bc_pad_2022_adhd_medications_-_drug_table_feb_2024

Oct 12, 2026

Drug table content outlining how ADHD medications are dosed and managed, focusing on dose response, dose titration, maximum dosing, and administration guidance. Includes Health Canada indications and dosage considerations for methylphenidate immediate-release and extended-release formulations (Ritalin, Ritalin SR, Concerta) and controlled-release products (Biphentin, Foquest), noting when regulators do not report certain parameters. Discusses titration intervals, duration of effect, switching considerations, and safety notes such as gastrointestinal obstruction risk.

LanguageEnglish

CategoryForms

FormatPDF

Pages6

Reading Time2 min

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Dose Response and Titration

Duration of Effect

Methylphenidate ER Brand and Generic Interchangeability

ADHD Health Canada Indications, Dosage Considerations

▪ ▪ ▪ Dose Response and Titration Dose response relationships for ADHD medications are often not well characterized by Health Canada and the US FDA. 1,2 ADHD medications are approved with a defined dosage range, informed by fixed-dose trials which typically use rapid or no dose titration and not apply to clinical practice. 1,2 Health Canada advises starting ADHD medications at the lowest dose, then titrating slowly upward to the lowest effective dose; methylphenidate and amphetamines are generally titrated at weekly intervals, atomoxetine (Strattera) at 1 to 2 week intervals, and guanfacine (Intuniv XR) at weekly intervals.1 Duration of Effect Defined by regulators as the time period for which a change in ADHD symptoms were statistically different from placebo. 1,2 Longer-acting methylphenidate and amphetamine formulations have durations that range from ~8 to 16 hours.4-7,10-13 Not reported by Health Canada or the US FDA for immediate release formulations. 10,11,14,15 | Generic Name, Brand Name, available strengths, dosage form, cost, coverage | ADHD Health Canada Indications, Dosage Considerations
indication, initial dosing, dose response, dose titration, maximum dose, administration, tapering | | | --- | --- | --- | | METHYLPHENIDATE1,2,10,11,16, 17 | | | | methylphenidate immediate-release
RITALIN, generics
5, 10, 20 mg IR tablets
methylphenidate extended-release
RITALIN SR, generics
20 mg film-coated SR tablets
Cost per 30 days:
generic: $10 to $30; SR: $25 to $70
brand: discontinued
BC PharmaCare: Regular Benefit | Indication | ▪ ADHD: ages ≥ 6 years | | | Initial Dosing | ▪ IR tablets: 5 to 10 mg BID or TID with or without food
▪ SR tablets: may be used in place of IR tablets when the 8-hour dosage of SR corresponds to the titrated 8-hour dosage of IR | | | Dose Response | ▪ not reported by Health Canada, US FDA | | | Dose Titration | ▪ 5 to 10 mg/day at weekly intervals | | | Maximum Dose | ▪ 60 mg/day | | | Administration | ▪ SR tablets: swallow whole, do not crush or chew | | | | | Methylphenidate ER Brand and Generic Interchangeability ▪ Consider cost differences and monitor for changes in effectiveness and adverse events when switching between ADHD medication formulations. ▪ The US FDA states that for methylphenidate and amphetamines, there is a relationship between drug concentration and efficacy and adverse events; modification to a drug’spharmacokinetics may impact the onset and duration of its effects. 18 It is unclear which specific pharmacokinetic parameter (Cmax, AUC, Tmax) is the most informative and these parameters can show substantial inter-individual variability. For example, the time to maximum concentration for Concerta methylphenidate ER is 6 hours in adults, but varies from 1–10 hours.12 ▪ Like several methylphenidate sustained release products, Concerta methylphenidate ER provides a combination of immediate release (IR) and sustained release (SR) properties. 1,12 There are two generic products currently marketed in Canada (APOTEX, Actavis); the manufacturers indicate that the APO generic is only an SR formulation while the ACT generic is a combined IR and SR formulation. 19,20 Small, single-dose bioavailability studies find modest differences in some of the pharmacokinetic parameters between these two generic products and the brand name.1 We could not find applicable comparisons of these generics to the brand name product examining patientimportant outcomes. | Generic Name, Brand Name, available strengths, dosage form, cost, coverage | ADHD Health Canada Indications, Dosage Considerations
indication, initial dosing, dose response, dose titration, maximum dose, administration, tapering | | | --- | --- | --- | | METHYLPHENIDATE1-5,12,16,17,21-25 | | | | methylphenidate extended-release
CONCERTA, generics
18, 27, 36, 54 mg ER tablets
brand name: OROS® in a non-absorbable shell
brand name biphasic: IR 22%, ER 78%

FAQs

How does Health Canada recommend starting and titrating ADHD medications?

Start at the lowest dose, then titrate slowly upward. Methylphenidate and amphetamines are generally titrated at weekly intervals, atomoxetine at 1 to 2 week intervals, and guanfacine at weekly intervals.

How is the duration of effect defined for ADHD medications?

Regulators define duration as the time period when changes in ADHD symptoms are statistically different from placebo. Longer-acting methylphenidate and amphetamine formulations range from about 8 to 16 hours.

What should be considered when switching methylphenidate formulations or between brand and generic?

Consider cost differences and monitor effectiveness and adverse events after switching. Changes in pharmacokinetics can affect onset and duration, and generic products may differ in certain parameters even if therapeutic outcomes are not clearly compared.

Oct 12, 2026

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