a. Methylphenidates

**Dosage should be individualized according to the therapeutic needs and response of the patient**

BrandGenericFormStrengthDosingMax doseDuration Peak EffectSide effectsNotes/Medication guide Tier SoonerStartTier BCBSTier TriCare
FocalinDexmethylphenidateTablets2.5, 5, 106 y: 2.5 mg/BID, at least 4 h apart, increments of 2.5-5 mg wkly20mg3-4 hrs1-1.5 hrsCommon:
Nervousness, insomnia, loss appetite, mood swings, nausea/vomiting, abdominal pain, weight t loss, digested problems, dizziness, headache, withdrawal symptoms.
Less common:
palpitation, rare myocardial infarctions, changes in heart rate & blood pressure (usually increase of both, occasional decrease) skin rashes & itching, seizures, blurred vision, toxic psychosis, psychotics episodes, drug dependence synd. Growth retardation, severe depression upon withdraw
ext. peak time if taken with high fat food.
Med guide
1NFNF ($44 network)
Focalin XRDexmethylphenidateCapsules5, 10,15, 206 y: 5 mg/day, increments of 5 mg wkly30 mg8-12 hrs2 peaks: 1.5 h & 6.5 (4.5-7) h *High fat food delays 1st and 2nd peak; concentration and absorption no change on 1st peak and 2nd 25% lower. @
*can sprinkle with applesauce, contents should not be crushed, chewed, or divided.
Med guide
1NFNF ($44 network)
Metadate CD30% immediate rel (d-methylphenidate, 70 % ref delayed (l-methylphenidate) Capsules 10, 20, 30, 40, 50, 606 y: 10 mg before BF; increments of 10 mg wkly60 mg 4-8 hrs2 peaks: 1.5 h and 4.5 h; 25-30% han only 1 observed peak*High fat food delay early peak by 1 h; ↑Cmax 30%.
*Can ne sprinkle without chewing beads
Med guide
2NFgeneric/brand1
Metadate ERMethylphenidateCapsules 10, 206 y: 10 mg daily; increments of 10 mg wkly60 mg4-8 hrs4.7 (3-5) hrsFood ↑Cmax2NFgeneric/brand1
Methylind-methylphenidatesolution

chewable

scored tabs
5 or 10 mg/5ml

2.5, 5, 10 mg

5, 10, 20 mg
6y: 5 mg, BID, AC, BF and lunch; increment of 5-10 wkly60 mg4-6 hrs1-2 hrs

1-2 hrs

2 hrs
Food delays peak by 1 h, ↑Cmax
Med guide-solution
Med guide-chewable
Med guide
1NFgeneric/brand1
Methylin ERd-methylphenidateTablets10, 20 mg 10 mg daily or = titrated 8h dose of Methylin60 mg 4-8 hrs3-5hrs Taken 30-45 min AC. Don’t chew or crush
Med guide
not coveredMethylphenidate ER 20 mg tab onlygeneric/brand1
RitalinMethylphenidateScored Tablets 5, 10, 20, mg 6 y: 5 mg BID before BF/lunch; increments of 5-10 wkly60 mg 3-4 hrs 2 (0.3-4.4) hrs Taken 30-45 min AC
Med guide
1generic generic/brand1
Ritalin SRMethylphenidateTablets20 mg6 y: 10 mg daily or = titrated 8 h dose of Ritalin60 mg 6-8 hrs4.7 (1.3-8.2) hrsTaken 30-45 min AC.
Med guide
1Methylphenidate ER 20 mg tab onlygeneric/brand1
Ritalin LA50% immediate rel (d-methylphenidate, 50% ref delayed (l-methylphenidate)Capsules10, 20, 30, 40 mg 6 y: 10-20 mg daily; increments of 10 mg wkly60 mg 6-8 hrs 3-5 hrs, 2 peaks: 2 (1-3) h and 5 (5-8) h *High fat food delays 1st and 2nd peaks; concentration and absorption no change on 1st peak and 2nd 25% lower.
*Can be sprinkle without chewing beads.
Med guide
2generic
generic/brand1
ConcertaMixed d- and L methylphenidate OROS Capsules18, 27, 36, 54 mg6 y: 18 mg daily; increments of 18 mg wkly

Dose conversion:
short MP, BID/TID
to Concerta dose

05 > 18 mg
10 > 36 mg
15 > 54 mg
20 > 72 mg
6-12y: 54mg;

13-17y: 72 mg
8-12 hrsInitial @ 1 hr then ascend over 6-10 hrsNot crushable, take w/ or w/o food
Med guide
1genericgeneric/brand1
DaytranaMethylphenidatePatches10,15,20,306 y: 10 mg/day;

titration:
Wk patch
1 10 mg
2 15 mg
3 20 mg
4 30 mg
30 mg 9 hrs2 hrs after applied, 3 h after removedApplied to hip area 2 h before and remove 9 h after post applied
Med guide
2NFNF ($44 network)
Quillivant XRMethylphenidate HCL Extended-release oral suspension Oral solution25 mg/5 ml>6 y: 20 mg/daily: increment10-20 weekly60 mg10-hrs5 hrsvigorously shake bottle for at least 10 seconds
Med guide
3NFBrand-name formulary (17 network)