Rev. Fri, Aug 13, 2010
Attention-Deficit Hyperactivity Disorder
(AD/HD) in Children and Youth:
Medication Guide for Physicians
Compiled by Michael Cheng,
Child and Family Psychiatrist, Ottawa
Purpose of this Handout
This handout is only a very brief summary of key ADHD medications and dosages. For more
detailed information, please see:


the excellent Canadian ADHD Practice Guidelines at http://www.caddra.ca as well as
the Revised Texas Mediation Algorithm for ADHD, in the June 2006 issue of the Journal of
the Academy of Child and Adolescent Psychiatry.

Where to Get this Handout
This handout is available from http://www.drcheng.ca in the Mental Health Information section. Any
comments and suggestions are welcome and will help ensure this handout is helpful.
Disclaimer
The content of this document is for general information and education only. It is not to be used in any other manner, and is
not intended as medical, psychiatric or psychological advice. No doctor/patient relationship is formed. The accuracy,
completeness, adequacy, or currency of the content is not warranted or guaranteed. The content is not intended to be a
substitute for professional medical advice, diagnosis, or treatment. Users should always seek the advice of physicians or
other qualified health providers with any questions regarding a medical condition. Any procedure or practice described
here should be applied by a health professional under appropriate supervision in accordance with professional standards
of care used with regard to the unique circumstances that apply in each practice situation. The authors disclaim any
liability, loss, injury, or damage incurred as a consequence, directly or indirectly, or the use and application of any of the
contents of this document.
This work is “licensed” under a Creative Commons License (Attribution-Non Commercial-Sharelike 2.0,
http://creativecommons.org/licenses/by-nc-sa/2.0/) which means that you are free to copy, distribute, display and perform
the work, and make derivative works as long as you give the original author credit, the work is not used for commercial
purposes, and if you alter, transform, or build upon this work, you may distribute the resulting work only under a license
identical to this one.
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Table of Contents
ADHD Strategies from the Texas Algorithm Project, 2006 ............................................................. 3
ADHD Medications: Dextroamphetamine Formulations .................................................................. 4
ADHD Medications: Methylphenidate Formulations ........................................................................ 5
Conversion Chart Comparing Immediate Release (IR) to Long-Acting Preparations ..................... 6
ADHD Medications: Non-Stimulants................................................................................................ 7
ADHD Medications: Non-Stimulants (Continued) ............................................................................ 8
Medical Issues for ADHD Medications ............................................................................................ 9
ADHD and Comorbid Conditions ..................................................................................................... 9
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ADHD Strategies from the Texas Algorithm Project, 2006
(Reproduced under Fair Use Provision of U.S. Copyright Law)
4 of 9
ADHD Medications: Dextroamphetamine Formulations
Medication
 Trade name

Adderall XR (5,
7.5,10, 12.5, 15,
20,30 mg tabs)
www.adderall.com
(Capsule can be
opened and beads
sprinkled on apple
sauce, but not
chewed)
Dextroamphetaminelevoamphetamine

Adderall (5.10,20
mg tabs)
www.adderall.com
(Not commonly
used in Canada
due to availability
of XR)
Dextroamphetamine

Dexedrine
(regular) (5 mg
scored tabs)
Dextroamphetamine
sustained release

Dexedrine
spansules (10, 15
mg sustained
release capsule –
cannot be split)
Lisdexamfetamine

