If switching from immediate release tablets 5 mg 2 or 3 times a day: If switching from immediate release tablets 10 mg 2 or 3 times a day: If switching from immediate release tablets 15 mg 2 or 3 times a day: If switching from immediate release tablets 20 mg 2 or 3 times a day: May increase by 18 mg increments at weekly intervals up to a maximum of 72 mg once daily in the morning before breakfast.
Tablets should not be chewed, divided, or crushed. Dose should be titrated to effect based on the following recommended titration schedule: However, wear time should be individualized according to the needs and response of the individual patient.
Usual Adult Dose for Narcolepsy: Immediate release tablets Ritalin, Methylin, methylphenidate: Usual Adult Dose for Depression: The manufacturers warn that methylphenidate should not be used for severe depression of either exogenous or endogenous origin.
Some studies have shown methylphenidate to be an effective adjuvant medication when used along with other standard antidepressant drug therapy SSRIs or TCAs for depression.
However, no specific coadministered antidepressant medication or dose of methylphenidate has been generally accepted as optimum therapy. Therefore, no specific therapy or dose of methylphenidate can be recommended at this time for use in patients with depression. Concerta uses osmotic pressure to deliver the medication throughout the day at a controlled rate, from a two-layered tablet that releases an initial dose within 1 hour and the rest of the medication over 6 to 7 hours.
Is there anything else important I should know about Concerta or generic methylphenidate ER? It is possible that the shell of the tablet may come out in your stool and may be visible on abdominal x-rays. Are the generics all interchangeable with Concerta? All of these generics can be substituted for Concerta.
Although Concerta is the only ADHD medication to use the OROS drug delivery system, the generic manufacturers have all designed comparable delivery systems that are interchangeable and can be substituted. She does not receive any form of compensation from pharmaceutical manufacturers for the opinions expressed here. Follow her on twitter at orrangemd. Her realm of pharmacy experience includes but is not limited to retail, compounding, and specialty pharmacy. She hand-assembled the GoodRx drug database and has researched virtually every available discount program and savings opportunity.
The recommended starting dose of Matoride XL 54 mg prolonged-release tabletsfor patients who are not currently taking methylphenidate, or for patients who are on stimulants other than methylphenidate, is 18 mg once daily.
Patients Currently Using Methylphenidate: Dosing recommendations are based on current dose regimen and clinical judgement. TABLE 1 Recommended Dose Conversion from Other Methylphenidate Hydrochloride Regimens, where available, to Matoride XL 54 mg prolonged-release tablets Previous Methylphenidate Hydrochloride Daily Dose Recommended Matoride XL 54 mg prolonged-release tablets Dose 5 mg methylphenidate three times daily 18 mg once daily 10 mg methylphenidate three times daily 36 mg once daily 15 mg methylphenidate three times daily 54 mg once daily If improvement is not observed after appropriate dosage adjustment over a one-month period, the drug should be discontinued.
Long-term more than 12 months use in children and adolescents The safety and efficacy of long-term use of methylphenidate has not been systematically evaluated in controlled trials. Methylphenidate treatment should not and need not, be indefinite. Methylphenidate treatment is usually discontinued during or after puberty. The physician who elects to use methylphenidate for extended periods over 12 months in children and adolescents with ADHD should periodically re-evaluate the long-term usefulness of the medicinal product for the individual patient with trial periods off medication to assess the patient's functioning without pharmacotherapy.
It is recommended that methylphenidate is de-challenged at least once yearly to assess the child's condition preferable during times of school holidays. Improvement may be sustained when the medicinal product is either temporarily or permanently discontinued. Dose reduction and discontinuation: Treatment must be stopped if the symptoms do not improve after appropriate dosage adjustment over a one month period.
If paradoxical aggravation of symptoms or other serious adverse events occur, the dosage should be reduced or discontinued Adults In adolescents whose symptoms persist into adulthood and who have shown clear benefit from treatment, it may be appropriate to continue treatment into adulthood.
However, start of treatment with methylphenidate in adults is not appropriate see sections 4. Older people Methylphenidate should not be used in older people. Safety and efficacy has not been established in this age group. Children under 6 years of ageMethylphenidate should not be used in children under the age of 6 years.
Safety and efficacy in this age group has not been established. Method of administration Matoride XL 54 mg prolonged-release tablets must be swallowed whole with the aid of liquids, and must not be chewed, divided, or crushed see section 4.
