Selected immediate-release stimulant preparations for children with attention deficit hyperactivity disorder

Medication (how supplied)	United States trade name (generic availability)	Duration of action	Initial dose*	Dose advancement*	Maximum dose (per day)
Methylphenidate
5, 10, 20 mg tablets 2.5, 5, 10 mg chewable tablets 5 mg/5 mL flavored oral solution 10 mg/5 mL flavored oral solution	Ritalin (generic available) Generic chewable tablets Methylin oral suspension (generic available)	3 to 5 hours	5 mg once per day on Day 1, then 5 mg 2 times per day Children ≤25 kg may be started with 2.5 mg per day	Increments of 5 mg per day every 3 to 7 days Children ≤25 kg may be increased by 2.5 mg per day every 3 to 7 days	≤25 kg – 35 mg 25 kg – 60 mg
Dexmethylphenidate^¶
2.5, 5, 10 mg tablets, non-scored	Focalin (generic available)	5 to 6 hours	Patients not taking methylphenidate – 2.5 mg 2 times per day Patients taking methylphenidate – Dose is one-half current daily dose up to 10 mg 2 times per day	Increments of 2.5 to 5 mg per day every 3 to 7 days	20 mg
Amphetamine
5, 10 mg tablets, scored	Evekeo (generic available)	4 to 6 hours	3 to 5 years
			2.5 mg once per day	Increments of 2.5 mg per day every 7 days	40 mg
			≥6 years
			5 mg 1 or 2 times per day	Increments of 5 mg per day every 7 days	40 mg
Amphetamine
2.5, 5, 10, 15, 20 mg orally disintegrating tablets	Evekeo ODT	4 to 6 hours	≥6 years
			5 mg 1 or 2 times per day	Increments of 2.5 to 5 mg per day every 7 days	40 mg
Dextroamphetamine
2.5, 5 [scored], 7.5, 10 [scored], 15, 20, 30 mg tablets 5 mg/5 mL flavored oral solution	Dexedrine, Zenzedi (generic available for 5 and 10 mg strengths) ProCentra oral solution (generic available)	4 to 6 hours	3 to 5 years
			2.5 mg once per day on Day 1, then 2.5 mg 2 times per day	Increments of 2.5 mg per day every 3 to 7 days	20 mg
			≥6 years
			5 mg once per day on Day 1, then 5 mg 2 times per day	Increments of 5 mg per day every 3 to 7 days	≤50 kg – 40 mg >50 kg – 60 mg^Δ
Dextroamphetamine-amphetamine
5, 7.5, 10, 12.5, 15, 20, 30 mg scored tablets	Adderall (generic available)	4 to 6 hours	3 to 5 years		≤50 kg – 40 mg >50 kg – 60 mg^Δ
			2.5 mg once per day on Day 1, then 2.5 mg 2 times per day	Increments of 2.5 mg per day every 3 to 7 days
			≥6 years
			5 mg once per day on Day 1, then 5 mg 2 times per day	Increments of 5 mg per day every 3 to 7 days

* Doses of immediate-release preparations are given in the morning on rising and at lunch time 4 to 6 hours later. Three times per day dosing is an option for children needing control of symptoms in the late afternoon or early evening.

¶ Dexmethylphenidate may not be an appropriate choice for children aged <6 years, due to its relatively higher potency and lack of commercially available chewable tablets or flavored oral solution.

Δ Doses above 40 mg per day total are rarely needed and warrant close monitoring for adverse effects.

References:

Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:894.
Wender EH. Managing stimulant medication for attention-deficit/hyperactivity disorder. Pediatr Rev 2001; 22:183.
Drugs for ADHD. Med Lett Drugs Ther 2020; 62:9.

Prepared with additional data from the US Food and Drug Administration approved product information, available at www.accessdata.fda.gov/scripts/cder/daf/index.cfm (accessed on October 4, 2022).

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Selected immediate-release stimulant preparations for children with attention deficit hyperactivity disorder