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Tables for:
New-Generation Long-Acting Stimulants for the Treatment of Attention-Deficit/Hyperactivity Disorder

[Medscape Psychiatry & Mental Health 8(2), 2003. © 2003 Medscape]


Table 1. Stimulant Medications Available for the Treatment of ADHD*[6-9]


  Onset of Action Peak Clinical Effect Duration of Action Required Number of Daily Doses
Immediate-release preparations
Methylphenidate (Ritalin, Methylin, Metadate, others) 20-60 minutes ~ 2 hours; range, 0.3-4 hours 2-4 hours 2-3
D-amphetamine (Dexedrine, Dextrostat) 20-60 minutes 1-2 hours 3-6 hours 2-3
D,L-amphetamine (Adderall) 30-60 minutes 1-2 hours 3-6 hours 2
First-generation, sustained-release preparations (older delivery systems)
Methylphenidate (Ritalin-SR, Metadate ER, Methylin ER) 60-90 minutes ~ 5 hours; range 1.3-8.2 hours 4-6 hours 2
D-amphetamine (Dexedrine, Spansule) 60-90 minutes NA 4-6 hours 2
Second-generation, extended-release preparations
Methylphenidate (Metadate CD, Ritalin-LA) 30 minutes-2 hours Bimodal pattern 6-8 hours 1-2
Methylphenidate (Concerta) 30 minutes-2 hours Ascending pattern 12 hours 1
D,L-amphetamine 1-2 hours Bimodal pattern 10-12 hours 1

*Use of pemoline has been associated with rare but life-threatening hepatic failure. It is not considered first-line therapy for ADHD and is not included in this table.
These products display bimodal patterns representing early and late release of medication.
NA = not available.


Table 2. Long-Duration Stimulant Drugs: Dosage Forms


Agents With an 8-Hour Duration
Drug Titration Dosage Forms Starting Doses and Suggested Titration
Metadate CD 20-mg capsule 20 mg daily, increase at intervals >/= 1 week until a target range of 1-2 mg/kg/day is reached
Ritalin-LA 20-mg, 30-mg, and 40-mg capsules Younger child: 20 mg daily, increase by 10 mg daily at intervals >/= 1 week until a target range of 1-2 mg/kg/day is reached

Older child or adolescent: 30 mg daily, increase by 10 mg daily at intervals >/= 1 week until a target range of 1-2 mg/kg/day is reached
Agents With a 10- to 12-Hour Duration
Drug Titration Dosage Forms Starting Doses and Suggested Titration
Adderall XR 5-mg, 10-mg, 15-mg, 20-mg, 25-mg and 30-mg capsules Younger child: 10 mg daily, increase at intervals >/= 1 week until a target range of 0.5-1 mg/kg/day is reached

Older child or adolescent: 20 mg daily, increase at intervals >/= 1 week until a target range of 0.5-1 mg/kg/day is reached
Concerta 18-mg, 27-mg, 36-mg, and 54-mg capsules Younger child: 18 mg daily, increase at intervals >/= 1 week until a target range of 1-2 mg/kg/day is reached

Older child or adolescent: 36 mg daily, increase at intervals >/= 1 week until a target range of 1-2 mg/kg/day is reached

Table 3. Approximate Dosage Strengths for Concerta and Adderall XR


Concerta Adderall XR
(Factor = 0.55)
27 mg 15 mg
54 mg 30 mg
72 mg 40 mg
108 mg 60 mg
144 mg 80 mg