Stimulant ADHD Medication Aid
Stimulant ADHD 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 | 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 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 | |
| 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 | |
| Adhansia XR | 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, 85 mg | 25 mg daily | 70 mg daily (85 mg daily for adults) |
20% IR layer/80% XR layer 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 | 39.2 mg/ 7.8 mg | 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 guidecan 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, 350 mg, 40 mg | 5 mg daily | 30 mg daily | Can be opened/sprinkled |
Amphetamine Derivatives
| 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, 30 mg | 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 | 2.5 mg daily | 5 mg daily or BID | |||
| Evekeo (d- & l- amphetamine sulfate) | 5 mg, 10 mg | 2.5 mg daily | 5 mg daily or BID | |||
| Evekeo ODT | 5 mg, 10 mg | 2.5 mg daily | 5 mg daily or BID | |||
| Procentra (d-amphetamine liquid) | 5 mg/5 ml | 2.5 mg daily | 5 mg daily or BID | |||
| Mixed Amphetamine salts immediate release capsule |
||||||
| Adderall XR | 5 mg, 10 mg, 15 mg, 20 mg 25 mg, 30 mg | 10 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 12+ |
||
| Lisdexamfetamine (prodrug) |
||||||
| Vyvanse | 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70mg 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 | |||
| Adzenys ER | 3.1 mg/2.5ml | 6.3 mg daily | 18.8 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
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.
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.