Version June 2024
| Medication (trade name in United States) | Onset of initial effect | Duration of effect | Initial dosage | Titration if needed based upon response | Usual maintenance dosage | Usual maximum dose (per day) |
| Stimulants* | ||||||
| Amphetamine | ||||||
| Long-acting | ||||||
| Adzenys XR orally disintegrating tablet | ≤1 hour | 8 to 12 hours | 12.5 mg once per day in morning | Increase by 3.1 or 6.3 mg per day at weekly or greater intervals | 12.5 mg once per day in morning | 18.8 mg |
| Dyanavel XR tablet and oral suspension | ≤1 hour | Up to 13 hours | 2.5 or 5 mg once per day in morning | Increase by 2.5 to 10 mg per day every 4 to 7 days | 5 to 20 mg once per day in morning | 20 mg |
| Dextroamphetamine | ||||||
| Short-acting | ||||||
| Generics¶Δ | ≤1 hour | 4 to 6 hours | 5 mg twice per day | Increase total daily dose by 5 mg at weekly or greater intervals | 20 mg twice per day | 60 mg in divided doses◊ |
| Long-acting | ||||||
| Dexedrine spansule and generic equivalents¶Δ | ≤1 hour | 6 to 8 hours | 5 mg twice per day | Increase total daily dose by 5 mg at weekly or greater intervals | 40 mg once per day in morning | 60 mg◊ |
| Dextroamphetamine transdermal patch (Xelstrym) | 2 hours | 9 to 12 hours (when applied for 9 hours)§ | 9 mg patch once daily; keep patch on for 9 hours§ | Increase to 18 mg patch after 1 to 2 weeks, if needed | 9 to 18 mg once daily | 18 mg |
| Dextroamphetamine and amphetamine (mixed salts) | ||||||
| Short-acting | ||||||
| Adderall and generic equivalents¶ | ≤1 hour | 4 to 6 hours | 5 mg once or twice per day | Increase total daily dose by 5 or 10 mg at weekly to monthly intervals | 5 to 40 mg per day, once daily or in 2 divided doses | 60 mg◊ |
| Long-acting | ||||||
| Adderall XR and generic equivalents¶ | ≤1 hour | 8 to 12 hours | 10 to 20 mg once per day in morning | Increase daily dose by 10 mg at weekly to monthly intervals | 10 to 40 mg once per day in morning | 60 mg◊ |
| Mydayis triple bead extended release | 2 to 4 hours | 16 hours | 12.5 mg once per day in morning | Increase daily dose by 12.5 mg at weekly or greater intervals | 12.5 to 50 mg once per day in morning | 50 mg |
| Lisdexamfetamine | ||||||
| Vyvanse | ≤1 hour; onset delayed if taken with food | ~10 hours | 10 to 30 mg once per day in morning | Increase daily dose by 10 or 20 mg at weekly or greater intervals | 30 to 70 mg once per day in morning | 70 mg |
| Dexmethylphenidate | ||||||
| Short-acting | ||||||
| Focalin and generic equivalents¶Δ | 0.5 to 1 hour; delayed if taken with a high-fat meal | 4 to 6 hours | 5 mg twice per day | Increase total daily dose by 5 to 10 mg at weekly or greater intervals | 10 to 15 mg two times daily or 10 mg three times daily | 40 mg in divided doses¥ |
| Long-acting | ||||||
| Focalin XR and generic equivalents¶ | 0.5 to 1 hour; a second peak effect occurs ~6.5 hours after dose | 12 hours | 10 mg once per day in morning | Increase daily dose by 10 mg at weekly or greater intervals | 20 to 30 mg once per day in morning | 40 mg |
| Azstarys 70% serdexmethylphenidate (dexmethylphenidate prodrug) and 30% dexmethylphenidate (immediate release) | ≤1 hour | 6 to 11 hours | Serdexmethylphenidate 39.2 mg/ dexmethylphenidate 7.8 mg once per day in morning | After 1 week, increase daily dose to serdexmethylphenidate 52.3 mg/ dexmethylphenidate 10.4 mg | Serdexmethylphenidate 52.3 mg/ dexmethylphenidate 10.4 mg once per day in morning | Serdexmethylphenidate 52.3 mg/ dexmethylphenidate 10.4 mg |
| Methylphenidate | ||||||
| Short-acting | ||||||
| Ritalin and generic equivalents | ≤1 hour; delayed if taken with a high-fat meal | 3 to 5 hours | 10 mg before breakfast and lunch | Increase total daily dose by 5 or 10 mg at weekly or greater intervals | 40 to 60 mg per day in two or three divided doses | 60 mg in divided doses |
| Methylin chewable | ||||||
| Methylin oral solution | ||||||
| Intermediate-acting | ||||||
| Ritalin SR and generic equivalents | ≤1 hour | 8 hours | 20 mg once per day in morning | Increase daily dose by 10 mg at weekly or greater intervals | 40 to 60 mg once per day in morning | 100 mg‡ |
| Metadate ER and generic equivalents | 8 hours | 10 mg twice per day | Increase daily dose by 10 mg at weekly or greater intervals | 40 to 60 mg once per day in morning | ||
| Long-acting | ||||||
| Metadate CD and generic equivalents | ≤1 hour; a second peak effect occurs ~4.5 hours after dose | 8 to 12 hours | 20 mg once per day in morning | Increase daily dose by 10 or 20 mg at weekly or greater intervals | 40 to 60 mg once per day in morning | 100 mg‡ |
| Quillivant XR oral suspension and Quillichew ER chewable tabletΔ | ≤1 hour | 8 to 12 hours | 20 mg once per day in morning | Increase daily dose by 10 to 20 mg at weekly or greater intervals | 40 to 60 mg once per day in morning | 60 mg |
| Ritalin LA and generic equivalent¶ | ≤1 hour; a second peak effect occurs ~5.5 hours after dose | 8 to 12 hours | 10 or 20 mg once per day in morning | Increase daily dose by 10 mg at weekly or greater intervals | 40 to 60 mg once per day in morning | 100 mg‡ |
