Stimulant Dosing Comparison Table
Quick Reference Tool | PsychHQ
Source: Module 3, Stimulant Pharmacotherapy | Last Updated: February 2026
First-Line Recommendations by Age
| Population |
Recommended First-Line |
Rationale |
| Children & Adolescents |
Methylphenidate |
Better tolerability profile; amphetamines had significantly higher adverse-event-related dropout in pediatric trials (Cortese et al., 2018, Lancet Psychiatry) |
| Adults |
Amphetamine |
Tolerability penalty disappears in adults; amphetamines demonstrate greater efficacy with no difference in side-effect dropout (Cortese et al., 2018). Note: NICE, CADDRA, and European Consensus guidelines recommend MPH and AMP as equivalent first-line options for adults |
| Preschoolers (3–5) |
Methylphenidate (after behavioral parent training) |
Only stimulant class with adequate preschool RCT data (PATS trial). AAP recommends behavioral parent training first-line (Grade A). Lower doses required (mean optimal 14.2 mg/day). Off-label under age 6 for MPH |
Methylphenidate Formulations
Immediate-Release
| Brand |
Generic |
Duration |
Starting Dose (Children ≥6) |
Typical Range |
Notes |
| Ritalin |
Methylphenidate IR |
3–5 hrs |
5 mg BID |
10–60 mg/day |
Multiple daily doses required; sharp peak-and-crash PK profile; higher rebound risk |
| Focalin |
Dexmethylphenidate IR |
4–5 hrs |
2.5 mg BID |
5–20 mg/day |
Active enantiomer only; half the mg dose of racemic MPH for equivalent effect |
Extended-Release
| Brand |
Generic |
Delivery Mechanism |
Duration |
Starting Dose (Children ≥6) |
Typical Range |
Can Open/Sprinkle? |
Key Clinical Notes |
| Concerta |
MPH OROS |
Osmotic pump (laser-drilled tablet) |
10–12 hrs |
18 mg QAM |
18–72 mg/day |
No, cannot crush, chew, or divide |
Ascending release profile outpaces intra-day tachyphylaxis. Ghost tablet passes in stool (counsel families). Verify AB-rated generic, some generics (Mallinckrodt, Kudco) downgraded to BX rating for failing to replicate ascending profile. Low abuse potential (rigid shell) |
| Ritalin LA |
MPH ER (beaded) |
Dual-bead (50% IR : 50% DR) |
10–12 hrs |
20 mg QAM |
20–60 mg/day |
Yes, sprinkle beads on applesauce |
Two-pulse delivery mimics BID IR dosing |
| Metadate CD |
MPH ER (beaded) |
Dual-bead (30% IR : 70% DR) |
10–12 hrs |
20 mg QAM |
20–60 mg/day |
Yes, sprinkle beads on food |
More back-loaded than Ritalin LA; may provide better afternoon coverage |
| Aptensio XR |
MPH ER (beaded) |
Dual-bead (40% IR : 60% DR) |
10–12 hrs |
10 mg QAM |
10–60 mg/day |
Yes, sprinkle beads on food |
Intermediate IR:ER ratio |
| Focalin XR |
Dexmethylphenidate ER |
Dual-bead (50% IR : 50% DR) |
10–12 hrs |
5 mg QAM |
5–40 mg/day |
Yes, sprinkle beads on food |
Active enantiomer only; half the mg dose of racemic MPH formulations |
| Jornay PM |
MPH delayed-release |
Delayed-release coating (evening dosing) |
~12 hrs (after 10-hr delay) |
20 mg QPM (6:30–9:30 PM) |
20–100 mg/day |
No |
Only stimulant designed for evening dosing. FDA approved ages ≥6. <5% drug released during sleep. Child wakes with therapeutic levels. Eliminates morning gap. Ideal for families with difficult morning routines |
| Azstarys |
SDX/d-MPH |
Prodrug (30% IR d-MPH + 70% serdexmethylphenidate prodrug) |
~13 hrs |
26.1/5.2 mg QAM |
Up to 52.3/10.4 mg/day |
Yes, capsule can be opened |
Prodrug component (serdexmethylphenidate) classified as Schedule IV due to low abuse potential; combination product remains Schedule II |
| Quillivant XR |
MPH ER (liquid) |
Extended-release oral suspension |
~12 hrs |
20 mg QAM |
20–60 mg/day |
N/A, liquid |
Must shake vigorously for 10 seconds before each dose. Ideal for children who cannot swallow pills |
