Concerta dosage, forms, and strengths

Concerta (extended-release methylphenidate) is indicated for the treatment of attention deficit-hyperactivity disorder (ADHD) in individuals ages 6 to 65. Belonging to the stimulant class of medication, Concerta and related drugs continue to be a first-line treatment of ADHD. ADHD symptoms of overactivity, inattention, and impulsivity can affect one’s academic, professional, and social life. Concerta can help to control all of these symptoms. It is available in a tablet that must be swallowed and comes in 18 mg, 27 mg, 36 mg, and 54 mg strengths.

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Concerta forms and strengths

• Extended-release tablets: 18 mg, 27 mg, 36 mg, 54 mg

Concerta dosage for adults

The FDA has approved Concerta for the treatment of ADHD in adults up to age 65. Other formulations of methylphenidate are also approved for use in adult narcolepsy, but Concerta is not listed among them.

Concerta dosage for ADHD

Concerta acts as a central nervous system (CNS) stimulant. Methylphenidate’s mechanism of action is likely related to its ability to increase norepinephrine and dopamine levels in the synapse (the junction between two nerve cells). This mechanism is felt to be similar to amphetamines, like Adderall, which is the other variety of CNS stimulants used in ADHD management. Amphetamines may be more effective than methylphenidate for adult ADHD but may have more adverse events.

RELATED: Concerta vs. Adderall

Dose responsiveness cannot be reliably predicted, so starting with the lowest tablet strength, 18 mg, is recommended. An increase of the dose as much as 18 mg per day can be made as quickly as every seven days. Monitoring for adverse effects is an ongoing process as the dose is adjusted. The maximum daily dose of Concerta is 72 mg, which can be achieved by taking two 36 mg tablets concurrently.

Concerta dosage for children

The stimulant medications methylphenidate and amphetamines are the preferred agents for most children needing treatment for ADHD. Methylphenidate products may be somewhat preferable to amphetamines in children. 

• Standard Concerta dosage for children ages 6 and older: 18 mg

• Maximum Concerta dosage for children ages 6 to 12: 2 mg/kg of body weight up to 54 mg

• Maximum Concerta dosage for children ages 13 and older: 2 mg/kg of body weight up to 72 mg

Children taking Concerta must have their weight and growth monitored. Weight loss or slowing of normal weight gain can occur, and ultimately, growth can be affected. These adverse reactions may result from the appetite suppression that occurs with the drug. Other common side effects include headache, dizziness, abdominal pain, nausea, nervousness, irritability, insomnia, palpitations, fast heart rate (tachycardia), vision changes, dry mouth, and excess sweating (hyperhidrosis).

Concerta dosage restrictions

The FDA states that safety and effectiveness in adults older than 65 years of age have not been established. Therefore, the indication for Concerta use in adults has an upper age limit. The FDA indication for Concerta use in the management of ADHD in children has a lower age limit of 6, based on safety and efficacy not being established in children younger than 6.

Dosing limitations are neither listed by the manufacturer Janssen nor defined in general for use in the setting of renal (kidney) or hepatic (liver) impairment. However, a number of coinciding medical conditions do elevate the need for caution before taking Concerta. These include:

• Hypertension (high blood pressure)

• Hyperthyroidism (overactive thyroid)

• Seizure disorder

• Bipolar disorder

• Psychosis

• Congestive heart failure

• Substance abuse history

The list of conditions makes sense when considering that some of the possible serious adverse reactions to Concerta are hypertension, myocardial infarction, sudden death, seizure, Raynaud’s phenomenon (reduced blood flow to fingertips and toes), priapism (prolonged and painful erections), manic symptoms, abuse, and drug dependence.

Most importantly, there are a number of contraindications to Concerta use that would usually preclude the medication being used, including the following:

• History of hypersensitivity or allergy to the drug

• Monoamine oxidase inhibitor (MAOI) use within the past 14 days

• Severe agitation or anxiety

• Motor tics, Tourette syndrome, or family history of Tourette syndrome

• Severe cardiovascular disease, structural cardiac abnormalities, arrhythmia (abnormal heart rhythm), cardiomyopathy (abnormal heart muscle), or coronary artery disease

• Glaucoma

• Severe intestinal stricture (narrowing in the bowel)

Concerta dosage for pets

There is no FDA-approved indication for Concerta use in pets. Even small amounts of Concerta can be life-threatening to a pet.

RELATED: Help! My pet ingested one of my pills

How to take Concerta

Concerta is typically taken first thing in the morning. The tablet is to be swallowed whole and not crushed, cut, or chewed. It can be taken with food, and this is often advisable because appetite can be diminished after the medication’s onset of action.

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Drop off any unused medicine at a drug take-back location right away. Check your local drug store and clinics for take-back locations. You can also check the DEA website for locations. The FDA has a website regarding safe disposal of medicines.

