Current medication and dose | New medication | Recommended starting dose | Comments | |
Switching from one form of methylphenidate to another | ||||
Methylphenidate IR 5 mg twice daily or three times daily | Methylphenidate osmotic release (Concerta) | 18 mg once daily in the morning | ||
Methylphenidate IR 10 mg twice daily or three times daily | Methylphenidate osmotic release | 36 mg once daily in the morning | ||
Methylphenidate IR 15 mg twice daily or three times daily | Methylphenidate osmotic release | 54 mg once daily in the morning | ||
Methylphenidate IR 20 mg twice daily or three times daily | Methylphenidate osmotic release | 72 mg once daily in the morning | Conversion dosage should not exceed 72 mg per day. | |
Methylphenidate IR | Dexmethylphenidate (Focalin or Focalin XR) | One-half the current total daily dose | ||
Methylphenidate IR 5 mg three times per day | Methylphenidate patch (Daytrana) | 10 mg (12.5 cm2) patch applied once daily | Methylphenidate patch has greater systemic bioavailability than oral preparations. Patients changing from oral methylphenidate IR doses ≤20 mg per day should be started on the 10 mg patch. Allow at least 1 week before increasing to the next higher patch strength, if needed. | |
Methylphenidate IR 7.5 mg three times per day | Methylphenidate patch | 15 mg (18.75 cm2) patch applied once daily | ||
Methylphenidate IR 10 mg three times per day | Methylphenidate patch | 20 mg (25 cm2) patch applied once daily | ||
Methylphenidate IR 15 mg three times per day | Methylphenidate patch | 30 mg (37.5 cm2) patch applied once daily | ||
Methylphenidate osmotic release 18 mg | Methylphenidate patch | 10 mg (12.5 cm2) patch applied once daily | ||
Methylphenidate osmotic release 27 mg | Methylphenidate patch | 15 mg (18.75 cm2) patch applied once daily | ||
Methylphenidate osmotic release 36 mg | Methylphenidate patch | 20 mg (25 cm2) patch applied once daily | ||
Methylphenidate osmotic release 54 mg | Methylphenidate patch | 30 mg (37.5 cm2) patch applied once daily | ||
Switching to serdexmethylphenidate-dexmethylphenidate | ||||
Any stimulant¶ | Serdexmethylphenidate-dexmethylphenidate (Azstarys) | 39.2/7.8 mg once daily in the morning | If switching from any other stimulant, including methylphenidate products, discontinue the treatment and titrate serdexmethylphenidate-dexmethylphenidate from the appropriate initial starting dose. | |
Switching to dextroamphetamine | ||||
Any stimulant¶ | Dextroamphetamine or dextroamphetamine spansules | 5 mg once or twice per day | Daily dosage may be increased in increments of 5 mg at weekly intervals until optimal response is obtained (maximum daily dose 40 mg). | |
Any stimulant¶ | Lisdexamfetamine (Vyvanse) | 30 mg once daily in the morning | Daily dosage may be increased in increments of 10 or 20 mg at approximately weekly intervals until optimal response is obtained (maximum daily dose 70 mg). | |
Any stimulant¶Δ | Dextroamphetamine patch | 6 to 17 years: 4.5 mg per 9 hour patch applied once daily | Daily dosage may be increased in increments of 4.5 mg at approximately weekly intervals until optimal response is obtained (maximum daily dose 18 mg) | |
Switching to dextroamphetamine-amphetamine | ||||
Methylphenidate¶◊ | Dextroamphetamine-amphetamine IR | 6 to 12 years: 10 mg once daily in the morning | Daily dosage may be adjusted in increments of 5 or 10 mg at weekly intervals until optimal response is obtained (maximum daily dose 30 mg; may be divided in 2 doses). | |
13 to 17 years: 10 mg once daily in the morning | Daily dosage may be adjusted in increments of 5 or 10 mg at weekly intervals until optimal response is obtained (maximum daily dose 40 mg; may be divided in 2 doses). | |||
Dextroamphetamine-amphetamine (Adderall) IR | Dextroamphetamine-amphetamine XR | Same total daily dose | ||
Any stimulant other than dextroamphetamine-amphetamine IR¶◊ | Dextroamphetamine-amphetamine XR | 6 to 12 years: 10 mg once daily in the morning | Daily dosage may be adjusted in increments of 5 or 10 mg at weekly intervals until optimal response is obtained (maximum daily dose 30 mg/day). | |
13 to 17 years: 10 mg once daily in the morning | Daily dosage may be increased to 20 mg/day after 1 week if symptoms are not adequately controlled. | |||
Switching from one form of XR dextroamphetamine-amphetamine to another§ | ||||
Dextroamphetamine-amphetamine XR (Adderall XR) capsule | Amphetamine XR orally disintegrating tablet (Adzenys XR-ODT) Amphetamine ER oral suspension (1.25 mg amphetamine base per mL, Adzenys ER) | Each 5 mg of dextroamphetamine-amphetamine salts (Adderall XR) is equivalent to approximately 3.1 mg of amphetamine XR-ODT (Adzenys XR-ODT) or amphetamine ER oral suspension (Adzenys ER) | XR capsule (Adderall XR) | Dose expressed as base: ODT-XR tablet and ER oral suspension (Adzenys XR-ODT, Adzenys ER) |
Approximate equivalence (taken once daily in the morning): | ||||
5 mg | 3.1 mg | |||
10 mg | 6.3 mg | |||
15 mg | 9.4 mg | |||
20 mg | 12.5 mg | |||
25 mg | 15.7 mg | |||
30 mg | 18.8 mg |
IR: immediate release; XR: extended release; ODT: orally-disintegrating tablet; ER: extended release.
* Ultimate dose must be individualized based upon patient needs and response as children may respond differently to new medication.
¶ There are no reliable data to provide guidelines for switching between different classes of long-acting stimulants.
Δ Discontinue the previous stimulant and titrate the dextroamphetamine patch from the initial starting dose. Other amphetamine products have different amphetamine base compositions and pharmacokinetic profiles. They cannot be substituted on a milligram-per-milligram basis.
◊ When switching from methylphenidate to dextroamphetamine-amphetamine, the ultimate dose of dextroamphetamine-amphetamine is approximately one-half the current dose of methylphenidate (eg, 30 mg of methylphenidate is approximately equal to 15 mg of dextroamphetamine-amphetamine); however, for children who are currently receiving ≥20 mg per day of methylphenidate, we suggest converting to dextroamphetamine-amphetamine at a starting dose of 10 mg once per day and titrating the dose to the child's response (as described in the table).
§ Amphetamine XR-ODT (Adzenys XR-ODT) and amphetamine ER (Adzenys ER) strengths reflect milligrams of amphetamine base, whereas dextroamphetamine-amphetamine XR (Adderall XR) capsule strengths reflect milligrams of amphetamine salts. These cannot be substituted on a milligram-per-milligram basis. If switching from any other amphetamine product, discontinue the treatment and retitrate the new product from the appropriate initial starting dose.