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Pharmacotherapy of adult attention deficit hyperactivity disorder (ADHD)

Medication Titration if needed Usual

Onset of Duration Usual maximum
(trade name in United Initial dosage based upon maintenance
initial effect of effect dose (per day)
States) response dosage

Stimulants*

Amphetamine

Long-acting

Adzenys XR orally ≤1 hour 8 to 12 12.5 mg once per day Increase by 3.1 or 6.3 12.5 mg once per day 18.8 mg
disintegrating tablet hours in morning mg per day at weekly in morning
or greater intervals

Dyanavel XR tablet and ≤1 hour Up to 13 2.5 or 5 mg once per Increase by 2.5 to 10 5 to 20 mg once per 20 mg
oral suspension hours day in morning mg per day every 4 to 7 day in morning
days

Dextroamphetamine

Short-acting

Generics ¶ Δ ≤1 hour 4 to 6 5 mg twice per day Increase total daily 20 mg twice per day 60 mg in divided
hours dose by 5 mg at weekly doses ◊
or greater intervals

Long-acting

Dexedrine spansule ≤1 hour 6 to 8 5 mg twice per day Increase total daily 40 mg once per day in 60 mg ◊
and generic hours dose by 5 mg at weekly morning
equivalents ¶ Δ or greater intervals

Dextroamphetamine 2 hours 9 to 12 9 mg patch once daily; Increase to 18 mg 9 to 18 mg once daily 18 mg

transdermal patch hours keep patch on for 9 patch after 1 to 2
(Xelstrym) (when hours § weeks, if needed
applied for
9 hours) §

Dextroamphetamine and amphetamine (mixed salts)

Short-acting

Adderall and generic ≤1 hour 4 to 6 5 mg once or twice per Increase total daily 5 to 40 mg per day, 60 mg ◊
equivalents ¶ hours day dose by 5 or 10 mg at once daily or in 2
weekly to monthly divided doses
intervals

Long-acting

Adderall XR and ≤1 hour 8 to 12 10 to 20 mg once per Increase daily dose by 10 to 40 mg once per 60 mg ◊
generic equivalents ¶ hours day in morning 10 mg at weekly to day in morning
monthly intervals

Mydayis triple bead 2 to 4 hours 16 hours 12.5 mg once per day Increase daily dose by 12.5 to 50 mg once per 50 mg
extended release in morning 12.5 mg at weekly or day in morning
greater intervals

Lisdexamfetamine

Vyvanse ≤1 hour; onset ~10 hours 10 to 30 mg once per Increase daily dose by 30 to 70 mg once per 70 mg
delayed if day in morning 10 or 20 mg at weekly day in morning
taken with or greater intervals
food

Dexmethylphenidate

Short-acting

Focalin and generic 0.5 to 1 hour; 4 to 6 5 mg twice per day Increase total daily 10 to 15 mg two times 40 mg in divided
equivalents ¶ Δ delayed if hours dose by 5 to 10 mg at daily or 10 mg three doses ¥
taken with a weekly or greater times daily
high-fat meal intervals

Long-acting

Focalin XR and generic 0.5 to 1 hour; a 12 hours 10 mg once per day in Increase daily dose by 20 to 30 mg once per 40 mg
equivalents ¶ second peak morning 10 mg at weekly or day in morning
 effect occurs greater intervals
~6.5 hours
after dose

Azstarys 70% ≤1 hour 6 to 11 Serdexmethylphenidate After 1 week, increase Serdexmethylphenidate Serdexmethylphenidate

serdexmethylphenidate hours 39.2 mg/ daily dose to 52.3 mg/ 52.3 mg/
(dexmethylphenidate dexmethylphenidate serdexmethylphenidate dexmethylphenidate dexmethylphenidate
prodrug) and 30% 7.8 mg once per day in 52.3 mg/ 10.4 mg once per day 10.4 mg
dexmethylphenidate morning dexmethylphenidate in morning
(immediate release) 10.4 mg

Methylphenidate

Short-acting

Ritalin and generic ≤1 hour; 3 to 5 10 mg before breakfast Increase total daily 40 to 60 mg per day in 60 mg in divided doses
equivalents delayed if hours and lunch dose by 5 or 10 mg at two or three divided
taken with a weekly or greater doses
Methylin chewable
high-fat meal intervals
Methylin oral solution

Intermediate-acting

Ritalin SR and generic ≤1 hour 8 hours 20 mg once per day in Increase daily dose by 40 to 60 mg once per 100 mg ‡
equivalents morning 10 mg at weekly or day in morning
greater intervals

Metadate ER and 8 hours 10 mg twice per day Increase daily dose by 40 to 60 mg once per
generic equivalents 10 mg at weekly or day in morning
greater intervals

Long-acting

Metadate CD and ≤1 hour; a 8 to 12 20 mg once per day in Increase daily dose by 40 to 60 mg once per 100 mg ‡
generic equivalents second peak hours morning 10 or 20 mg at weekly day in morning
effect occurs or greater intervals
~4.5 hours
after dose

Quillivant XR oral ≤1 hour 8 to 12 20 mg once per day in Increase daily dose by 40 to 60 mg once per 60 mg
suspension and hours morning 10 to 20 mg at weekly day in morning
Quillichew ER chewable or greater intervals
tablet Δ

Ritalin LA and generic ≤1 hour; a 8 to 12 10 or 20 mg once per Increase daily dose by 40 to 60 mg once per 100 mg ‡
equivalent ¶ second peak hours day in morning 10 mg at weekly or day in morning
effect occurs greater intervals
~5.5 hours
after dose