| Concerta, Relexxii, and generic equivalents | ≤1 hour; plateau at 1 to 4 hours and peak at 6 hours after dose | 10 to 12 hours | 18 or 36 mg once per day in morning | Increase daily dose by 18 mg at weekly or greater intervals | 54 to 72 mg once per day in morning | 72 mg |
| Aptensio XR and generic equivalents | 1 hour (peak at 2 hours); a second peak occurs at ~8 hours after dose | 12 hours | 10 mg once per day in morning | Increase daily dose in 10 mg increments at weekly or greater intervals | 20 to 60 mg once per day in the morning | 60 mg |
| Jornay PM | ~12 hours (peak at ~14 hours) | 13 hours | 20 mg once daily in the evening between 6:30 PM and 9:30 PM | Increase daily dose in 20 mg increments at weekly or greater intervals | 20 to 100 mg once per day in the evening | 100 mg |
| Biphentin (Canadian) | 1 hour (peak at 2 hours); a second peak occurs ~6 hours after dose | 12 hours | 10 to 20 mg once per day in morning | Increase daily dose in 10 mg increments at weekly or greater intervals | 20 to 80 mg once per day in the morning | 80 mg |
| Foquest (Canadian) | 1 hour (peak at ~2 hours); a second peak occurs at ~12.5 hours after dose | 16 hours | 25 mg once per day in the morning | Increase daily dose by 10 to 15 mg increments at intervals of ≥5 days | 25 to 100 mg once per day in the morning | 100 mg |
| Daytrana transdermal patchΔ | ≤2 hours | 10 to 12 hours | 10 mg patch on for 9 hours and off for 15 hours each day Apply patch 2 hours before needed onset | Increase to next higher patch strength at weekly or greater intervals Available patch strengths: 10 mg, 15 mg, 20 mg and 30 mg per 9 hours | 30 to 60 mg patch on for 9 hours and off for 15 hours each day | 60 mg (ie, two 30 mg patches) |
| Non-stimulants | ||||||
| Atomoxetine | ||||||
| Strattera and generic equivalents | 1 to 2 weeks | 24 hours | 40 mg once per day | Increase after three or more days to 80 mg; after two to four additional weeks may increase to 100 mg per day | 80 mg once per day or in two equally divided doses | 100 mg |
| Viloxazine (extended-release)† | ||||||
| Qelbree | 1 to 2 weeks | 24 hours | 200 mg once per day | Increase daily dose by 200 mg at weekly or greater intervals | 200 to 600 mg once per day | 600 mg |
| Nortriptyline** | ||||||
| Pamelor and generic equivalents | 1 to 4 weeks | 24 hours | 25 mg | Advance by 25 mg every 3 to 4 weeks | 1 to 3 mg/kg per day in one dose at bedtime | 150 mg |
| Bupropion | ||||||
| Wellbutrin SR and generic equivalents | 1 to 2 weeks | 12 hours | 100 mg once per day in morning | After several weeks increase to 100 mg twice per day | 100 to 150 mg twice per day | 400 mg in divided doses |
| Wellbutrin XL and generic equivalents | 24 hours | 150 mg once per day in morning | After several weeks increase to 300 mg once per day | 300 mg once per day | 450 mg | |
For approach to product selection and individualization of dosage, refer to UpToDate topic review of treatment of attention deficit hyperactivity disorder in adults. When switching between stimulant formulations due to insufficient effect, an equivalent dose (where available) may be a consideration when selecting the initial dose of the new stimulant medication. When switching stimulant medications for another reason (eg, adverse effects) UpToDate contributors generally start with a low initial dose of the new stimulant and retitrate as needed.
The doses listed in this table are for oral administration (exception: patches) in patients with normal kidney and liver function; the doses of several of these agents may require adjustment in the setting of kidney or liver impairment; refer to the Lexicomp drug monographs included within UpToDate.US FDA: United States Food and Drug Administration.
* Stimulants are United States Drug Enforcement Agency Schedule II controlled substances.
¶ Should not be taken with antacids or other drugs that decrease gastric acidity.
Δ US FDA approval is for use in patients 6 to 17 years or children ≥6 years old. Doses for the methylphenidate patches are not equivalent to those for the oral preparations.
◊ Doses above 40 mg per day are rarely necessary and warrant close monitoring.
§ Patch can be removed earlier to control duration; effect lasts approximately 2 to 3 hours after patch removed. Doses for the dextroamphetamine patches are not equivalent to those for the oral preparations.
¥ Maximum dose recommended by UpToDate contributors exceeds the US FDA approved maximum of 20 mg per day; careful monitoring for adverse effects is warranted.
‡ Maximum dose recommended by UpToDate contributors exceeds the US FDA approved maximum dose of 60 mg per day; careful monitoring for adverse effects is warranted.
† For individuals with severe kidney impairment (eg, estimated glomerular filtration rate <30 mg/min/1.73 m2), recommended starting dose is 100 mg once daily. May titrate daily dose by 50 to 100 mg at weekly or greater intervals to maximum dose of 200 mg once per day.
** Dosing not well established; may be started as low as 10 mg twice daily. If serum concentration levels are deemed necessary for guiding therapy, levels within a range of 50 to 150 ng/mL are considered appropriate by UpToDate contributors.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
