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©2013 UpToDate ® Print Email Dosing guidelines when switching from one stimulant to another in the treatment of attention deficit hyperactivity disorder in children and adolescents* 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 every morning Methylphenidate IR 10 mg twice daily or three times daily Methylphenidate osmotic release 36 mg every morning Methylphenidate IR 15 mg twice daily or three times daily Methylphenidate osmotic release 54 mg every morning Methylphenidate IR 20 mg twice daily or three times daily Methylphenidate osmotic release 72 mg every 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 cm 2 ) Methylphenidate patch has greater systemic bioavailability than oral preparations. Patients changing from oral methylphenidate IR doses ≤20 mg/day should be started on the 10 mg patch. Allow at least one 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 cm 2 ) Methylphenidate IR 10 mg three times per day Methylphenidate patch 20 mg (25 cm 2 ) Methylphenidate IR 15 mg three times per day Methylphenidate patch 30 mg (37.5 cm 2 ) Methylphenidate osmotic release 18 mg Methylphenidate patch 10 mg (12.5 cm 2 ) Methylphenidate osmotic release 27 mg Methylphenidate patch 15 mg (18.75 cm 2 ) Methylphenidate osmotic release 36 mg Methylphenidate patch 20 mg (25 cm 2 ) Methylphenidate osmotic release 54 mg Methylphenidate patch 30 mg (37.5 cm 2 ) 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 dose 70 mg/day) Switching to amphetamine-dextroamphetamine Amphetamine-dextroamphetamine (Adderall®) IR Amphetamine-dextroamphetamine XR Same total daily dose Any stimulant other than amphetamine-dextroamphetamine IR •

Daily dosage may be increased in increments of 10 or 20 mg at approximately weekly intervals until optimal response is obtained (maximum dose 70 mg/day) Switching to amphetamine-dextroamphetamine Amphetamine-dextroamphetamine (Adderall®) IR Amphetamine-dextroamphetamine XR Same total daily dose Any stimulant other than amphetamine-dextroamphetamine IR • Amphetamine-dextroamphetamine XR 6 to 12 years: 10 mg once daily in the morning Daily dosage may be adjusted in increments of 5 mg 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 Daily dosage may be increased to 20 mg/day after one week if symptoms are not adequately controlled IR: immediate release; XR: extended release. * Ultimate dose must be individualized based upon patient needs and response. • There are no reliable data to provide guidelines for switching between different classes of long-acting stimulants. Data from: Daily Med, US product information: file://dailymed.nlm.nih.gov/dailymed/about.cfm . Accessed on June 8, 2011. Arnold LE, Lindsay RL, López FA, et al. Treating attention-deficit/hyperactivity disorder with a stimulant transdermal patch: the clinical art. Pediatrics 2007; 120:1100.