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.

• Extended-release tablet: Take the medicine in the morning. Swallow it whole with water or other liquid. Do not crush, break, or chew it.

• If you take the extended-release tablet, part of the tablet may pass into your stools. This is normal and is nothing to worry about.

• Use only the brand of medicine your doctor prescribed. Other brand names may not work the same way.

• This medicine should come with a medication guide. Ask your pharmacist for a copy if you do not have one.

Concerta dosage FAQs

Ritalin (methylphenidate hydrochloride) vs. Concerta (extended-release methylphenidate): What’s the difference?

Concerta is an extended-release form of methylphenidate HCl. The tablet is engineered with a medication coating that provides an onset of action in less than one hour and internal medication that is gradually released to provide relief for up to 12 hours. In comparison, Ritalin is an immediate-release form of methylphenidate that has a similar onset of action time but a duration of only five hours or less.

Doses of Ritalin are typically needed multiple times per day due to its relatively short duration of action. The starting dose and maximum daily doses are quite different for Ritalin and Concerta, and the healthcare provider must carefully guide a change from one form of methylphenidate to another.

RELATED: Concerta vs. Ritalin

How long does it take Concerta to work?

Concerta can be effective with the first dose. It does not take weeks for the medicine to be beneficial. For this reason, the prescribing healthcare professional may suggest that students do not have to take the medicine on weekends, holidays, and summer breaks. While Concerta can be effective quickly, it can take time to find the proper dosage, and dosage adjustments can be made weekly if necessary.

How long does Concerta stay in your system?

The half-life of elimination of this extended-release methylphenidate product is about 3.5 hours, meaning it takes this long for the bodily concentration of the medicine to be reduced in half.  Therefore, it takes about 18 hours for 97% of the drug to be eliminated from the body.

What happens if I miss a dose of Concerta?

Concerta is typically taken first thing in the morning. If a missed dose is remembered early enough on the same day, it can still be taken. Taking a dose too late in the day can make sleep difficult. Concerta’s duration of action of up to 12 hours should be considered when deciding if it is too late to take the dose because taking a dose too late could hamper the night’s sleep. Doubling up on the dose should never be done.

How long can you take Concerta?

The treatment duration for Concerta is not firmly defined and must be individualized. A pediatric healthcare provider will usually seek feedback from the patient, teachers, and parents to determine if treatment still needs to be continued. In some cases, observing a child during breaks from the ADHD medication can help to guide the decision. For adults, the patient and prescriber work together to determine if and when to stop the medication.

RELATED: Adult ADHD

How do I stop taking Concerta?

In typical use, Concerta can be taken some days and not others and even stopped if needed. If Concerta is taken every day, particularly at high doses, or if it is being abused, withdrawal symptoms may occur if the medication is discontinued abruptly. Discontinuation of Concerta should be decided in consultation with the treating healthcare professional to determine if it is advisable.

What is the maximum dosage for Concerta?

For children, the maximum dosage of Concerta is 2 mg/kg, up to 54 mg in those ages 12 and younger and up to 72 mg in those ages 13 and older. Adult patients can take a maximum dose of 72 mg.

Can you overdose on Concerta?

An overdose of Concerta could be fatal due to its effects on the cardiovascular system. An elevation in heart rate and blood pressure could be signs of serious heart problems. Obtaining immediate medical attention and calling the Poison Help line at 1-800-222-1222 are warranted.

What interacts with Concerta?

Due to the potential for serious interactions, Concerta should not be taken with isocarboxazid, linezolid, methylene blue, phendimetrazine, phenelzine, safinamide, selegiline transdermal, tranylcypromine, and Yohimbe. Concerta use is also contraindicated within 14 days of use of an MAOI.

Numerous other medications can interact with Concerta and may need to be avoided in combination with it. Many others require additional monitoring or caution. Thus, a thorough review of all medications by a medical provider is necessary before starting the drug.

What happens when you mix Concerta and alcohol?

Alcohol use should be avoided when taking Concerta. The adverse effects of the medication can be heightened by alcohol.

Is it safe to take Concerta during pregnancy?

No adverse effects of Concerta use during pregnancy or breastfeeding are known, but data from clinical trials is limited. Caution is advisable before use in these circumstances, in order to fully discuss the risks and benefits of treatment with the healthcare professional.

RELATED: Is it safe to take Adderall during pregnancy?

Related resources for Concerta dosages:

• Adult dosing, Epocrates

• Pediatric dosing, Epocrates

• Concerta drug information, FDA

• Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults, The Lancet Psychiatry

• Top 10 human medications poisonous to pets, Pet Poison Hotline

• Disposal of unused medications, FDA

• Drug interactions, Epocrates