Comparison of ADHD Medications (United States)

Product

Dosage Forms

Cost/Month^a

Dosing Frequency

Duration of Action(approx.)

Initial and Titration Dose (every 7 days, unless noted otherwise)^e

Max Daily Dose

Stimulants (i.e., methylphenidate, dexmethylphenidate, serdexmethylphenidate/dexmethylphenidate, amphetamines):

• Patients not responding to one stimulant may respond to another.⁴ For information on switching, see Dose Conversion Information at the end of this document, or start with initial recommended doses and titrate.
• Commonly used in preschoolers with an inadequate response to behavior therapy, but studies are limited.^1,4 Dose conservatively and titrate slowly.
• Methylphenidate is metabolized slowly in this age group.⁴
• In children less than 16 kg, short-acting agents are typically used initially.¹

Immediate-release (IR) methylphenidate

Ritalin (Sandoz)

Generics from Accord, Ascend (Alkem), Camber (Ascent), Impax (Mountain), KVK-Tech (Abhai), Mallinckrodt (SpecGx). Solco (Prinston), XL Care (Ascent), and Sun are AB rated.^b

Sandoz products are authorized generics.^f

5, 10, 20 mg tabs

~$14 (10 mg BID)

BID to TID (AM, noon,
4 PM if needed),^4,5 preferably
30 to 45 minutes before meals.

3 to 5 h⁴

Initial: 5 mg BID to TID.⁵

Titration:
5 to 10 mg⁵

FDA:

60 mg

Off-label:

100 mg if

>50 kg¹

Methylin Chewable Tabs

(SpecGx

Brand discontinued. Generics from Camber (Ascent), Rising, and XL Care (Ascent) are AB rated.^b

2.5, 5, 10 mg chewable tabs

~$200 (10 mg BID)

BID to TID (AM, noon,
4 PM if needed),^4,5preferably
30 to 45 minutes before meals.

3 to 5 h⁴

See Ritalin

See Ritalin

Methylin Oral Solution

(SpeecGx)

Generics from are Eywa (Wes), KVK-Tech (Abhai), Quagen, Tris Pharma, are AA rated.^b

5 mg/5 mL,
10 mg/5 mL oral solution

~$70 (10 mg BID)

BID to TID (AM, noon, 4 PM if needed),^4,5 preferably
30 to 45 minutes before meals.

3 to 5 h⁴

See Ritalin

See Ritalin

Immediate-release (IR) dexmethylphenidate

Focalin (Sandoz)

Generics from Ascend, KVK-Tech (Abhai), Sun, and Tris Pharma are AB rated.^b

Sandoz products are authorized generics.^f

2.5, 5, 10 mg tabs

~$20 (5 mg BID)

BID at least 4 hours apart without regard to meals.

3 to 5 h⁴

Initial: 2.5 mg BID (children and adults)

Titration:

2.5 mg with AM and/or midday dose⁶

FDA:
20 mg

Off-label:

50 mg¹

Extended-release (ER) dexmethylphenidate

Focalin XR^c (Sandoz)

Generic from Camber (Ascent), Granules, Impax, Lannett (Adare), Endo, Sun, and Teva are AB rated.^b

Sandoz products are authorized generics.^f

5, 10, 15, 20, 25, 30, 35, 40 mg caps

~$50 (10 mg daily)

Once daily in the morning without regard to meals. May be taken whole or sprinkled on applesauce.ⁱ

8 to 12 h⁴

Initial: 5 mg (children) or

10 mg (adults)

Titration:

5 mg (children) or

10 mg (adults)

FDA:
30 mg children;

40 mg adults

Off-label:

50 mg¹

Extended-release (ER) methylphenidate

Aptensio XR(Rhodes)

Capsules filled with multi-layered beads. IR layer contains 40% of the dose, controlled-release layer contains 60% of the dose.

Peaks at 2 and 8 hours post-dose.

Generic from Teva is AB rated.^b

10, 15, 20, 30, 40, 50, 60 mg caps

~$216 (any strength daily)

Once daily in the morning, at a consistent time in regard to meals. May be taken whole or sprinkled on applesauce.ⁱ

12 h⁷

Initial: 10 mg (patients 6 yrs and older)

Titration: 10 mg

FDA:

60 mg

Concerta^d (Janssen)

OROS (osmotic system has hole for sustained drug release) with IR overcoat.

