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. SUBJECTS AND 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.