| QuilliChew ER |
MPH ER (chewable) |
Extended-release chewable tablet |
~12 hrs |
20 mg QAM |
20–60 mg/day |
N/A, chewable |
For children with pill aversion or dysphagia |
| Cotempla XR-ODT |
MPH ER (orally disintegrating) |
Extended-release ODT |
~12 hrs |
17.3 mg QAM |
17.3–51.8 mg/day |
N/A, dissolves on tongue |
Orally disintegrating; no water needed |
| Daytrana |
MPH transdermal patch |
Transdermal delivery |
~12 hrs total (apply 2 hrs before effect needed) |
10 mg/9 hr patch |
10–30 mg/9 hr patch |
N/A, patch |
Bypasses first-pass metabolism. Duration modulated by removing patch earlier. Rotate application sites daily. Common: localized skin reactions |
Amphetamine Formulations
Immediate-Release
| Brand |
Generic |
Duration |
Starting Dose (Children ≥6) |
Typical Range |
Notes |
| Adderall |
Mixed amphetamine salts IR |
4–6 hrs |
5 mg QD–BID |
5–40 mg/day |
3:1 ratio of d-AMP to l-AMP base equivalents |
| Dexedrine |
Dextroamphetamine IR |
4–6 hrs |
5 mg QD–BID |
5–40 mg/day |
Pure d-amphetamine |
| Evekeo |
Amphetamine sulfate IR |
4–6 hrs |
5 mg QD–BID |
5–40 mg/day |
1:1 ratio d-AMP to l-AMP (more noradrenergic) |
| Zenzedi |
Dextroamphetamine IR |
4–6 hrs |
2.5–5 mg QD |
5–40 mg/day |
Available in multiple tablet strengths |
Extended-Release
| Brand |
Generic |
Delivery Mechanism |
Duration |
Starting Dose (Children ≥6) |
Typical Range |
Can Open/Sprinkle? |
Key Clinical Notes |
| Adderall XR |
Mixed AMP salts XR |
Dual-bead (50% IR : 50% DR) |
10–12 hrs |
10 mg QAM |
10–30 mg/day |
Yes, sprinkle beads on food |
Mimics two IR doses 4 hours apart |
| Vyvanse |
Lisdexamfetamine |
Prodrug (lysine-conjugated d-AMP) |
10–13 hrs |
30 mg QAM |
30–70 mg/day |
N/A, dissolve powder in water, juice, or yogurt |
Lowest abuse liability of any stimulant, prodrug requires enzymatic cleavage in RBCs; rate-limited and saturable. Smooth PK curve with low inter-patient variability. Preferred first-line for patients with SUD history/risk |
| Mydayis |
Mixed AMP salts triple-bead |
Triple-bead (3 release populations) |
14–16 hrs |
12.5 mg QAM |
12.5–25 mg/day |
Yes, sprinkle beads on food |
Longest-acting oral amphetamine. Ages 13+ only (not approved under 13). High-fat meal delays peak by up to 5 hrs (largest food effect in class). Insomnia: 31% in adult trials vs 8% placebo |
| Dyanavel XR |
Amphetamine ER (liquid) |
Ion-exchange resin suspension |
~13 hrs |
2.5–5 mg QAM |
Up to 20 mg/day |
N/A, liquid |
Liquid ER formulation for children who cannot swallow pills |
| Xelstrym |
Dextroamphetamine transdermal |
Transdermal patch |
10–12 hrs |
Apply 2 hrs before effect needed |
Titrate per labeling |
N/A, patch |
Similar principles to Daytrana (MPH patch) |
Adult Dosing Quick Reference
| Class |
Starting Dose |
Typical Target |
Usual Maximum |
| Methylphenidate (OROS) |
18–36 mg/day |
36–72 mg/day |
72–108 mg/day |
| Methylphenidate (IR) |
10 mg BID |
20–60 mg/day |
60 mg/day |
| Amphetamine (ER) |
5–10 mg QAM |
20–40 mg/day |
40–60 mg/day |
| Lisdexamfetamine |
30 mg QAM |
50–70 mg/day |
70 mg/day |
Titration Protocol Summary
General principles (per AAP Clinical Practice Guideline, Wolraich et al., 2019):
- MPH in children ≥6: Start 5 mg BID (IR) or 18 mg QAM (OROS). Increase by 5–10 mg/week (IR) or 18 mg/week (OROS). Target: 0.5–1.0 mg/kg/day
- AMP in children: Start 2.5–5 mg QD–BID (IR) or lowest ER dose. Increase by 2.5–5 mg/week. Target: 0.3–0.5 mg/kg/day
- Preschoolers (3–5): MPH only. Start lower, titrate slower. Mean optimal dose ~14.2 mg/day (PATS trial)
- Minimum 1 week between dose increases
- Monitor with standardized rating scales at each titration step, not just "how's it going?"
