Common use of Methylphenidate Clause in Contracts

Methylphenidate. Plain – Ritalin® and Medikinet®: Child 4-5 years old (unlicensed), initially 2.5 mg twice daily, increased in steps of 2.5 mg daily if required, at weekly intervals For Children over 6 years initially 5mg once or twice daily with or after breakfast and lunch, increasing if necessary in weekly intervals of 5-10mg in 2 to 3 divided doses. The maximum licensed dose for methylphenidate is 60mg daily, with 90mg daily used in some specialist centres, which is supported by NICE (NICE NG 87 March 2018). In some children rebound hyperactivity may occur if the effect of the drug wears off in the evening. An additional dose later in the day may eliminate this difficulty but may disturb sleep. Equasym XL®: Child 6* years or over, initially 10mg once daily (in the morning before breakfast), increasing if necessary in weekly intervals to a maximum of 60mg daily. For children 4-5 years 10mg daily (in the morning with breakfast) could be considered but this is unlicensed. Medikinet XL®: Child 6* years or over, initially 10mg once daily (in the morning with breakfast), adjusted according to response at weekly intervals to a maximum of 60mg daily. For children 4-5 years old Medikinet XL 5mg once daily (in the morning before breakfast) could be considered, with this being unlicensed Concerta XL®, Xaggitin XL Matoride XL® & Xenidate XL®: Child 6* years or over initially 18mg once daily (in the morning), increasing if necessary in weekly increments of 18mg up to a maximum licensed dose of 54mg once daily. For children 4-5 years 18mg daily (in the morning with breakfast) could be considered but this is unlicensed. A 15mg dose of all other formulations of methylphenidate is considered equivalent to Concerta XL® 18mg and branded generic versions of this. The unlicensed dose of Concerta XL® 72mg is therefore equivalent to the licensed maximum 60mg dose of Ritalin®, Medikinet®, Equasym XL® or Medikinet XL®. The usual starting dosage for children aged 3-5 years is 2.5mg a day, increased if necessary by 2.5mg a day at weekly intervals; for children aged 6 years and over, the usual starting dose is 2.5mg 2 to 3 times per day increasing if necessary by 5mg per day at weekly intervals. The usual upper limit is 20mg a day though some older children have needed 40mg or more for optimal response. Maintenance dose should be given in 2 to 4 divided doses. Lisdexamfetamine is a pro-drug formulation of dexamfetamine, which is converted to free dexamfetamine by enzymes present on red blood cells. The starting dose in children of 5* years and over is 20mg once daily taken in the morning, which can be increased in dose by 10-20mg increments, at minimum intervals of one week up to a maximum of 70mg once daily. *NICE (NG 87 March 2018) supports the unlicensed use in 5 year olds.