Generics from Kremers Urban (Lannett), and Mallinckrodt (SpecGx) are BX rated.^b Generics from Camber (Ascent), Dr. Reddy’s, Teva, Sun, Trigen (Osmotica), and XL Care (Ascent) are AB rated.^b

18, 27, 36, 54 mg
ER tabs

~$70 (36 mg daily)

Once daily in the morning without regard to meals. Must be swallowed whole.

12 h

Initial: 18 mg (children or adolescents) or

18 to 36 mg (adults)

Titration: 18 mg (27 mg tablet is available for titration between 18 mg and 36 mg)

FDA: 54 mg (children);
72 mg (adolescents and adults)

Off-label:
72 mg (children
≤40 kg);⁵
90 mg (adolescents >40 kg);⁵

108 mg (adults)^1,5,h

Cotempla XR-ODT (Neos)

Contains approximately
25% IR and 75% ER methylphenidate

8.6, 17.3, 25.9 mg
ER orally disintegrating tabs

~$513 (all strengths)

Once daily in the morning, at a consistent time in regard to meals. Tablet should be allowed to dissolve (with saliva, no liquid needed) on the tongue without chewing or crushing.

12 h

Initial: 17.3 mg (children)

Titration: 8.6 to 17.3 mg

FDA:
51.8 mg

Daytrana (Noven)

transdermal patch

Generic from Viatris is AB rated.^b Generic from Padagis is authorized generic.^f

1.1 mg/hr (10 mg/9 hr)

1.6 mg/hr (15 mg/9 hr)

2.2 mg/hr (20 mg/9 hr)

3.3 mg/hr (30 mg/9 hr)

~$402 (all strengths)

Worn daily for 9 hours (apply
2 hours before desired effect). Can be worn up to 16 hours if longer effect is needed.⁸ Remove at least 3 hours before bedtime.⁸ Replace patch once daily in the morning. Apply to hip area. Change application site daily.

12 h

(with 9-h

wear time)⁸

Initial: 10 mg

Titration: Next highest patch strength

Dosing based on studies in children
6 to 17 yrs old.

FDA:

30 mg

Jornay PM (Ironshore)

Delayed- and extended-release properties. No more than 5% of drug is available within 10 hours after dosing. A single peak level occurs about
14 hours after a dose.

20, 40, 60, 80, 100 mg ER caps

~$456 (all strengths)

Once daily in the EVENING, at the same time, usually between 6:30 and 9:30 PM, consistently with or without food. May be taken whole or sprinkled on applesauce.ⁱ

10 h

Initial: 20 mg (children and adults)

Titration: 20 mg

FDA:
100 mg

Metadate CD^d (Aytu)

Bead-filled capsule (30% IR and 70% ER)

Generics from Impax, Mallinckrodt (SpecGx), and Teva are AB rated.^b Lannett products are authorized generics.^f

10, 20, 30, 40, 50,
60 mg ER caps

~$60 (20 mg daily)

Once daily in the morning before breakfast. May be taken whole or sprinkled on applesauce.ⁱ Avoid alcohol; alcohol may cause more rapid release.

6 to 9 h^4,9

Initial: 20 mg (children and adults)

Titration:

10 to 20 mg

See Ritalin

Relexxii (Osmotica)

Osmotic system has hole for sustained drug release with IR overcoat.

18, 27, 36, 45, 54 63, 72 mg ER tabs

~$375 (36 mg daily)

Once daily in the morning without regard to meals. Must be swallowed whole.

12 h

Initial: See Concerta.

Titration: 18 mg (27, 45, and 63 mg tablets are available for additional titration options)

See Concerta.

Ritalin LA^c (Sandoz)

Bead-filled capsule (50% IR and 50% enteric coated, delayed release)

Generics from Granules and Mayne (Dr. Reddy’s) are AB rated.^b Sandoz products are authorized generics.^f

10, 20, 30, 40, 60 mg* LA caps

~$80 (20 mg daily)

*60 mg caps only available generically.

