Methylphenidate Superior Efficacy Dosing Schedule: Three Hour Schedule for Immediate Release Tablets and Six Hour Schedule for Extended-Release Capsules

Abstract

Background: Methylphenidate Hydrochloride is used mostly for treating Attention Deficit and Hyperactivity Disorder and Narcolepsy. It is available in Immediate Release tablets, liquids, extended-release doses, and transdermal patches. Clinicians instruct patients to take Immediate Release tablets four hours apart or eight to nine hours after an extended-release dose. Four-hour dosing has been used for decades while many patients complain of a “roller coaster” of symptoms stopping and returning several times each day. Four-hour dosing is inaccurate because Immediate Release tablets are effective for two to three hours. Methods: The “roller coaster” was addressed with information from a 2014 to 2022 research program and from analyzing over 400 Dopamine deficiency articles. Results: The four-hour Immediate Release schedule and the eight-to-nine-hour extended-release schedule are inaccurate for research and treatment. Four-hour dosing causes two hours of non-efficacy during transitions between doses. The eight-to-nine-hour schedule causes three to four hours of non-efficacy during transitions. Three-hour and six-hour schedules sustain efficacy across and between sequential doses. Conclusion: Under four-hour dosing, soon after hour-three a patient’s plasma concentration drops below and stays below the efficacy threshold for an hour and forty-five minutes. The loss of efficacy occurs during every transition from one dose to the next. Under four-hour dosing, patients who take four sequential doses experience 205 minutes of loss of efficacy every two hours three times every day, totaling 615 minutes per day. To the best knowledge of this author, he is the first person to find three-hour dosing stops the roller coaster. Efficacy occurs during transitions because dose-onset adds plasma concentration at the same rate that termination loses plasma concentration. Sequential doses taken at hour-3 combine into a level that stays above the efficacy threshold. When sequential doses are taken sometime after hour-3, the termination-dose drops below the efficacy-threshold and the sequential onset-dose does not create enough plasma concentration to bring a terminating plasma concentration to a higher level. Proper timing is critical for patients to receive high quality benefits of Methylphenidate. Three-hour dosing matches the biochemistry of Methylphenidate and enables high quality benefits.