ADHD Stimulant Medication Aid

Last reviewed: August 2024

ADHD Stimulant Medication Aid

Methylphenidate
Generic Medication Brand Names Dosage Forms Starting Dose Max Dose Notes
Methylphenidate
(immediate release)
         
Ritalin 5 mg, 10 mg, 20 mg 5 mg BID 60 mg divided BID or TID  
   
Methylin chewable 2.5 mg, 5 mg, 10 mg
   
Methylin liquid 5 mg/5 ml,10 mg/5 ml
         
Methylphenidate extended release capsule          
Ritalin LA 10 mg, 20 mg, 30 mg, 40 mg, 60 mg 20 mg daily 60 mg daily Can be opened/sprinkled
     
Metadate CD 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg  
         
Methylphenidate Osmotic extended release tablet          
Concerta 18 mg, 27 mg, 36 mg, 54 mg 18 mg daily 54 mg (for 6-12 years)
72 mg (for age 13+)
Cannot be divided or crushed
     
Relexxii 18 mg, 27 mg, 36 mg, 45 mg, 54 mg, 63 mg, 72 mg Cannot be divided or crushed
         
Methylphenidate multilayer extended release capsule          
Aptensio XR 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg 10 mg daily 60 mg Can be opened/sprinkled
         
Methylphenidate extended release liquid          
Quillivant XR 25 mg/ 5ml solution 20 mg daily 60 mg daily Bottles intended to last one month
20% imm. release, 80% ext. release
 
Bottles (ml): 60 mg, 120 mg, 150 mg, 180 mg
         
Methylphenidate extended release chewable tablet          
QuilliChew ER 20 mg, 30 mg scored chew tabs 20 mg daily 60 mg daily 30% imm. release, 70% ext. release
 
40 mg unscored chew tabs
         
Methylphenidate extended release orally disintegrating          
Cotempla XR-ODT 8.6 mg, 17.3 mg, 25.9 mg 17.3 mg daily 51.8 mg daily Orally disintegrating tab
         
Methylphenidate extended release transdermal          
Daytrana 10 mg, 15 mg, 20 mg, 30 mg 10 mg daily 30 mg daily Possible adverse skin reaction/irritation due to patch
Not suitable for swimming/heavy sweating
         
Methylphenidate extended release administered at night          
Jornay PM 20 mg, 40 mg, 60 mg, 80 mg, 100 mg 20 mg daily 100 mg daily Has extended release coating, administered in the evening
Start at 8pm, adjust to between 6:30-9:30 as needed, works in AM
Insomnia at higher rates (33%) than some other stimulants
         
Methylphenidate sustained release tablet          
Metadate ER 10 mg, 20 mg 20 mg daily 60 mg daily Must be swallowed whole
         
Serdexmethylphenidate and dexmethylphenidate          
Azstarys 26.1 mg/ 5.2 mg, 39.2 mg/ 7.8 mg, 52.3 mg/ 10.4 mg 26.1 mg/ 5.2 mg (Ages 6-12) 39.2 mg/ 7.8 mg (Ages 13+) 52.3 mg/ 10.4 mg Combination of 30% immediate release dexmethylphenidate plus 70% of serdexmethylphenidate, a dexmethylphenidate prodrug; can be opened & sprinkled
         

 

All the tables in this guide can be downloaded in PDF format via the button below:

Stimulant ADHD Medication Aid - Medication Tables

 

Dexmethylphenidate
Generic Medication Brand Names Dosage Forms Starting Dose Max Dose Notes
Dexmethylphenidate
(immediate release) tab
Focalin 2.5 mg, 5 mg, 10 mg 2.5 mg BID 20 mg divided BID  
Dexmethylphenidate
extended release capsule
Focalin XR 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg 5 mg daily 30 mg daily Can be opened/sprinkled

 

Amphetamine Derivatives
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Generic Medication Brand Names Dosage Forms Starting Dose Max Dose Notes
Ages 3-5 Age 6+
Amphetamine
(immediate release)
           
Adderall (mixed amphetamine salts) 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg (scored), 30 mg (scored) 2.5 mg daily 5 mg daily or BID 40 mg divided BID  
Zenzedi (d-amphetamine sulfate) 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
Evekeo (d- & l- amphetamine sulfate) 5 mg (scored), 10 mg (cross-scored)
Evekeo ODT 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg
Procentra (d-amphetamine liquid) 5 mg/5 ml
       
Mixed Amphetamine
salts immediate release
capsule
           
Adderall XR 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg   5 mg daily 30 mg daily Can be opened/sprinkled
           