Key Conversion Notes
- Racemic MPH → Dexmethylphenidate: Halve the dose (d-MPH is the active enantiomer)
- Cross-class switches (MPH ↔ AMP): Do not convert mg-for-mg. Different mechanisms and potency ratios. Restart titration from a low dose
- Sequential trial data: If first stimulant class fails, try the other. Cumulative response rate: 87–91% when both classes trialed systematically (Hodgkins et al., 2012)
Formulation Selection Decision Guide
| Clinical Scenario |
Recommended Formulations |
| Standard school/work coverage (10–12 hrs) |
Concerta, Vyvanse, Adderall XR, Focalin XR, Azstarys |
| Extended coverage needed (14–16 hrs) |
Mydayis (age 13+); or XR + IR booster strategy |
| Morning routine crisis |
Jornay PM (evening dosing, child wakes with therapeutic levels) |
| Cannot swallow pills |
Vyvanse (dissolve in liquid), Focalin XR / Adderall XR / Ritalin LA / Aptensio XR (open capsule, sprinkle beads on food), Quillivant XR / Dyanavel XR (liquids), QuilliChew ER / Cotempla XR-ODT (chewable/dissolving), Daytrana / Xelstrym (transdermal patches) |
| High diversion risk or SUD history |
Vyvanse (prodrug), Azstarys (prodrug component), Concerta (rigid shell) |
| Afternoon wear-off with current ER |
Add IR booster (typically half the ER dose or less, early-to-mid afternoon); or switch to longer-duration formulation |
| Coverage gap requiring XR + IR booster |
Use same stimulant class for both primary and supplemental dose |
| Comorbid tic disorder |
Methylphenidate preferred first-line; add alpha-2 agonist if tics persist |
| Comorbid anxiety |
Start methylphenidate at low dose, titrate slowly. Stimulants typically reduce anxiety (indirect anxiolysis). If anxiety worsens, reduce dose before switching class |
| Comorbid ASD |
Methylphenidate first-line. Lower response rate (~49% vs ~70%), higher side-effect burden. Start lower, titrate slower |
Metabolism and Drug Interaction Highlights
| Factor |
Methylphenidate |
Amphetamine |
| Primary metabolism |
Hepatic CES1 to ritalinic acid (inactive). Nearly 100% hepatic clearance. |
Renal excretion of unchanged drug (majority); minor CYP2D6 oxidation to 4-hydroxy-amphetamine |
| CYP450 interactions |
Minimal. Largely insulated from P450 system. |
Weak CYP2D6 involvement. Strong 2D6 inhibitors (fluoxetine, paroxetine, bupropion) may increase AMP levels |
| Pharmacogenetic variable |
CES1 rs71647871 variant: up to 2.5x higher MPH exposure. Ultra-rapid CES1 metabolizers may clear drug too quickly |
CYP2D6 poor/ultra-rapid metabolizer status (minor clinical impact since most AMP excreted renally) |
| Urinary pH sensitivity |
Minimal |
Major. Acidic urine = rapid clearance (shorter duration). Alkaline urine = retention (longer duration, toxicity risk). Review vitamin C, antacids, PPIs |
| First-pass metabolism |
Extensive (CES1) |
Minimal |
Efficacy Benchmarks
| Metric |
Stimulants (Children) |
Stimulants (Adults) |
Context |
| Effect size vs placebo |
AMP: SMD −1.02; MPH: SMD −0.78 |
AMP most efficacious |
For comparison: SSRIs in depression = 0.3–0.4 |
| NNT for symptom response |
2–3 |
2–3 |
Among the lowest NNTs in all of medicine |
| Cumulative response (both classes trialed) |
87–91% |
Similar |
Sequential trial is essential before concluding "stimulants don't work" |
| Quality of life improvement |
AMP: Hedge's g 0.51; MPH: g 0.38 |
-- |
Smaller than symptom effect sizes but captures functional/social gains |
This quick reference tool is extracted from Module 3: Stimulant Pharmacotherapy. For full evidence review, clinical vignettes, and complete references, see the full clinical module.
For the full clinical curriculum, visit psychhq.com
Key References: Cortese et al. (2018) Lancet Psychiatry; Hodgkins et al. (2012) Eur Child Adolesc Psychiatry; Wolraich et al. (2019) Pediatrics; Faraone (2018) Neurosci Biobehav Rev; Zhang et al. (2024) JAMA Psychiatry