Concerta, Relexxii, and ≤1 hour; 10 to 12 18 or 36 mg once per Increase daily dose by 54 to 72 mg once per 72 mg
generic equivalents plateau at 1 to hours day in morning 18 mg at weekly or day in morning
4 hours and greater intervals
peak at 6 hours
after dose

Aptensio XR and 1 hour (peak at 12 hours 10 mg once per day in Increase daily dose in 20 to 60 mg once per 60 mg
generic equivalents 2 hours); a morning 10 mg increments at day in the morning
second peak weekly or greater
occurs at ~8 intervals
hours after
dose

Jornay PM ~12 hours 13 hours 20 mg once daily in the Increase daily dose in 20 to 100 mg once per 100 mg
(peak at ~14 evening between 6:30 20 mg increments at day in the evening
hours) PM and 9:30 PM weekly or greater
intervals

Biphentin (Canadian) 1 hour (peak at 12 hours 10 to 20 mg once per Increase daily dose in 20 to 80 mg once per 80 mg
2 hours); a day in morning 10 mg increments at day in the morning
second peak weekly or greater
occurs ~6 intervals
hours after
dose

Foquest (Canadian) 1 hour (peak at 16 hours 25 mg once per day in Increase daily dose by 25 to 100 mg once per 100 mg
~2 hours); a the morning 10 to 15 mg increments day in the morning
second peak at intervals of ≥5 days
occurs at ~12.5
hours after
dose
 Daytrana transdermal ≤2 hours 10 to 12 10 mg patch on for 9 Increase to next higher 30 to 60 mg patch on 60 mg (ie, two 30 mg
patch Δ hours hours and off for 15 patch strength at for 9 hours and off for patches)
hours each day weekly or greater 15 hours each day
intervals
Apply patch 2 hours
before needed onset Available patch
strengths: 10 mg, 15
mg, 20 mg and 30 mg
per 9 hours

Non-stimulants

Atomoxetine

Strattera and generic 1 to 2 weeks 24 hours 40 mg once per day Increase after three or 80 mg once per day or 100 mg
equivalents more days to 80 mg; in two equally divided
after two to four doses
additional weeks may
increase to 100 mg per
day

Viloxazine (extended-release) †

Qelbree 1 to 2 weeks 24 hours 200 mg once per day Increase daily dose by 200 to 600 mg once per 600 mg
200 mg at weekly or day
greater intervals

Nortriptyline**

Pamelor and generic 1 to 4 weeks 24 hours 25 mg Advance by 25 mg 1 to 3 mg/kg per day in 150 mg
equivalents every 3 to 4 weeks one dose at bedtime

Bupropion

Wellbutrin SR and generic 1 to 2 weeks 12 hours 100 mg once per day in After several weeks 100 to 150 mg twice 400 mg in divided
equivalents morning increase to 100 mg per day doses
twice per day

Wellbutrin XL and generic 24 hours 150 mg once per day in After several weeks 300 mg once per day 450 mg
equivalents morning increase to 300 mg
once per day

For approach to product selection and individualization of dosage, refer to UpToDate topic review of treatment of attention deficit hyperactivity disorder
in adults. When switching between stimulant formulations due to insufficient effect, an equivalent dose (where available) may be a consideration when
selecting the initial dose of the new stimulant medication. When switching stimulant medications for another reason (eg, adverse effects) UpToDate
contributors generally start with a low initial dose of the new stimulant and retitrate as needed.

The doses listed in this table are for oral administration (exception: patches) in patients with normal kidney and liver function; the doses of several of
these agents may require adjustment in the setting of kidney or liver impairment; refer to the Lexicomp drug monographs included within UpToDate.

US FDA: United States Food and Drug Administration.

* Stimulants are United States Drug Enforcement Agency Schedule II controlled substances.

¶ Should not be taken with antacids or other drugs that decrease gastric acidity.

Δ US FDA approval is for use in patients 6 to 17 years or children ≥6 years old. Doses for the methylphenidate patches are not equivalent to those for
the oral preparations.

◊ Doses above 40 mg per day are rarely necessary and warrant close monitoring.

§ Patch can be removed earlier to control duration; effect lasts approximately 2 to 3 hours after patch removed. Doses for the dextroamphetamine
patches are not equivalent to those for the oral preparations.

¥ Maximum dose recommended by UpToDate contributors exceeds the US FDA approved maximum of 20 mg per day; careful monitoring for adverse
effects is warranted.

‡ Maximum dose recommended by UpToDate contributors exceeds the US FDA approved maximum dose of 60 mg per day; careful monitoring for
adverse effects is warranted.

† For individuals with severe kidney impairment (eg, estimated glomerular filtration rate <30 mg/min/1.73 m 2 ), recommended starting dose is 100 mg
once daily. May titrate daily dose by 50 to 100 mg at weekly or greater intervals to maximum dose of 200 mg once per day.

** Dosing not well established; may be started as low as 10 mg twice daily. If serum concentration levels are deemed necessary for guiding therapy,
levels within a range of 50 to 150 ng/mL are considered appropriate by UpToDate contributors.

Courtesy of Oscar Bukstein, MD, with additional data from Lexicomp Online. Copyright © 1978-2024 Lexicomp, Inc. All Rights Reserved and manufacturer's product labeling (available at
https://dailymed.nlm.nih.gov/dailymed/index.cfm).

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