ADHD Stimulant Medication Aid

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

 

 

 

 

 

 

 

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.