Vyvanse
(20,30,40,50,60
mg capsules)
For all Dextroamphetamine formulations (including Dexedrine, Dexedrine
spansules, Adderall, Adderall XR), use Dosage range of 2.5-40 mg/day or 0.1-0.8
mg/kg/day (1), usually target for 0.5 mg/kg/day
Dosage range of 2.5-40 mg/day or 0.1-0.8 mg/kg/day (1), usually target for 0.5
mg/kg/day
Given only once daily due to extended release formulation
Give 10-30 mg in morning
Half-life 11-13 hours; Onset of action 1-2 hr min; Peak effect bimodal; Duration of
action 10-12 hr
Child’s Size
Starting Dose
Dosage range
<25 kg
5 mg q morning
Up to 15 mg q morning
25-35 kg
10 mg q morning
Up to 20 mg q morning
>35 kg
10 mg q morning
Up to 30 mg q morning
Dosage range of 2.5-40 mg/day or 0.1-0.8 mg/kg/day (1), usually target for 0.5
mg/kg/day
Generally given morning, lunch, possibly lunch
Half-life 4-6 hours; Onset of action 30-60 min; Peak effect 1-2 hr; Duration of action
4-6 hr
Child’s Size
Starting Dose
Dosage range
<25 kg
2.5-5 mg q morning
Up to 10 mg q morning or
bid
25-35 kg
5-10 mg q morning
Up to 10-15 mg q morning
or bid
>35 kg
10 mg q morning
Up to 20-40 mg q morning
or bid
Dosage range of 2.5-40 mg/day or 0.1-0.8 mg/kg/day, usually target for 0.5
mg/kg/day
Generally given morning, lunch, possibly lunch
Half-life 4-6 hours; Onset of action 20-60 min; Peak effect in 1-2 hr; Duration of
action 4-6 hr
Child’s Size
Starting Dose
Dosage range
<25 kg
2.5 mg q morning
Up to 10-15 mg bid
25-35 kg
5 mg bid
Up to 10 mg tid
>35 kg
10 mg bid
Up to 15 mg tid
Dosage range of 2.5-40 mg/day or 0.1-0.8 mg/kg/day (1), usually target for 0.5
mg/kg/day
Generally given once daily, but may need afternoon dosage of the regular shortacting
Half-life 6-10 hrs; Onset of action 60-90 min, Peak effect (info not available);
Duration of action 6-8 hr
Child’s Size
Starting Dose
Dosage range
<25 kg
Per clinical judgement
Per clinical judgement
25-35 kg
10 mg spansule q morning
>35 kg
20 mg spansule q morning
Up to 30 mg spansule q
morning
Up to 45 mg spansule q
morning
Start 20-30 mg od q AM
Increase up to 60 mg daily
Capsule contents may be dissolved in glass of water
Consider starting first with long-acting formulation, e.g. Dexedrine spansules.
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ADHD Medications: Methylphenidate Formulations
Medication Name
 Trade Name
Comments
Methylphenidate (standard)

Ritalin (5,10,20 mg
scored tabs)
www.adhdinfo.com

Generic
Dosage range 0.6-2.1 mg/kg/day, usually target for 1 mg/kg/day in divided
doses
Usually given morning, lunch, often afternoon as well
Half-life 4-6 hrs; Onset of action 20-60 min, Peak effect ~ 2-hr; Duration of
action 3-6 hr
Child’s Size
Starting Dose
Dosage Range
<25 kg
2.5 mg bid
Up to 15 mg tid
25-35 kg
5 mg bid
Up to 20 mg tid
>35 kg
10 mg bid
Up to 20 mg tid
Dosage range 0.6-2.1 mg/kg/day, usually target for 1 mg/kg/day in divided
doses
Usually given once in morning only, but may need afternoon dosage
Half-life 8 hrs; Onset of action 60-90 min, Peak effect ~ 5-hr; Duration of action
5-8 hr
Child’s Size
Starting Dose
Dosage Range
< 25 kg
Per clinical judgement
Per clinical judgement
25-35 kg
20 mg SR in morning
Up to 20 mg SR in
morning + 10 mg tid
>35 kg
20 mg SR in morning
Up to 40 mg SR in
morning, or
20 mg SR in morning + 20
mg tid
Target for 1 mg/kg/day, maximum of 2 mg/kg/day
Given only once daily, since controlled release
Half-life 12-hr; Onset of action 30-120 min, Peak effect bimodal; Duration of
action 12-hr
Methylphenidate (longacting)

Ritalin SR (20 mg slow
or sustained release
capsule)
www.adhdinfo.com

Concerta (controlled
release) (18,27,36,54
mg controlled release
tabs with immediate
release outer coating –
cannot be split)
www.concerta.net
For patients not currently taking methylphenidate, or for patients who
are on stimulants other than methylphenidate
Child’s Size
Starting Dose
Dosage Range
< 25 kg
Per clinical judgement
Per clinical judgement
25-35 kg
18 mg daily, increase by
18 mg weekly
18 mg daily, increase by
18 mg weekly
18-36 mg daily
>35 kg
36-54 mg daily
For patients already on methylphenidate:
Previous Methylphenidate (MPH) Daily Dose
5 mg bid or 5 mg tid or 20 mg SR
10 mg bid or 10 mg tid or 40 mg SR
15 mg bid or 15 mg tid or 60 mg SR