Methylphenidate. Plain – Ritalin® and Medikinet®: Child 4-5 years old (unlicensed), initially 2.5 mg twice daily, increased in steps of 2.5 mg daily if required, at weekly intervals For Children over 6 years initially 5mg once or twice daily with or after breakfast and lunch, increasing if necessary in weekly intervals of 5-10mg in 2 to 3 divided doses. The maximum licensed dose for methylphenidate is 60mg daily, with 90mg daily used in some specialist centres, which is supported by NICE (NICE NG 87 March 2018). In some children rebound hyperactivity may occur if the effect of the drug wears off in the evening. An additional dose later in the day may eliminate this difficulty but may disturb sleep. Equasym XL®: Child 6* years or over, initially 10mg once daily (in the morning before breakfast), increasing if necessary in weekly intervals to a maximum of 60mg daily. For children 4-5 years 10mg daily (in the morning with breakfast) could be considered but this is unlicensed. Medikinet XL®: Child 6* years or over, initially 10mg once daily (in the morning with breakfast), adjusted according to response at weekly intervals to a maximum of 60mg daily. For children 4-5 years old Medikinet XL 5mg once daily (in the morning before breakfast) could be considered, with this being unlicensed Concerta XL®, Xaggitin XL Matoride XL® & Xenidate XL®: Child 6* years or over initially 18mg once daily (in the morning), increasing if necessary in weekly increments of 18mg up to a maximum licensed dose of 54mg once daily. For children 4-5 years 18mg daily (in the morning with breakfast) could be considered but this is unlicensed. A 15mg dose of all other formulations of methylphenidate is considered equivalent to Concerta XL® 18mg and branded generic versions of this. The unlicensed dose of Concerta XL® 72mg is therefore equivalent to the licensed maximum 60mg dose of Ritalin®, Medikinet®, Equasym XL® or Medikinet XL®. The usual starting dosage for children aged 3-5 years is 2.5mg a day, increased if necessary by 2.5mg a day at weekly intervals; for children aged 6 years and over, the usual starting dose is 2.5mg 2 to 3 times per day increasing if necessary by 5mg per day at weekly intervals. The usual upper limit is 20mg a day though some older children have needed 40mg or more for optimal response. Maintenance dose should be given in 2 to 4 divided doses. Lisdexamfetamine is a pro-drug formulation of dexamfetamine, which is converted to free dexamfetamine by enzymes present on red blood cells. The starting dose in children of 5* years and over is 20mg once daily taken in the morning, which can be increased in dose by 10-20mg increments, at minimum intervals of one week up to a maximum of 70mg once daily. *NICE (NG 87 March 2018) supports the unlicensed use in 5 year olds. Initially a total daily dose of approximately 0.5mg/kg per day. This should be maintained for a minimum of 7 days, before titrating upwards according to clinical response and tolerability. Maintenance dose is approximately 1.2mg/kg per day (depending on the patient's weight and available dosage strengths of atomoxetine). No additional benefit has been demonstrated for doses higher than 1.2mg/kg/day. The safety of doses above 1.8mg/kg has not been systematically evaluated.

Methylphenidate. Plain – Ritalin® and Medikinet®: Child 4-5 years old (unlicensed), initially 2.5 mg twice daily, increased in steps of 2.5 mg daily if required, at weekly intervals For Children over 6 years initially 5mg once once, or twice daily with or after breakfast and lunch, increasing if necessary in weekly intervals of 5-10mg in 2 to 3 divided doses. The maximum licensed dose for methylphenidate is 60mg daily, with 90mg daily used in some specialist centres, which is supported by NICE (NICE NG 87 March 2018). In some children rebound hyperactivity may occur if the effect of the drug wears off in the evening. An additional dose later in the day may eliminate this difficulty but may disturb sleep. Equasym XL®: Child 6* years or over, initially 10mg once daily (in the morning before breakfast), increasing if necessary in weekly intervals to a maximum of 60mg daily. For children 4-5 years 10mg daily (in the morning with breakfast) could be considered but this is unlicensed. Medikinet XL®: Child 6* years or over, initially 10mg once daily (in the morning with breakfast), adjusted according to response at weekly intervals to a maximum of 60mg daily. For children 4-5 years old Medikinet XL 5mg once daily (in the morning before breakfast) could be considered, with this being unlicensed Concerta XL®, Xaggitin XL Matoride XL® & Xenidate XL®: Child 6* years or over initially 18mg once daily (in the morning), increasing if necessary in weekly increments of 18mg up to a maximum licensed dose of 54mg once daily. For children 4-5 years 18mg daily (in the morning with breakfast) could be considered but this is unlicensed. A 15mg dose of all other formulations of methylphenidate is considered equivalent to Concerta XL® 18mg and branded generic versions of this. The unlicensed dose of Concerta XL® 72mg is therefore equivalent to the licensed maximum 60mg dose of Ritalin®, Medikinet®, Equasym XL® or Medikinet XL®. The usual starting dosage for children aged 3-5 years is 2.5mg a day, increased if necessary by 2.5mg a day at weekly intervals; for children aged 6 years and over, the usual starting dose is 2.5mg 2 to 3 times per day increasing if necessary by 5mg per day at weekly intervals. The usual upper limit is 20mg a day though some older children have needed 40mg or more for optimal response. Maintenance dose should be given in 2 to 4 divided doses. Lisdexamfetamine is a pro-drug formulation of dexamfetamine, which is converted to free dexamfetamine by enzymes present on red blood cells. The starting dose in children of 5* years and over is 20mg once daily taken in the morning, which can be increased in dose by 10-20mg increments, at minimum intervals of one week up to a maximum of 70mg once daily. *NICE (NG 87 March 2018) supports the unlicensed use in 5 year olds.