Concerta

Forms/Strengths

Age: ≥ 6 y/o
Onset: ~ 30-60 min
Duration: Up to 12 hours
Release Profile: 22% IR, 78% CR via osmotic delivery
Considerations: Must be swallowed whole; the non-absorbable shell may pass in stool. Administer once daily in the morning, with or without food. Do not chew or crush the tablet.
Initial Dose:
- 6-12 y/o: 18 mg daily
- 13+ y/o: 18 mg - 36 mg daily
Titration: 18 mg/day at weekly intervals
Max Dose:
- 6-12 y/o: 54 mg/day
- 13+ y/o: 72 mg/day

Blocks dopamine and norepinephrine reuptake; central nervous system stimulant
Uses OROS technology for immediate release followed by slow, consistent release; minimizes plasma fluctuations
Can cause psychiatric adverse events; assess for bipolar disorder before starting
Common side effects: decreased appetite, insomnia, headache, gastrointestinal discomfort

Take once daily in the morning to reduce the risk of insomnia.
Can be taken with or without food; high-fat meals may delay absorption.
Swallow the tablet whole with water; do not crush, chew, or split.
The osmotic-controlled release system (OROS) shell may appear in the stool; this is normal.

Common: Decreased appetite, headache, dry mouth, nausea, insomnia, anxiety, dizziness, weight loss, irritability, hyperhidrosis
Serious: Cardiovascular events, psychiatric adverse events, seizures, visual disturbances, growth suppression in children

Cardiovascular: Baseline and routine monitoring of heart rate and blood pressure.
Growth in Pediatrics: Regular monitoring of height and weight to detect growth suppression.
Psychiatric Symptoms: Observe for mood changes, anxiety, or psychosis.
Abuse Potential: Monitor for misuse or diversion.

When to Call the Doctor:
- Severe mood changes, aggression, or suicidal thoughts.
- Chest pain, rapid heartbeat, shortness of breath (cardiovascular concerns).
- Uncontrolled movements, tics, or worsening anxiety.
- Numbness, coldness, or color changes in fingers or toes (circulatory issues).
- Unexplained weight loss or delayed growth in pediatric patients.
Safety Tips:
- Monitor blood pressure and heart rate, especially in patients with cardiovascular risk.
- Use caution in patients with anxiety, bipolar disorder, or psychosis, as symptoms may worsen.
- Avoid caffeine and other stimulants, which may amplify side effects.
- Ensure adequate hydration and nutrition, as appetite suppression is common.
- Tapering may be required if discontinuing after long-term use.
Parent Tips for Pediatric Patients:
- Encourage a nutrient-dense diet to counteract appetite suppression.
- Administer in the morning before school for optimal effect.
- Monitor school performance and behavioral changes.
- Observe for sleep disturbances; adjust timing if necessary.
- Communicate regularly with teachers and caregivers about medication effects.

Contraindications:
- Hypersensitivity to methylphenidate or formulation components.
- Use within 14 days of MAOI therapy (risk of hypertensive crisis).
- Symptomatic cardiovascular disease, moderate-to-severe hypertension, hyperthyroidism, glaucoma.
- History of substance use disorder, unless benefits outweigh risks.
Pregnancy:
- Category C; use only if benefits outweigh risks.
- May cause neonatal withdrawal symptoms or low birth weight.
Lactation:
- Excreted in breast milk; not recommended due to potential infant exposure.
Drug Interactions:
- Serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs) increase serotonin syndrome risk.
- Acidifying agents (e.g., ascorbic acid) may reduce drug absorption.
- Alkalinizing agents (e.g., sodium bicarbonate) may increase methylphenidate levels.
- May potentiate hypertensive effects of certain medications (e.g., decongestants, beta-agonists).