Biphentin
(10,15,20,30,40,50,60,
80 mg controlled
release capsule)
Concerta Dose
~ 18 mg q am
~ 36 mg q am
~ 54 mg q am
Capsules may be sprinkled on soft foods (e.g. apple sauce, yogurt, ice cream), and
must be swallowed without chewing or crushing
Age 6-18: Start at 10-20 mg daily, titrate upwards weekly by 10 mg, up to 1 mg /kg/day
or max daily dosage of 60 mg
Age 18+: Start 10-20 mg daily, titrate upwards weekly by 10 mg, up to 1 mg/kg/day, or
max daily dosage 80 mg
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Switching Guide
Dosing schedule for switching medications (from Clinical Focus,
from ShireBioChem)
If you prescribe
Dexedrine
 Prescribe
Adderall XR
5 mg bid, or
Spansule 10 mg
10 mg bid, or
Spansule 20 mg
15 mg bid or
Spansule 30 mg
Plus a delayed
release dose of…
10 mg qAM
This provides an
immediate release
dose of..
5 mg
20 mg qAM
10 mg
10 mg
30 mg qAM
15 mg
15 mg
If you prescribe
Methylphenidate
 Prescribe
Concerta
Plus a delayed
release dose of…
5 mg bid/tid, or
20 mg SR
10 mg bid/tid or
40 mg SR
15 mg bid/tid or
60 mg SR
18 mg qAM
This provides an
immediate release
dose of..
4 mg
36 mg qAM
8 mg
28 mg
54 mg qAM
12 mg
42 mg
5 mg
14 mg
Conversion Chart Comparing Immediate Release (IR) to LongActing Preparations*
Methylphenidate-IR
5 mg po tid
10 mg po tid
15 mg po tid
20 mg po tid
Dextroamphetamine-IR
2.5 mg po tid
5 mg po tid
7.5 mg po tid
10 mg po tid
Adderall XR
5-10 mg po daily
15 mg po daily
25 mg po daily
30 mg po daily
Concerta
18 mg po daily
36 mg po daily
54 mg po daily
2 x 36 mg po daily
Note: 1 mg/day dextroamphetamine = 1 mg/day Adderall XR = 2 mg/day methyphenidate
Note: for Concerta, approximate the first-of-the-day IR dosage with 22% of the Concerta dose,
e.g. the first 5 mg of a 5 mg tid dose approximates 22% of the 18 mg Concerta dose, the first 10
mg of a 10 mg tid dose approximates 22% of the 36 mg dose = 8 mg, etc. If your patient is on 105-5 rather than 10-10-10, then s/he will probably need the 36 mg Concerta dose.
* Dr. Catharine Robertson, Psychiatrist, Children’s Hospital of Eastern Ontario, 401 Smyth Rd,
Ottawa, ON, K1H 8L1
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ADHD Medications: Non-Stimulants
Drug Name
 Trade Name
Comments
Bupropion (Wellbutrin)

Wellbutrin SR
(supplied as 100,150
mg tabs)
Consider for ADHD plus depression, or substance use problems
Child maximum: 6 mg/kg/day; Adolescent maximum 400 mg/day
Sample Titration:

Initial target: 100 bid for children; 150 mg bid for teens

In adults, target of 300-450 mg daily divided bid

Thus

Week 1: 100 mg mornings

Week 2: 100 mg morning + 100 mg dinner – leave at this initial target
dose with children, and reassess

Week 3: 150 mg morning and 100 mg dinner

Week 4: 150 morning and 150 mg dinner then reassess – leave at
this initial target dosage for adolescents
For child: Start at 100 mg daily; may increase up to 150 mg daily if necessary
For teens/adults: Start at 100 mg daily; increase up to 300-450 mg daily
Non-stimulant treatment, may be helpful in situations where stimulant side
effects are not tolerated
Do not break capsules
Target dosage range of 1.2 mg/kg/day
Sample Titration:

Week 1 : 0.5 mg/kg/day

Week 2 : 0.8 mg/kg/day

Week 3 : 1.2 mg/kg/day
Dosage for youth > 70 kg and for adults

Week 1: Start at 40 mg daily

Week 2: 60 mg daily

Week 3: 80 mg
After 30 days, re-assess and readjust dosage
Maximum dosage: 1.4 mg/kg/day or 100 mg/day, whichever is less

