Posology : מינונים

2 DOSAGE AND ADMINISTRATION
2.1 General Dosing Information
CONCERTA should be administered orally once daily in the morning with or without food.

CONCERTA must be swallowed whole with the aid of liquids, and must not be chewed, divided, or crushed [see Patient Counseling Information (17)].

2.2 Patients New to Methylphenidate
The recommended starting dose of CONCERTA for patients who are not currently taking methylphenidate or stimulants other than methylphenidate is 18 mg once daily for children and adolescents and 18 or 36 mg once daily for adults (see Table 1).

Table 1.       CONCERTA Recommended Starting Doses and Dose Ranges
Patient Age                      Recommended Starting Dose    Dose Range Children 6-12 years of age       18 mg/day                    18 mg - 54 mg/day Adolescents 13-17 years of age   18 mg/day                    18 mg - 72 mg/day not to exceed 2 mg/kg/day
Adults 18-65 years of age        18 or 36 mg/day              18 mg - 72 mg/day 

2.3 Patients Currently Using Methylphenidate
The recommended dose of CONCERTA for patients who are currently taking methylphenidate twice daily or three times daily at doses of 10 to 60 mg/day is provided in Table 2. Dosing recommendations are based on current dose regimen and clinical judgment. Conversion dosage should not exceed 72 mg daily.



Table 2.       Recommended Dose Conversion from Methylphenidate Regimens to CONCERTA Recommended CONCERTA
Previous Methylphenidate Daily Dose                    Starting Dose
5 mg Methylphenidate twice daily or three times daily  18 mg every morning 10 mg Methylphenidate twice daily or three times daily 36 mg every morning 15 mg Methylphenidate twice daily or three times daily 54 mg every morning 20 mg Methylphenidate twice daily or three times daily 72 mg every morning


Other methylphenidate regimens: Clinical judgment should be used when selecting the starting dose.

2.4 Dose Titration
Doses may be increased in 18 mg increments at weekly intervals for patients who have not achieved an optimal response at a lower dose. Daily dosages above 54 mg in children and 72 mg in adolescents have not been studied and are not recommended. Daily dosages above 72 mg in adults are not recommended.

A 27 mg dosage strength is available for physicians who wish to prescribe between the 18 mg and 36 mg dosages.

2.5 Maintenance/Extended Treatment
There is no body of evidence available from controlled trials to indicate how long the patient with ADHD should be treated with CONCERTA. It is generally agreed, however, that pharmacological treatment of ADHD may be needed for extended periods.

The effectiveness of CONCERTA for long-term use, i.e., for more than 7 weeks, has not been systematically evaluated in controlled trials. The physician who elects to use CONCERTA for extended periods in patients with ADHD should periodically re-evaluate the long-term usefulness of the drug for the individual patient with trials off medication to assess the patient’s functioning without pharmacotherapy. Improvement may be sustained when the drug is either temporarily or permanently discontinued.

2.6 Dose Reduction and Discontinuation
If paradoxical aggravation of symptoms or other adverse events occur, the dosage should be reduced, or, if necessary, the drug should be discontinued.

If improvement is not observed after appropriate dosage adjustment over a one-month period, the drug should be discontinued.