- Last edited on March 26, 2023
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 |