25). Adhansia has longest duration. Aim for lower dose in elderly (> 65, eg 10-30 mg).

EMR Text