Switching from immediate release to sustained release methylphenidate in the treatment of children and adolescents with attention deficit/hyperactivity disorder.
BACKGROUND
Switching from Immediate Release Methylphenidate (MPH-IR) to a sustained release formulation in treatment of attention deficit/hyperactivity disorder (ADHD) is often required to provide better compliance and convenience. However; the switch has been reported to be not always successful and small doses of MPH-IR may be added to sustained release preparations when its effect wears off.


METHODS
In this survey, clinical case notes of 77 subjects aged 6-18 years who had been switched from MPH-IR to Concerta XL were retrospectively analyzed to demonstrate the effectiveness of the switch. The impact of adding MPH-IR to Concerta XL on the outcome was evaluated.


RESULTS
Switch to Concerta XL alone was successful in 94% of cases and all 23 (100%) subjects who had MPH-IR added to Concerta XL showed good response to the switch. However; more than 43% of the subjects required additional doses of MPH-IR and 55% needed a larger than recommended equivalent doses of Concerta XL for a successful switch.


CONCLUSIONS
Higher than equivalent doses of Concerta XL or an additional dose of MPH-IR may be required for a successful switch from immediate to sustained release methylphenidate.
Child and Adolescent Mental Health Service, Community Team, Oxford Health NHS Foundation Trust, Oxford, UK. drgormez@doctors.org.uk  
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Gormez
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Avery
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Mann
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations; D008774:Methylphenidate