- Last edited on March 26, 2023
Ritalin® (methylphenidate)
Primer
Ritalin® (methylphenidate) is a stimulant medication in the methylphenidate class used primarily in the treatment of attention-deficit/hyperactivity disorder (ADHD).
Indications
Pharmacokinetics
- Ritalin is the shortest-acting form of methylphenidate
- Duration: 3-4 hours
- Formulations: 5 (generic), 10, 20 mg tabs
Dosing
- Starting Dose: 5 mg BID to TID (Adults QID)
- Titration: increase by 5mg qWeekly
- Max Dose: 60 mg, all ages
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 |
Pearls
- High abuse potential
- Can be crushed
- Ritalin SR (Sustained Release) also exists but is not really used clinically, since there is generally a really poor response in patients.