Once daily in the morning. May be taken whole or sprinkled on applesauce.ⁱ

6 to 9 h^4,10

Initial: 10 to 20 mg (children and adults)^11,p

Titration:

10 mg^11,p

See Ritalin

QuilliChew ER^d
(NextWave)

ER mechanism: drug is released from sodium polystyrene sulfonate particles via ion exchange. (30% IR, 70% ER)

20, 30, 40 mg cherry chewable ER tabs

20 mg and 30 mg tabs are scored.

~$375 (all strengths)

Once daily in the morning, without regard to meals.

8 h

Initial (patients 6 yrs and older): 20 mg

Titration: 10, 15, or 20 mg

FDA:

60 mg

Off-label: some experts recommend doses up to
100 mg daily if >50 kg⁶

Quillivant XR^d (NextWave)

Contains approximately
20% IR and 80% ER methylphenidate.

5 mg/mL

oral suspension

~$340 (doses of 10, 20, 25, or 30 mg daily)

Once daily in the morning with or without food. Pharmacist must reconstitute. Shake bottle vigorously for ≥10 seconds prior to dose. Measure dose only with the oral dosing dispenser provided. Store reconstituted suspension in original container at room temp for up to 4 months.

12 h

Initial: 20 mg

(patients 6 yrs and older)

Titration:

10 to 20 mg

FDA:

60 mg

Off-label: some experts recommend doses up to
100 mg daily if >50 kg⁶

Serdexmethylphenidate (prodrug of dexmethylphenidate) and dexmethylphenidate

Azstarys (Corium)

26.1/5.2, 39.2/7.8, 52.3/10.4 mg caps

~$418 (any strength daily)

Once daily in the morning without regard to meals. May be taken whole or sprinkled on applesauce or dissolved in
50 mL of water.ⁱ

10 h¹²

Initial: 39.2/7.8 mg once daily (patients
6 yrs and older)
Titration: next highest capsule strength

FDA:

52.3/10.4 mg

Amphetamines

Adderall

(mixed amphetamine salts)^g

Brand discontinued. Generics from Alvogen, Aurolife, Camber (Ascent), Elite, Epic, Granules, Lannett, Mallinckrodt (SpecGx), NorthStar (Aurolife), Oryza (US Pharma Windlas), Rhodes, Sun, Sandoz, Sunrise (Nuvo), Teva, and Zydus are AB rated.^b

5, 7.5, 10, 12.5, 15, 20, 30 mg tabs

~$15 (20 mg daily)

One to three times daily (usually once or twice daily⁴) at four- to six-hour intervals.

6 h⁴(dose-dependent)

Initial: 2.5 mg

once daily
(3 to 5 yrs of age) or

5 mg once or twice daily (6 yrs and older)or 10 mg BID (adults¹³)

Titration:

2.5 mg (3 to 5 yrs of age) and 5 mg (≥6 yrs) once or twice dailyor 10 mg BID (adults¹³)

FDA:

40 mg

Off-label:

60 mg if
>50 kg¹

Adderall XR^c (Takeda)

(mixed amphetamine salts)^g

Generics from Elite, Granules, Impax, Lannett, Rhodes, SpecGx, and Teva are AB rated.^b Amerigen, Prasco, and Sandoz products are authorized generics.^f

5, 10, 15, 20, 25,

30 mg ER caps

~$45 (any strength daily)

Once daily in the morning without regard to meals. May be taken whole or sprinkled on applesauce.ⁱ

10 to 12 h⁴

Initial: 5 to 10 mg

(6 to 12 yrs old),
10 mg (adolescents), or

20 mg (adults)

Titration:

5 to 10 mg^5,p

FDA:

30 mg (children),
20 mg (adolescents and adults)

Off-label:

30 mg, 60 mg if >50 kg¹

Adzenys XR-ODT (Neos)

(amphetamine ER orally disintegrating tabs)^g,j

3.1, 6.3, 9.4, 12.5, 15.7, 18.8 mg ER orally disintegrating tabs^j

~$500 (any strength daily)

Once daily in the morning without regard to meals. Tablet is placed on tongue and allowed to disintegrate. Tablet should not be not chewed, crushed, or swallowed whole.

