P-293 - An additional mid-afternoon dose of immediate release methylphenidate (MPH-IR) with concerta xl provides better symptom control in children and adolescents with attention deficit/hyperactivity disorder (ADHD)

Abstract

Switching from immediate release Methylphenidate (MPH-IR) to a sustained release formulation of MPH-IR in the treatment of ADHD is often required to provide better compliance and convenience; however switch was reported to be not always successful. Small doses of MPH-IR may be added to sustained release preparations when its effect wears off. Clinical case notes of 77 subjects aged 6–18 years who had been switched from MPH-IR to Concerta XL (an osmotic controlled-release formulation (OROS) of MPH) were retrospectively analysed for the effectiveness of the switch and the impact of an extra mid-afternoon dose of MPH-IR on the outcome. 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 switch. More than 43% of patients required late afternoon top-up with MPH-IR to make a successful switch whilst 55% of patients required a larger dose of Concerta XL than the manufacturer's recommended equivalent to the existing dose of MPH-IR. Clinical Response Response to start dose of Concerta compared to MPH-IR (n = 65) Response to final dose of Concerta compared to MPH-IR (n = 65) Response to Concerta + top-up MPH-IR compared to MPH-IR (n = 32) Worse 5 5 2 Same 11 3 2 Improved 49 57 28 [Response to switch] Higher than equivalent doses of Concerta XL or an additional dose of MPH-IR might be needed for a successful switch from short acting to sustained release MPH.