Version May 2024
| Current medication and dose | New medication | Recommended starting dose | Comments | |
| Switching from one form of methylphenidate to another | ||||
| Methylphenidate IR 5 mg twice daily or three times daily | Methylphenidate osmotic release (Concerta) | 18 mg once daily in the morning | ||
| Methylphenidate IR 10 mg twice daily or three times daily | Methylphenidate osmotic release | 36 mg once daily in the morning | ||
| Methylphenidate IR 15 mg twice daily or three times daily | Methylphenidate osmotic release | 54 mg once daily in the morning | ||
| Methylphenidate IR 20 mg twice daily or three times daily | Methylphenidate osmotic release | 72 mg once daily in the morning | Conversion dosage should not exceed 72 mg per day. | |
| Methylphenidate IR | Dexmethylphenidate (Focalin or Focalin XR) | One-half the current total daily dose | ||
| Methylphenidate IR 5 mg three times per day | Methylphenidate patch (Daytrana) | 10 mg (12.5 cm2) patch applied once daily | Methylphenidate patch has greater systemic bioavailability than oral preparations. Patients changing from oral methylphenidate IR doses ≤20 mg per day should be started on the 10 mg patch. Allow at least 1 week before increasing to the next higher patch strength, if needed. | |
| Methylphenidate IR 7.5 mg three times per day | Methylphenidate patch | 15 mg (18.75 cm2) patch applied once daily | ||
| Methylphenidate IR 10 mg three times per day | Methylphenidate patch | 20 mg (25 cm2) patch applied once daily | ||
| Methylphenidate IR 15 mg three times per day | Methylphenidate patch | 30 mg (37.5 cm2) patch applied once daily | ||
| Methylphenidate osmotic release 18 mg | Methylphenidate patch | 10 mg (12.5 cm2) patch applied once daily | ||
| Methylphenidate osmotic release 27 mg | Methylphenidate patch | 15 mg (18.75 cm2) patch applied once daily | ||
| Methylphenidate osmotic release 36 mg | Methylphenidate patch | 20 mg (25 cm2) patch applied once daily | ||
| Methylphenidate osmotic release 54 mg | Methylphenidate patch | 30 mg (37.5 cm2) patch applied once daily | ||
| Switching to serdexmethylphenidate-dexmethylphenidate | ||||
| Any stimulant¶ | Serdexmethylphenidate-dexmethylphenidate (Azstarys) | 39.2/7.8 mg once daily in the morning | If switching from any other stimulant, including methylphenidate products, discontinue the treatment and titrate serdexmethylphenidate-dexmethylphenidate from the appropriate initial starting dose. | |
| Switching to dextroamphetamine | ||||
| Any stimulant¶ | Dextroamphetamine or dextroamphetamine spansules | 5 mg once or twice per day | Daily dosage may be increased in increments of 5 mg at weekly intervals until optimal response is obtained (maximum daily dose 40 mg). | |
| Any stimulant¶ | Lisdexamfetamine (Vyvanse) | 30 mg once daily in the morning | Daily dosage may be increased in increments of 10 or 20 mg at approximately weekly intervals until optimal response is obtained (maximum daily dose 70 mg). | |
| Any stimulant¶Δ | Dextroamphetamine patch | 6 to 17 years: 4.5 mg per 9 hour patch applied once daily | Daily dosage may be increased in increments of 4.5 mg at approximately weekly intervals until optimal response is obtained (maximum daily dose 18 mg) | |
| Switching to dextroamphetamine-amphetamine | ||||
| Methylphenidate¶◊ | Dextroamphetamine-amphetamine IR | 6 to 12 years: 10 mg once daily in the morning | Daily dosage may be adjusted in increments of 5 or 10 mg at weekly intervals until optimal response is obtained (maximum daily dose 30 mg; may be divided in 2 doses). | |
| 13 to 17 years: 10 mg once daily in the morning | Daily dosage may be adjusted in increments of 5 or 10 mg at weekly intervals until optimal response is obtained (maximum daily dose 40 mg; may be divided in 2 doses). | |||
| Dextroamphetamine-amphetamine (Adderall) IR | Dextroamphetamine-amphetamine XR | Same total daily dose | ||
| Any stimulant other than dextroamphetamine-amphetamine IR¶◊ | Dextroamphetamine-amphetamine XR | 6 to 12 years: 10 mg once daily in the morning | Daily dosage may be adjusted in increments of 5 or 10 mg at weekly intervals until optimal response is obtained (maximum daily dose 30 mg/day). | |
| 13 to 17 years: 10 mg once daily in the morning | Daily dosage may be increased to 20 mg/day after 1 week if symptoms are not adequately controlled. | |||
| Switching from one form of XR dextroamphetamine-amphetamine to another§ | ||||
| Dextroamphetamine-amphetamine XR (Adderall XR) capsule | Amphetamine XR orally disintegrating tablet (Adzenys XR-ODT) Amphetamine ER oral suspension (1.25 mg amphetamine base per mL, Adzenys ER) | Each 5 mg of dextroamphetamine-amphetamine salts (Adderall XR) is equivalent to approximately 3.1 mg of amphetamine XR-ODT (Adzenys XR-ODT) or amphetamine ER oral suspension (Adzenys ER) | XR capsule (Adderall XR) | Dose expressed as base: ODT-XR tablet and ER oral suspension (Adzenys XR-ODT, Adzenys ER) |
| Approximate equivalence (taken once daily in the morning): | ||||
| 5 mg | 3.1 mg | |||
| 10 mg | 6.3 mg | |||
| 15 mg | 9.4 mg | |||
| 20 mg | 12.5 mg | |||
| 25 mg | 15.7 mg | |||
| 30 mg | 18.8 mg | |||
IR: immediate release; XR: extended release; ODT: orally-disintegrating tablet; ER: extended release.
* Ultimate dose must be individualized based upon patient needs and response as children may respond differently to new medication.
¶ There are no reliable data to provide guidelines for switching between different classes of long-acting stimulants.
Δ Discontinue the previous stimulant and titrate the dextroamphetamine patch from the initial starting dose. Other amphetamine products have different amphetamine base compositions and pharmacokinetic profiles. They cannot be substituted on a milligram-per-milligram basis.
◊ When switching from methylphenidate to dextroamphetamine-amphetamine, the ultimate dose of dextroamphetamine-amphetamine is approximately one-half the current dose of methylphenidate (eg, 30 mg of methylphenidate is approximately equal to 15 mg of dextroamphetamine-amphetamine); however, for children who are currently receiving ≥20 mg per day of methylphenidate, we suggest converting to dextroamphetamine-amphetamine at a starting dose of 10 mg once per day and titrating the dose to the child's response (as described in the table).
§ Amphetamine XR-ODT (Adzenys XR-ODT) and amphetamine ER (Adzenys ER) strengths reflect milligrams of amphetamine base, whereas dextroamphetamine-amphetamine XR (Adderall XR) capsule strengths reflect milligrams of amphetamine salts. These cannot be substituted on a milligram-per-milligram basis. If switching from any other amphetamine product, discontinue the treatment and retitrate the new product from the appropriate initial starting dose.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