See

Adderall XR(approval based on Adderall XR data)

Initial: 6.3 mg
q AM (6 to 17 yrs of age), or 12.5 mg
q AM (adults)

Titration:
3.1 to 6.3 mg

FDA:

18.8 mg (ages 6 to 12 yrs),

12.5 mg

(ages 13 yrs and older)

Dextrostat (brand discontinued), Dexedrine(brand discontinued), Zenzedi(Azurity; branded generic)

Dextroamphetamine

Generics from Aurobindo (Aurolife), Azurity, KVK-Tech (Avanthi), Mallinckrodt (SpecGx), Sunrise (Nuvo), Teva, Wilshire (Azurity), and Winder are AA rated.^b

2.5, 5, 7.5, 10, 15, 20, 30 mg tabs

~$71 (5 mg BID)

BID to TID. First dose upon awakening; additional doses at
4- to 6-hour intervals.

4 to 6 h⁴

Initial: 2.5 mg
q AM (3 to 5 yrs of age), or 2.5 mg to 5 mg BID (≥6 yrs and adults⁵)

Titration:

2.5 mg (3 to 5 yrs of age) or
2.5 to 5 mg (≥6 yrs and adults⁵)

FDA:

40 mg, rarely higher

Off-label:

60 mg if

>50 kg¹

Dexedrine Spansule^d (Impax)

(dextroamphetamine)

Coated capsule for gradual release.

Generics from Impax, Mallinckrodt (SpecGx) and Teva are AB rated.^b

5, 10, 15 mg ER caps

~$110 (10 mg once daily)

Usually once daily in the morning, or BID.

6 to 8 h⁵

Initial: 5 mg
q AM or BID (children) or 10 mg q AM (6 yrs and older⁵)

Titration: 5 mg^5,11

FDA:
40 mg, rarely higher

Off-label:

60 mg if

>50 kg¹

Dyanavel XR^d (Tris Pharma)

(amphetamine ER oral suspension)^g Contains IR and ER amphetamine. ER drug is released from sodium polystyrene sulfonate resin via ion exchange.

2.5 mg/mL oral suspension

5, 10, 15, 20 mg tablets

(5 mg tabs are scored)

10 mg daily

~$350 (suspension)

~$445 (tablets)

Once daily in the morning without regard to meals. Shake bottle prior to dose.

at least 12 h

Initial: 2.5 to 5 mg (children and adults)

Titration:

2.5 to 10 mg every 4 to 7 days

FDA:

20 mg

Evekeo (Arbor)

(amphetamine [1:1 ratio of dextroamphetamine/
amphetamine])

Generics from Amneal, Bionpharma, Dr. Reddy’s (Cerovene), Granules, Lannett, Solco, and SpecGx are AA rated.^b Wilshire products are authorized generics.^f

5, 10 mg scored tabs

~$86 (any strength BID)

One to three times daily. First dose upon awakening; additional doses at
4- to 6-hour intervals.

at least 9.25 h¹⁴

Initial: 2.5 mg once daily (3 to 5 yrs of age) or 5 mg once or twice daily (6 yrs and older), or 5 to
10 mg once daily (adults⁴³)

Titration: 2.5 mg (3 to 5 yrs of age), 5 mg (6 yrs and older),or
5 to 10 mg (adults⁶)

FDA:

40 mg, rarely higher

Off-label:

60 mg (adults)⁶

Mydayis (Shire)

(mixed amphetamine salts ER capsule)

Generics from SpecGx, Sun, and Teva are AB rated.^b

12.5, 25, 37.5, 50 mg XR caps

~$293 (any strength daily)

Once daily upon waking and at a consistent time in regard to meals.

Up to 16 h

Initial: 12.5 mg (13 to 17 yrs of age and adults)

Titration: 12.5 mg

FDA:

25 mg (children 13 to 17 yrs),

50 mg (adults)

ProCentra (Prasco; branded generic)

(dextroamphetamine)

Generics from Tris Pharma and Prasco are AA rated.^b

1 mg/mL oral solution

~$456 (5 mg BID)

BID to TID. First dose upon awakening; additional doses at 4- to 6-hour intervals.

