Methylphenidate

Primer

Methylphenidate (Trade names: Ritalin, Biphentin, Concerta) is a central nervous system (CNS) stimulant of the phenethylamine and piperidine class used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It blocks dopamine and norepinephrine transporters in the presynaptic neuron, thus inhibiting reuptake and resulting in increased synaptic concentrations of these neurotransmitters.

Formulations

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.

Conversion

Converting Short-acting Methylphenidate (Ritalin) to Long-acting (Concerta)

Short-acting methylphenidate (Ritalin) Concerta (Ritalin “TID”)
5 mg PO TID 18 mg PO qAM
7.5 mg PO TID 27 mg PO qAM
10 mg PO TID 36 mg PO qAM
12.5 mg PO TID 45 mg PO qAM (27 mg + 18 mg)
15 mg PO TID 59 mg PO qAM
17.5 mg PO TID 63 mg PO qAM (36 mg + 27 mg)
20 mg PO TID 72 mg PO qAM (36 mg × 2)