Wellbutrin XL
Atomoxetine

Strattera
www.strattera.com
(supplied as
10,18,25,40,60 mg
capsule)
Recommended Atomoxetine (Strattera) Dose Titration in Children and
Adolescents up to 70 kg Body Weight (from Strattera Product
Monograph, Dec 22, 2004)
Body
Weight
Start Dose
(~ 0.5 mg/kg/day)
Intermediate Dosage
(~0.8 mg/kg/day)
20-29 kg
30-44 kg
45-64 kg
65-70 kg
10 mg
18 mg
25 mg
40 mg
18 mg
25 mg
40 mg
60 mg
Initial Target Dosage
(“High Dose”) (~ 1.2
mg/kg/day)
25 mg
40 mg
60 mg
80 mg
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ADHD Medications: Non-Stimulants (Continued)
Drug Name
 Trade Name
Comments
Modafinil

Provigil (supplied as
100,200mg tablets)
Novel ‘stimulant’, which appears to increase arousal where needed, but
without causing typical stimulant side effects such as insomnia
For adults: 100-200 mg once daily in the morning
For children/youth (Cephalon study): dosages used in studies included

300 mg once in the morning; alternatively,

100 mg morning; then gradually increase to 200 mg morning and 100 mg
lunchtime;
(Note that Cephalon will be releasing a new proprietary 340 mg/425 mg
formulation specifically for ADHD)
Primarily for impulsivity, or used at bedtime as sleep-aid
0.05 mg given orally qhs
Target: up to 0.4 mg/day (4-5 mcg/kg/day).
Bid/tid for daytime impulsivity (or QHS if just for sleep)
Start: 10-25 mg
Target: up to 100-150 mg daily
Clonidine

Catapres (supplied as
0.1, 0.2, 0.3 / tab)
Desipramine

Norpramin (supplied as
10,35,50,75,100,150
mg tabs)
Imipramine

Tofranil (supplied as
10,25,50 mg tabs)
Nortriptyline

Pamelor (supplied as
10,25,50,75 mg
capsules)
Start: 10-25 mg
Target 100-150 mg daily
Max: 5 mg/kg/day
Start 10-25 mg
Target: 100-150 mg daily
Max: 3 mg/kg/day
References for Modafinil :

Recent study by Cephalon in summer 2004 showed effectiveness with youth aged 6-17 with mean
dosage of 300 mg daily, given 200 mg morning and 100 mg lunchtime

Rugino et al.: Modafinil in children with attention-deficit hyperactivity disorder. Pediatr Neurol. 2003
Aug;29(2):136-42.

Turner DC et al.: Modafinil improves cognition and response inhibition in adult attentiondeficit/hyperactivity disorder. Biol Psychiatry. 2004 May 15;55(10):1031-40.

Biederman J, Swanson JM, Wigal SB, et al. Efficacy and safety of modafinil film-coated tablets in
children and adolescents with attention-deficit/hyperactivity disorder: results of a randomized, doubleblind, placebo-controlled, flexible-dose study. Pediatrics 2005;116:E777–84.
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Medical Issues for ADHD Medications
Recommended Baseline Testing by American Heart Association
(published in Circulation on Apr 21, 2008)
To help identify children who are at potentially increased risk, including those already taking
stimulant medication, AHA recommends:
History
 Take a patient history, including fainting, dizziness, seizures, chest pain or shortness of
breath
 Take a family history, including sudden cardiac death at young ages (<30 years old) and
cardiac arrhythmias;
Physical Examination
 Always assess blood pressure and heart rate, particularly in adults
 Look for abnormal heart murmur, hypertension, arrhythmia and findings suggestive of Marfan
syndrome; and
Investigations
 Baseline ECG and have it read by a pediatric cardiologist or physician with expertise in
reading pediatric ECGs.
 For pediatric patients, holter or graded exercise is not necessary unless clinically indicated
If any significant findings on physical exam, ECG or history  consult pediatric
cardiologist
Monitoring
 Regular assessments of blood pressure and pulse, repeat ECGs in certain situations,
 Careful monitoring and possible discontinuation of stimulant medication in children found to
be at increased risk.
ADHD and Comorbid Conditions



With ADHD and comorbid conditions, generally need to treat the comorbidity prior to treating
the ADHD
First, treat depression, bipolar disorder, severe anxiety, or addiction prior to ADHD
For adults, consider dual action agents or combined medications