4 to 6 h⁴

Initial: 2.5 mg
q AM (3 to 5 yrs of age), or 5 mg q AM or BID (children 6 yrs and older)

Titration:

2.5 mg (3 to 5 yrs of age), 5 mg (children 6 yrs and older)

FDA:
40 mg, rarely higher

Off-label:

60 mg if
>50 kg¹

Vyvanse (Takeda)

(lisdexamfetamine)

Converted to active dextroamphetamine in the bloodstream.²²

Generics from Alvogen, Amneal, Apotex, Hikma, Lannett, Rhodes, Novadoz, Solco, Sun, SpecGx, are AB rated.^b

10, 20, 30, 40, 50, 60,

70 mg* chewable tabs and caps (*70 mg only avail as capsule).

~$230 (40 mg daily)

Once daily in the morning without regard to meals. Capsule may be taken whole or contents dissolved in water, yogurt, or orange juice and taken immediately.

10 to 12 h⁴

(up to 14 h, adults)

Initial: 30 mg (children and adults)

Titration:

10 to 20 mg

FDA:

70 mg

Xelstrym
(Noven)

(dextroamphetamine)

4.5, 9, 13.5, 18 mg transdermal patch

~$490

Apply two hours before desired effect. Remove patch within nine hours of application.

9 h¹⁵

Initial: 4.5 mg
(children);

9 mg (adults)

Titration: 4.5 mg (children); individualize (adults)

FDA: 18 mg (children and adults)

Nonstimulants: Some caregivers are uncomfortable with stimulants, and some patients respond poorly to stimulants.⁴ May be used as adjuncts to stimulants.⁵ Options include atomoxetine, extended-release guanfacine, extended-release clonidine, or extended-release viloxazine.

Strattera (Lilly USA)

(atomoxetine)

Generics from Apotex, Burel (Aurobindo), Camber (Hetero), Dr. Reddy’s, Glenmark, Major (Dr. Reddy’s), NorthStar (Glenmark), Rising (Aurobindo), and Teva are AB rated.^b Prasco products are authorized generics.^f

Response rate is lower compared to stimulants.⁵

Consider atomoxetine for patients with anxiety, tics, insomnia, or substance abuse disorders.⁵

Contains a “black box” warning for increased suicidal ideation in children and adolescents.

10, 18, 25, 40, 60, 80, 100 mg caps

~$108 (40 mg daily)

Once daily or divided BID (i.e., morning and late afternoon/early evening) without regard to meals.

At least

10 to 12 h⁴

Initial:
0.5 mg/kg/day
(≤70 kg) or
40 mg/day (>70 kg)

Titration for patients ≤70 kg: after at least 3 days, increase to
~ 1.2 mg/kg/day. Alternatively, after
4 days increase to

1 mg/kg/day, then increase to

1.2 mg/kg/day after

4 more days.¹

Titration patients >70 kg: after at least 3 days, increase to
80 mg/day, then up to 100 mg/day after two to four additional weeks.

FDA: children and adolescents up to 70 kg, lesser of
1.4 mg/kg or
100 mg; children and adolescents over 70 kg and adults, 100 mg

Off-label: Lesser of 1.8 mg/kg or 100 mg¹

Kapvay^k (brand discontinued)

(clonidine ER)

Generics from Ajanta, Blue Point (Ajanta), Ingenus (Novast), Lupin (Chartwell), Solco (Xiamen), and Teva are AB rated.^b

May be a good alternative for children who are intolerant to stimulants (e.g., kids with tics, insomnia).¹

0.1 mg ER tabs

~$100 (0.1 mg BID)

Tablets should not be crushed, chewed, or broken before swallowing. Do not substitute for other clonidine products on a mg-per-mg basis due to different pharmacokinetic profile. Doses above
0.1 mg/day should be divided BID with an equal or higher split dosage being given at bedtime. When discontinuing, taper the dose in decrements of no more than 0.1 mg every 3 to
7 days.

At least

10 to 12 h⁴

Initial: 0.1 mg

at bedtime

Titration: 0.1 mg

Dosing based on studies in children
6 to 17 yrs of age.

FDA:

0.4 mg

Onyda XR (Tris Pharma)

(clonidine ER oral suspension)

0.1 mg/mL

$480
(0.1 to 0.2 mg/day)

Once daily at bedtime, without regard to meals. Do not substitute for other clonidine products on a mg-per-mg basis due to different pharmacokinetic profile. When discontinuing, taper the dose in decrements of no more than 0.1 mg every 3 to

7 days.

See Kapvay.

