MedicationStarting dosage*Titration and timing of dosesCommon adverse effectsComments
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
In patients converting from methylphenidate, starting dosage should be one-half the total daily methylphenidate dosage
DextroamphetamineChildren 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

Children six years and older: 5 mg once or twice per day
MethylphenidateChildren 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
Children eight years and older: 10 mg twice per day
Sustained-release and long-acting stimulants
Amphetamine/dextroamphetamine salts
Adderall2.5 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 XRChildren 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
DextroamphetamineCalculated 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
ConcertaChildren 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 CDChildren 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 ER30 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 ER30 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 LAChildren 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 SR20 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

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