👩‍⚕️ADHD Stimulant Medications

First line medications are the stimulants. There are essentially 2 different types - dexamfetamine or methylphenidate. Both have short-acting and long-acting versions.

DEXAMFETAMINES - SHORT ACTING

Dexamfetamine (5mg tablets)

Dosing:

• Start at 2.5/5mg twice daily (morning and lunch) (second daily dose NOT to be administered after 3pm due to likely insomnia).

• The dose can be increased by 5-10mg per week until optimal symptom control is achieved or side-effects are intolerable.

• The max daily dose is 60mg for adults (as per Australian product information - 12 tabs) - in divided doses - 2 to 3 times per day, about 3 -4 hours apart.

• Alternatively, 5 - 10 mg can be added to Vyvanse in the early afternoon if the Vyvanse is wearing off.

DEXAMFETAMINES - LONG ACTING

Lisdexamfetamine (VYVANSE) (20-70mg capsules)

Dosing:

• Start at 20mg daily in the morning.

• The dose can be increased by 10mg per week until optimal symptom control is achieved or side-effects are intolerable.

• The usual daily dose is 30 - 50mg.

• The max daily dose is 70mg.

Patient must have a retrospective diagnosis of ADHD if PBS-subsidised treatment is commencing after turning 18 years of age.

METHYLPHENIDATE - SHORT ACTING (IR)

Methylphenidate (RITALIN) (10mg tablets)

(1/2 tab) 5mg morning and midday initially. Second daily dose no later than 2pm.

Increase by 5mg twice daily every week, up to 30mg twice daily, or say 20mg three times/day (60mg total daily).

Can do 1-4 doses throughout day.

(The usual dose is 40-60mg total daily dose.)

Once optimum symptom control is acheived, it can be switched to longer acting versions.

METHYLPHENIDATE - LONG ACTING

CONCERTA (18, 27, 36, 54 mg tablets) * MUST have tried IR methylphenidate first

Initially 18mg each morning

Increase daily dose by 18mg per week

Max dose of 72mg (2 x 36mg tabs)

PBS criteria is that patient must have demonstrated a response to immediate-release methylphenidate with no emergence of serious adverse effects, AND patient must be or have been diagnosed between the ages of 6 and 18 years inclusive. Will need to be prescribed as a private script if diagnosed after turning 19.

RITALIN-LA (10-60mg capsules) * MUST have tried IR methylphenidate first

Initially 20mg each morning

Increase daily dose by 20mg per week

Max dose of 80mg (2 x 40mg tabs)

PBS criteria is that patient must have demonstrated a response to immediate-release methylphenidate with no emergence of serious adverse effects AND patient must have a retrospective diagnosis of ADHD if PBS-subsidised treatment is commencing after turning 18 years of age.

It is possible to take a combination of long-acting and immediate-release methylphenidate. The total maximum combined daily dose must not exceed 72mg in adults.