Section - CAP Smart Takes

05. Dose Titration of OROS-Methylphenidate in Pediatric ADHD

Published on August 1, 2023 Certification expiration date: August 1, 2026

David R. Rosenberg, M.D.

Chair of the Department of Psychiatry & Behavioral Neuroscience - Wayne State University School of Medicine

Key Points

OROS-MPH is frequently prescribed as a first-line medication for ADHD, but real-world prescribing patterns in youth are not well-studied.
Although guidelines recommend maximum limits for OROS-MPH, some clinicians in both countries exceed these limits, indicating that individual patient needs, such as tolerance to side effects and treatment response, might influence dosage decisions.

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Greetings, I am David Rosenberg representing the Psychopharmacology Institute. In this CAP—or Child and Adolescent Psychiatry—Smart Take, we will analyze real-world dosage initiation and titration of osmotic release oral system-methylphenidate (OROS-MPH), a frequently prescribed and often considered first-line medication for ADHD. Despite its prevalent use, there is a notable scarcity of focus on real-world prescribing patterns of OROS-MPH in youth afflicted with ADHD.

Xu and colleagues investigated nearly 100,000 children aged 6–12 years and over 60,000 adolescents aged 13–17 years in the United States, all diagnosed with ADHD and treated with OROS-MPH. This data was juxtaposed with that of over 4,500 children and more than 1,500 adolescents from Japan, similarly diagnosed with ADHD and treated with OROS-MPH. In Japan, 92% of the children and 78% of the adolescents with ADHD initiated OROS-MPH treatment at its lowest dose of 18 mg/day. However, in contrast, youth with ADHD in the United States

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Learning Objectives:

Learn effective strategies for evaluating, monitoring, and managing antidepressant-related side effects in young patients.
Understand the impact of age on antidepressant response in patients with major depressive disorder and its implications for clinical practice.
Recognize that lamotrigine appears to be effective in pediatric mood disorders as monotherapy or an augmenting agent.
Recognize that ADHD with comorbid anxiety requires distinct diagnostic and treatment approaches.
Understand the real-world prescribing patterns of OROS-MPH in treating ADHD in children and adolescents.

Original Release Date: August 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: August 1, 2026

Expert: David Rosenberg, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.