Initial: 0.1 mg at bedtime.

Titration: 0.1 mg

Dosing based on Kapvay studies in children
6 to 17 yrs of age.

FDA:

0.4 mg

Intuniv^k (Shire)

(guanfacine ER tabs)

Generics from Alembic, Apotex, Northstar (Sun), Sandoz, Slate Run (Yichang Humanwell), Sun, Teva, Twi Pharmaceuticals are AB rated.^b

May be a good alternative for children who are intolerant to stimulants (e.g., kids with tics, insomnia)¹or those with anxiety or aggression.⁵

Appears at least as effective as other nonstimulants.^16,17

1, 2, 3, 4 mg ER tabs

~$16 (any strength daily)

Once daily at approximately the same time each day; avoid high-fat meals. Tablets should not be crushed, chewed, or broken. Do not substitute for immediate-release guanfacine tablets on a mg-per-mg basis due to different pharmacokinetic profiles. When discontinuing, taper the dose in decrements of no more than 1 mg every
3 to 7 days.²⁵

At least

8 to 12 h^4,16

Initial: 1 mg²⁵

Titration: 1 mg²⁵

Efficacy is evident at doses of

0.05 to 0.08 mg/kg once daily. Doses up to 0.12 mg/kg once daily may provide additional benefit.²⁵

Dosing based on studies in children
6 to 17 yrs of age.²⁵

FDA: 7 mg²⁵

Doses above
4 mg have not been evaluated in children
6 to 12 yrs of age.²⁵

Qelbree (Supernus)

(viloxazine ER caps)

Contains a “black box” warning for increased suicidal ideation in pediatric patients.

100, 150, 200 mg ER caps

~$360 (any strength daily)

Once daily without regard to meals. May be taken whole or sprinkled on applesauce.ⁱ

No published data.

Initial: 100 mg (patients 6 to 11 yrs old); 200 mg (patients ≤12 yrs old)

Titration: 100 mg (6 to 11 yrs) or
200 mg (≥12 yrs old)

FDA:

400 mg (children)

600 mg (adults)

Drug

Switching Approach

Concerta

OR

Relexxii

Previous methylphenidate daily dose: Recommended Concerta or Relexxii starting dose

• 5 mg BID or TID (IR): 18 mg Concerta or Relexxii every morning
• 10 mg BID or TID (IR): 36 mg Concerta or Relexxii every morning
• 15 mg BID or TID (IR): 54 mg Concerta or Relexxii every morning
• 20 mg BID or TID: 72 mg Concerta or Relexxii every morning

Daytrana

Previous methylphenidate daily dose: Recommended Daytrana starting dose (9-h wear time)^8,n

• 5 mg TID or Concerta 18 mg daily: Daytrana 10 mg
• 7.5 mg TID or Concerta 27 mg daily: Daytrana 15 mg
• 10 mg TID or Concerta 36 mg daily: Daytrana 20 mg
• 15 mg TID or Concerta 54 mg daily: Daytrana 30 mg

Dexmethylphenidate

Start with half the total daily dose of methylphenidate. For IR dexmethylphenidate, divide BID with at least four hours between doses. Give Focalin XR once daily in AM. If converting from IR dexmethylphenidate to Focalin XR, use same total daily dose, given as a single morning dose.

Ritalin LA

Dosage conversion from methylphenidate IR (BID dosing) to Ritalin LA: use same total daily dose. Give once daily.

Methylphenidate/

dextroamphetamine/mixed amphetamine salts conversion

No specific guidance in literature. Amphetamines are dosed at about half the methylphenidate dose.⁵ Consider switching from methylphenidate to amphetamines at half the dose, or from amphetamines to methylphenidate at the same dose and titrating up.⁵ Or, start with recommended initial dose and titrate up.⁵

Adzenys XR-ODT

Previous Adderall XR daily dose: Recommended Adzenys XR-ODT daily dose

• 5 mg: Adzenys XR-ODT 3.1 mg
• 10 mg: Adzenys XR-ODT 6.3 mg
• 15 mg: Adzenys XR-ODT 9.4 mg
• 20 mg: Adzenys XR-ODT 12.5 mg
• 25 mg: Adzenys XR-ODT 15.7 mg
• 30 mg: Adzenys XR-ODT 18.8 mg