Mydayis 12.5 mg, 25 mg, 37.5 mg, 50 mg   12.5 mg daily1 25 mg daily
(50 mg daily for adults)
Mydayis has a third phase of extended release, prolonging the duration of action
 
1Mydayis is FDA approved for ages 13+
           
Lisdexamfetamine
(prodrug)
           
Vyvanse 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg capsule   30 mg 70 mg daily Capsules can be opened and mixed with water, yogurt, or orange juice
   
10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg chewable tablet  
           
Amphetamine
extended release
orally disintegrating
           
Adzenys XR-ODT 3.1 mg, 6.3 mg, 9.4 mg, 12.5 mg, 15.7 mg, 18.8 mg 6.3 mg daily 18.8 mg daily  
           
Amphetamine
extended release
liquid
           
Dynavel XR 2.5 mg/ml   2.5 mg daily 20 mg daily  
           
Amphetamine
extended release
tablet
           
Dynavel XR 5 mg, 10 mg, 15 mg, 20 mg   2.5 mg daily 20 mg daily  
           
Dextroamphetamine
extended release
capsule
           
Dexedrine Spansule 5 mg, 10 mg, 15 mg   5 mg daily or BID 60 mg daily Can be opened/sprinkled
           

 

 

 

Tips for combining Medications

 

Prescribers may consider combining medications under the following circumstances:

 

Circumstance: Option:
Partial response to stimulant or have breakthrough symptoms Consider combining a stimulant with a non-stimulant medication
Child continues to experience hyperactivity/impulsivity symptoms Add clonidine or guanfacine to a stimulant as adjunct
Inattention symptoms, if intolerability to stimulants with inattention symptoms as primary concern Add atomoxetine
Note: Avoid combining atomoxetine with stimulants
Depression comorbidity Add bupropion to a stimulant as treatment for depression & potential adjunct for ADHD
Aggression and mood lability If adequate response for ADHD, but still significant aggression then may consider addition of a low dose, short term atypical antipsychotic

 

Common Side Effects for Stimulant Medications

Reduced appetite/weight loss, insomnia, nervousness, stomachaches, headaches, mild irritability as medicine kicks in, mild irritability as medicine wears off, mild social withdrawal, mild increases in heart rate or blood pressure

 

 

 

Serious Side Effects for Stimulant Medications (Rare)

Severe mood problems, serious aggression, hallucinations, severe social withdrawal, severe tics, large increases in heart rate or blood pressure

 

 

 

See the Ohio Department of Medicaid Unified Preferred Drugs List for information about prescription coverage for children enrolled in Medicaid.

 

Medicaid Unified Preferred Drugs List

 

For additional resources, visit the Ohio Medicaid Pharmacy Program.

 

 

 

Tips for follow-up medication management

 

When a stimulant medication is well-tolerated but ineffective, the dose can be increased. Improvements are often seen right away, so with good data from caregivers and schools about current state of symptoms/response to the current dose, this titration could occur after a short time (e.g., one week).

 

Obtaining information about the timing of when the medicine wears off and when side effects are seen is an important part of medication follow-up. For instance, patients receiving stimulant pharmacotherapy may experience increased irritability in two distinct patterns: increased irritability soon after the medication kicks in, indicating poor tolerability of that agent/dose, or increased irritability much later after the medication begins to wear off, indicating a difficulty due to a sharp drop-off of the medication, which in some cases can be addressed with a short-acting stimulant “booster” dose later in the day.

 

Patients who tolerate methylphenidate without significant side effects but do not seem to experience benefit may be trialed on an amphetamine stimulant such as mixed amphetamine salts or lisdexamfetamine, which sometimes shows efficacy in those who do not adequately respond to methylphenidate, although the likelihood of stimulant-related side effects with amphetamine is modestly higher.

 

Reduced appetite from stimulant medications can sometimes be managed by thoughtfully prioritizing adequate nutrition in the morning before the medicine is taken or kicks in, and in the evening when the medicine is wearing off or has worn off. While the appetite may be low at lunchtime, when the stimulant is active, the nutritional intake at other times may compensate, making it adequate over the course of the day.

 

If a patient continues to experience breakthrough ADHD symptoms, titrate dose of the stimulant as tolerated and consider adding clonidine or guanfacine to a stimulant as adjunct. For monotherapy, although non-stimulant medications for ADHD have a lower effect size, they can be a good choice for individuals who do not tolerate stimulant medications.