Matoride XL 54 mg prolonged-release tablets may be administered with or without food see section 5. Matoride XL 54 mg prolonged-release tablets is taken once daily in the morning. Long-term use more than 12 months in children and adolescents The safety and efficacy of long-term use of methylphenidate has not been systematically evaluated in controlled trials.
Patients on long-term therapy i. Psychiatric disorders to monitor for are described below, and include but are not limited to motor or vocal tics, aggressive or hostile behaviour, agitation, anxiety, depression, psychosis, mania, delusions, irritability, lack of spontaneity, withdrawal and excessive perseveration.
It is recommended that methylphenidate is de-challenged at least once yearly to assess the child's condition preferably during times of school holidays. Use in adults Safety and efficacy have not been established for the initiation of treatment in adults or the routine continuation of treatment beyond 18 years of age. If treatment withdrawal has not been successful when an adolescent has reached 18 years of age continued treatment into adulthood may be necessary.
The need for further treatment of these adults should be reviewed regularly and undertaken annually. Use in older people Methylphenidate should not be used in older people. Use in children under 6 years of age Methylphenidate should not be used in children under the age of 6 years.
Cardiovascular status Patients who are being considered for treatment with stimulant medications should have a careful history including assessment for a family history of sudden cardiac or unexplained death or malignant arrhythmia and physical exam to assess for the presence of cardiac disease, and should receive further specialist cardiac evaluation if initial findings suggest such history or disease.
Patients who develop symptoms such as palpitations, exertional chest pain, unexplained syncope, dyspnoea or other symptoms suggestive of cardiac disease during methylphenidate treatment should undergo a prompt specialist cardiac evaluation.
Analyses of data from clinical trials of methylphenidate in children and adolescents with ADHD showed that patients using methylphenidate may commonly experience changes in diastolic and systolic blood pressure of over 10 mmHg relative to controls.
The short- and long-term clinical consequences of these cardiovascular effects in children and adolescents are not known. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate.
Cardiovascular status should be carefully monitored. Blood pressure and pulse should be recorded on a centile chart at each adjustment of dose and then at least every 6 months. The use of methylphenidate is contraindicated in certain pre-existing cardiovascular disorders unless specialist paediatric cardiac advice has been obtained see section 4.
Sudden death and pre-existing structural cardiac abnormalities or other serious cardiac disorders Sudden death has been reported in association with the use of stimulants of the central nervous system at usual doses in children, some of whom had structural cardiac abnormalities or other serious heart problems.
Although some serious heart problems alone may carry an increased risk of sudden death, stimulant products are not recommended in children or adolescents with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant medicine.
Misuse and cardiovascular events Misuse of stimulants of the central nervous system may be associated with sudden death and other serious cardiovascular adverse events. Cerebrovascular disorders See section 4. Patients with additional risk factors such as a history of cardiovascular disease, concomitant medications that elevate blood pressure should be assessed at every visit for neurological signs and symptoms after initiating treatment with methylphenidate.
Cerebral vasculitis appears to be a very rare idiosyncratic reaction to methylphenidate exposure. There is little evidence to suggest that patients at higher risk can be identified and the initial onset of symptoms may be the first indication of an underlying clinical problem.
Early diagnosis, based on a high index of suspicion, may allow the prompt withdrawal of methylphenidate and early treatment. The diagnosis should therefore be considered in any patient who develops new neurological symptoms that are consistent with cerebral ischemia during methylphenidate therapy.
These symptoms could include severe headache, numbness, weakness, paralysis, and impairment of coordination, vision, speech, language or memory. Treatment with methylphenidate is not contraindicated in patients with hemiplegic cerebral palsy. Psychiatric disorders Co-morbidity of psychiatric disorders in ADHD is common and should be taken into account when prescribing stimulant products.
In the case of emergent psychiatric symptoms or exacerbation of pre-existing psychiatric disorders, methylphenidate should not be given unless the benefits outweigh the risks to the patient. Development or worsening of psychiatric disorders should be monitored at every adjustment of dose, then at least every 6 months, and at every visit; discontinuation of treatment may be appropriate.
Exacerbation of pre-existing psychotic or manic symptoms In psychotic patients, administration of methylphenidate may exacerbate symptoms of behavioural disturbance and thought disorder.
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