Concerta® (methylphenidate)

Primer

Concerta® (methylphenidate) is a stimulant medication in the methylphenidate class used primarily in the treatment of attention-deficit/hyperactivity disorder (ADHD).

Pharmacokinetics

  • Essentially mimics taking Ritalin three times a day (TID), by having 3 independent dose deliveries over a longer period of time.
    • OROS Delivery System
  • Capsule shell is excreted in the stool (tell patient this ahead of time!)
  • Capsule must not be cut or chewed and must be swallowed whole!
  • Cannot be easily tampered with for purposes of drug abuse or misuse
    • However, 22% of the total dosage is on the outside of the pill (for immediate release), which can be scrapped/extracted and abused.

Dosing

  • Formulations: 18, 27, 36, 54 mg tabs
  • Starting dose: 18mg qAM
  • Titration: increase by 9-18mg qWeekly
  • Maximum dose: 54 mg in children/adolescents, 72 mg in adults

Comparison Table

There are many different formulations of methylphenidate. These medications are all clinically the same basic ingredient — there are just different delivery mechanisms of each. The maximum dose of methylphenidate should be no more than 2 mg/kg in adults.

Different Formulations of Methylphenidate-based Psychostimulants

Adapted from Annick Vincent, MD (http://www.attentiondeficit-info.com)
Brand (%Immediate/%Delayed) Duration Formulations Starting Dose Titration Notes
Ritalin* (100/0) 3-4 hours 5 (generic), 10, 20mg tabs 5mg BID to TID (Adults QID) ­• ↑ by 5mg qWeekly
­• Maximum dose: 60mg, all ages 		• Short-acting methylphenidate
• High abuse potential
• Can be crushed
Biphentin (40/60) 10-12 hours 10, 15, 20, 30, 40, 50, 60, 80mg caps 10-20mg qAM ­• ↑ by 5-10mg qWeekly
­• Maximum dose: 60mg in children/adolescents, 80mg in adults 		• Called “Bi”-phentin because it mimics “BI”D Ritalin
• Two “pulses” of methylphenidate are released (each pulse lasts about 4-5 hours)
• Has a multi-layer release mechanism
• Purportedly lasts 10-12 hours, but more likely 8-10 hours
• High abuse potential
• Capsules can be opened and sprinkled as granules on soft foods (e.g. - apple sauce, yogurt, ice cream)
Concerta (22/78) 12 hours 18, 27, 36, 54mg tabs 18mg qAM ­• ↑ by 9-18mg qWeekly
­• Maximum dose: 54mg in children/adolescents, 72mg in adults 		• Essentially mimics taking Ritalin TID, by having 3 independent dose deliveries over a longer period of time.
• Capsule shell is excreted in the stool (tell patient this ahead of time!)
• OROS Delivery System
• Capsule must not be cut or chewed and must be swallowed whole!
• Cannot be easily tampered with for purposes of drug abuse or misuse
Foquest (20/80) 16 hours 25, 35, 45, 55, 70, 85, 100mg caps 25mg qAM ­• ↑ by 10-15mg q5 days
­• Maximum dose: 100mg in adults 		Capsules can be opened and sprinkled as granules
* = Ritalin SR (Sustained Release) also exists but is not really used clinically, since there is generally really poor response for patients.