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A Better Way to Find the Ideal Dose of Methylphenidate

Titrating medication over a longer period of time may help adults with ADHD more effectively reduce their symptoms.




March 24, 2017

A new study suggests that remission of ADHD symptoms — as well as better medication tolerance — is more likely with longer periods of medication titration to find the ideal dose.

The study, published in the January issue of the Journal of Clinical Psychiatry, examined 279 adult patients, treating 141 of them with extended-release methylphenidate and the remaining 138 with a placebo. Each patient was started on an 18 mg. dose; over the study period of six weeks, the dosage could be increased by an additional 18 mg. each week — a process known as titration — until symptoms were reduced below a certain point or side effects became intolerable. Symptoms were measured using the ADHD Investigator Symptom Rating Scale (AISRS). AISRS scores range from 0 to 54, with 18 commonly considered the baseline score for adults with unmanaged ADHD.

In the group that took methylphenidate, 13.6 percent remained on the initial dose of 18 mg. at the end of the sixth week, while 23.1 percent had moved to 36 mg., 24.3 percent had increased to 54 mg., and 39.1 percent ended on 72 mg. Nearly half of the methylphenidate group — 45 percent — saw a full “remission” in symptoms (indicated by an AISRS score of 18 or less). Subjects taking methylphenidate also reported better quality of life, improved work productivity, and improved cognitive function compared to the placebo group.

The study differs from others, the authors say, by allowing a longer period of time to find each subject’s “ideal” medication dosage. Prior studies looking at methylphenidate “did not explore the possibility that allowing additional OROS [osmotic controlled-release oral delivery system) methylphenidate dose adjustment(s) might produce further improvement, remission of symptoms, or better tolerability,” they write.

“This improvement over time as well as the waxing and waning of symptoms and responses suggests that clinicians may consider allowing a period of time, weeks or longer, between OROS methylphenidate dosage adjustments with continuous monitoring such that the benefits of a particular dose have sufficient time to emerge,” the authors conclude.

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