Is there a standard protocol for the use of stimulant medications in the treatment of pediatric attention deficit hyperactivity disorder (ADHD)?

Updated: Sep 09, 2021
  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
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Answer

The 2 major components in the medical care of children with attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), are behavioral and pharmaceutical therapies. The behavioral component is covered in the Treatment section.

Pediatric dosing of stimulant medications

Dosing of stimulant medications vary among ADHD (ADD) centers throughout the medical community in the United States. The table below is derived from the stimulant trial protocol of The Affinity Center, Inc, a center for the evaluation and treatment of ADHD (ADD) and mood disorders in Cincinnati, Ohio.

Table 1. Pediatric Dosing of Stimulant Medications (Open Table in a new window)

Medication

Initial Pediatric Dose

Pediatric Dosage Range and Maximum Dose*

Common Pediatric Dose*

Preparations

Methylphenidate immediate release (IR) (Ritalin, Methylin, generic)

2.5-5 mg

0.1-0.8 mg/kg/dose PO qd to 5 times/d; not to exceed 60 mg/d

0.3-0.5 mg/kg/dose PO tid/qid

All preparations available as 5-mg, 10-mg, or 20-mg scored tabs; Methylin also available as 2.5-mg, 5-mg, or 10-mg chewable tab and PO solution (5 mg/5 mL and 10 mg/mL)

Methylphenidate sustained-release (SR) (Ritalin LA, Metadate CD)

Convert from IR or use 10 mg.

0.2-1.4 mg/kg/dose PO qd/tid; not to exceed 60 mg/d

0.6-1 mg/kg/dose PO qd/bid

10-mg, 20-mg, 30-mg, or 40-mg tabs (Metadate also has 50-mg and 60-mg tabs.); can be sprinkled into soft food (Do not cut, crush, or chew.)

Methylphenidate extended release (ER)‡ (Ritalin SR, Methylin ER, Metadate ER, Quillivant XR, generic SR)

Convert from IR

May initiate treatment with Quillivant XR

0.2-1.4 mg/kg/dose PO qd/tid; not to exceed 60 mg/d

Quillivant XR: Once daily dosing

0.6-1 mg/kg/dose PO qd/bid

20-mg Spansules (Do not cut, crush, or chew)

Quillivant XR 5 mg/mL suspension

Methylphenidate OROS tablets (Concerta)

Convert from IR or use 18 mg.

0.3-2 mg/kg PO qd; not to exceed 54 mg/d

0.8-1.6 mg/kg PO qd

18-mg, 27-mg, 36-mg, and 54-mg tabs (Do not cut, crush, or chew.)

Methylphenidate transdermal patch (Daytrana)

Convert from IR or use 10 mg (12.5 cm2 patch) released over 9 h and titrate up prn.

0.3-2 mg/kg released over 9 h; not to exceed one 30-mg patch

10-30 mg released over 9 h

10-mg, 15-mg, 20-mg, 30-mg patches, applied to the hip

Dexmethylphenidate IR (Focalin)

2.5-5-mg

0.1-0.5 mg/kg/dose PO qd to qid; not to exceed 20 mg/d

0.2-0.3 mg/kg/dose PO bid/tid

2.5-mg, 5-mg, or 10-mg scored tabs (Do not cut, crush, or chew.)

Dexmethylphenidate extended release (Focalin-XR)

5-10-mg

0.2-1 mg/kg/dose PO qd to bid; not to exceed 20 mg/d

0.4-0.6 mg/kg/dose PO qd/bid

5-mg, 10-mg, or 20-mg scored tabs; can be sprinkled into soft food (Do not cut, crush, or chew.)

Dextroamphetamine (Dexedrine, Dextrostat)

2.5-5 mg

0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 60 mg/d

0.3-0.5 mg/kg/dose PO qd/tid

Dexedrine: 5-mg scored tabs; Dextrostat: 5-mg and 10-mg scored tabs

Dextroamphetamine Spansules (Dexedrine CR)

5 mg

0.1-0.75 mg/kg/dose PO qd/bid; not to exceed 60 mg/d

0.3-0.6 mg/kg/dose PO qd/bid

5-mg, 10-mg, or 15-mg Spansules; can be sprinkled into soft food (Do not cut, crush, or chew.)

Mixed amphetamine salts IR (Adderall, generic)

2.5-5 mg

0.1-0.7 mg/kg/dose PO qd/qid; not to exceed 40 mg/d

0.3-0.5 mg/kg/dose PO tid/qid

5-mg, 7.5-mg, 10-mg, 12.5-mg, 15-mg, 20-mg, or 30-mg scored tabs

Mixed amphetamine salt XR (Adderall-XR)

Convert from IR or use 5-10 mg

0.2-1.4 mg/kg/dose PO qd/tid

Not to exceed 30 mg/d

0.6-1 mg/kg/dose PO qd/bid

5-mg, 10-mg, 15-mg, 20-mg, 25-mg, or 30-mg Spansules; can be sprinkled into soft food (Do not cut, crush, or chew.)

Lisdexamfetamine (Vyvanse)

30 mg PO qam

30-70 mg PO qam

Data limited

20-mg, 30-mg, 40-mg, 50-mg, 60-mg, or 70-mg caps (Swallow cap whole, sprinkle into soft food, or dissolve contents in glass of water and drink immediately.)Risk of apnea in patients with chronic pulmonary disease; closely monitor these patients, when initiating and titrating therapy; alternatively, consider the use of alternative non-opioid analgesics in these patients (see Black Box Warnings and Contraindications)

Amphetamine (Evekeo, Dyanavel XR), Adzenys XR-ODT

Evekeo: 2.5 mg PO BID/TID

 

Dyanavel XR: 2.5-5 mg PO once daily

 

Adzenys XR-ODT: 6.3 mg PO qAM

Evekeo: 2.5 mg BID/TID; only in rare cases is it necessary to exceed 40 mg/day

 

Dyanavel XR: 2.5-5 mg/day; not to exceed 20 mg/day

 

Adzenys XR-ODT: Not to exceed 18.8 mg/day (aged 6-12 y) or 12.5 mg/day (aged 13-17 y)

Data limited

Evekeo: 5-mg, 10-mg tablets

 

Dyanavel XR: 2.5-mg/mL extended-release oral suspension (do not substitute oral suspension for other amphetamine products on a milligram-per-milligram basis)

 

Adzenys XR-ODT: 3.1-mg, 6.3-mg, 9.4-mg, 12.5-mg, 15.7-mg, 18.8-mg extended-release oral disintegrating tablets

Note. In general, when the terms methylphenidate, Dexedrine, and Ritalin are used without abbreviations for extended-release preparations (eg, continuous release [CR], SR, osmotic-release oral system [OROS]), a short-acting, IR preparation is implied.

* Maximum pediatric dose suggested by the US Food and Drug Administration (FDA). Although some children benefit greatly from doses greater than these, benefit from use of either the lowest and highest ends of the dose range is uncommon.

†The methylphenidate patch contains a different total methylphenidate dose than the name implies because it is designed to last 12 hours (eg, 10-mg patch [patch size 12.5 cm2] delivers about 10 mg over 9 h [estimated delivery rate is 1.1 mg/h for this particular patch]). Delivery rate varies depending on patch size.

‡Many patients describe their experience with methylphenidate SR preparations as erratic and uncomfortable.


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