Medication		Starting dosage*	Titration and timing of doses	Common adverse effects	Comments
Immediate-release stimulants
Dexmethylphenidate(Focalin)		Children six years and older who are not currently taking methylphenidate (Ritalin): 2.5 mg twice per day	Increase weekly in increments of 2.5 to 5 mg, to maximum dosage of 20 mg per day Doses should be spaced at least four hours apart	Headache, decreased appetite, restlessness, abdominal pain, increased heart rate	—
Dexmethylphenidate(Focalin)		In patients converting from methylphenidate, starting dosage should be one-half the total daily methylphenidate dosage			—
Dextroamphetamine		Children three to five years of age: 2.5 mg per day	Increase weekly in increments of 2.5 to 5 mg per dose Take in morning and at noon; add 4 p.m. dose if needed	Decreased appetite, insomnia, headache, increased heart rate	Typical dose is about one-half of equivalent methylphenidate dose
Dextroamphetamine		Children six years and older: 5 mg once or twice per day
Methylphenidate		Children younger than eight years: 5 mg twice per day	Increase each dose by 2.5 to 5 mg (depending on weight) every one to two weeks as needed and tolerated Take in morning and at noon; add 4 p.m. dose if needed	Decreased appetite, insomnia, headache, increased heart rate	—
Methylphenidate		Children eight years and older: 10 mg twice per day			—
Sustained-release and long-acting stimulants
Amphetamine/dextroamphetamine salts
	Adderall	2.5 to 5 mg in morning	Increase in increments of 2.5 mg; dosage may be increased weekly up to 10 mg per day, to a maximum of 40 mg per day Second dose can be added six to seven hours after morning dose; consider using a tapered dose (smaller afternoon dose than morning dose)	Decreased appetite, insomnia, headache, increased heart rate	Length of action is typically five to eight hours, depending on dose; as dose increases, drug effects will last longer
	Adderall	2.5 to 5 mg in morning
	Adderall XR	Children six years and older: 10 mg in morning	Dosage may be increased weekly by 5 to 10 mg per day, to a maximum of 30 mg per day in children six to 12 years of age, or 20 mg per day in adolescents	Decreased appetite, insomnia, headache, increased heart rate	—
Dexmethylphenidate (Focalin XR)		Children six years and older who are not currently taking methylphenidate: 5 mg per day	Increase weekly in increments of 5 mg, to a maximum dosage of 20 mg per day	Headache, decreased appetite, restlessness, abdominal pain, increased heart rate	—
		In patients converting from methylphenidate, starting dosage should be one-half the total daily methylphenidate dosage
		Dosage should remain the same in patients converting from immediate-release dexmethylphenidate
Dextroamphetamine		Calculated by adding together the first two doses of the day of immediate-release dextroamphetamine; give as one dose in morning	Add 5 mg of extended-release or immediate-release formulation to morning dose, to a maximum dosage of 40 mg per day	Decreased appetite, insomnia, headache, increased heart rate	Typical dose is about one-half of equivalent methylphenidate dose
Lisdexamfetamine (Vyvanse)		Children six years and older: 30 mg in morning	Increase weekly in increments of 10 to 20 mg per day, to a maximum dosage of 70 mg per day	Insomnia, headache, nervousness, dizziness, irritability, increased heart rate or blood pressure	Prodrug with a long duration of action
Methylphenidate
	Concerta	Children six years and older: 18 mg in morning	Increase weekly in increments of 18 mg per day, to a maximum dosage of 72 mg per day in adolescents	Decreased appetite, insomnia, headache, increased heart rate	Inert components of tablet may be seen in stools
	Daytrana (patch)	Children six to 12 years of age: 10-mg patch once per day	Increase to next patch size no more often than every week	Decreased appetite, insomnia, headache, increased heart rate, contact dermatitis	Apply patch to hip and hold for 30 seconds; alternate hips every other day Full effect is reached two hours after application; patch can be removed nine hours after application or sooner if desired; drug concentrations typically decrease after patch is removed, but drug absorption may continue for several hours Patch cannot be cut Used patches contain residual drug and should be disposed of properly



	Metadate CD	Children six years and older: 20 mg in morning	Increase weekly in increments of 10 to 20 mg per day	Decreased appetite, insomnia, headache, increased heart rate	—
	Metadate ER	30 mg in morning	Add 5- or 10-mg tablet in morning and/or at 4 p.m.	Decreased appetite, insomnia, headache, increased heart rate	—
	Methylin ER	30 mg in morning	Add 5- or 10-mg tablet in morning and/or at 4 p.m.	Decreased appetite, insomnia, headache, increased heart rate	—
	Ritalin LA	Children six years and older: 20 mg in morning	Increase weekly in increments of 10 mg per day	Decreased appetite, insomnia, headache, increased heart rate	—
	Ritalin SR	20 mg in morning	Add 5 or 10 mg of immediate-release formulation in morning and/or at 4 p.m.	Decreased appetite, insomnia, headache, increased heart rate	Switching to long-acting formulation is generally equivalent to previous total daily dosage
Nonstimulant drugs
Atomoxetine (Strattera)		Patients weighing up to 70 kg (156 lb): 0.5 mg per kg once per day	After three days, increase dosage to 1.2 mg per kg per day, to a maximum dosage of 1.4 mg per kg per day; may be divided into two doses (morning and evening)	Nausea, vomiting, gastrointestinal pain, anorexia, dizziness, somnolence, skin rash, pruritus, increased heart rate or blood pressure, urinary retention, severe liver injury (rare)	Full effect may not be reached for up to four weeks Do not use concurrently with or within two weeks of taking monoamine oxidase inhibitors; concurrent use with cytochrome P450 CYP2D6 inhibitors may increase atomoxetine concentrations, requiring atomoxetine dose reduction Discontinue use in patients who develop jaundice or evidence of liver injury
Atomoxetine (Strattera)		Patients weighing more than 70 kg: 40 mg once per day	After three days, increase to 80 mg per day, to a maximum dosage of 100 mg per day; may be divided into two doses (morning and evening)
Guanfacine extended-release (Intuniv)		Children six years and older: 1 mg once per day	Increase by up to 1 mg per week, based on clinical response	Somnolence (in up to 38 percent of patients), headache, fatigue, upper abdominal pain, nausea, lethargy, dizziness, irritability, decreased blood pressure, decreased appetite	Increased absorption when taken with high-fat meals Metabolized by cytochrome CYP3A4 system; drug interactions possible Not interchangeable with regular-release guanfacine Safety and effectiveness of long-term use(longer than two years) have not been established