Concerta

Overview

What is Concerta? 

Concerta, known generically as methylphenidate hydrochloride, is a prescription medication that acts as a central nervous system (CNS) stimulant to treat ADHD. It utilizes a unique delivery system called OROS (Osmotic Release Oral System) to release the medication slowly over the course of the day. The active ingredient is methylphenidate hydrochloride. 

Global Name

• Generic name: Methylphenidate hydrochloride (Extended-Release)
• Brand name: Concerta

Usage

What is Concerta used for?

Concerta is used to treat attention-deficit/hyperactivity disorder (ADHD) in children 6 years of age and older, adolescents, and adults up to 65 years of age. 

How do you use Concerta?

Dosage form:

Available in extended-release tablet in strengths of 18 mg, 27 mg, 36 mg, and 54 mg.  

Dosage information:

• For patients new to methylphenidate  

  • Children (6-12 years): The recommended starting dose is 18 mg once daily. The dose may be adjusted in 18 mg increments at weekly intervals to a maximum of 54 mg per day.

  • Adolescents (13-17 years): The recommended starting dose is 18 mg once daily. The dose may be adjusted in 18 mg increments at weekly intervals to a maximum of 72 mg per day. 

  • Adults (18-65 years): The recommended starting dose is 18 mg or 36 mg once daily. The dose may be adjusted in 18 mg increments at weekly intervals to a maximum of 72 mg per day.

• For patients currently using methylphenidate twice daily (BD) or three times daily (TID) at doses from 10 to 60 mg/day, dosing recommendations should be based on current dose regimen and clinical judgement. 

  • Current regimen of 5 mg methylphenidate BD/TID: Start with 18 mg concerta every morning  
  • Current regimen of 10 mg methylphenidate BD/TID: Start with 36 mg concerta every morning
  • Current regimen of 15 mg methylphenidate BD/TID: Start with 54 mg concerta every morning
  • Current regimen of 20 mg methylphenidate BD/TID: Start with 72 mg concerta every morning 

Are the following suitable for getting the drug?

• Children: Suitable for children aged 6 years or older for the treatment of ADHD.
• Adults: Suitable for adults for the treatment of ADHD.  
• Patients with renal insufficiency: Not suitable.
• Patients with hepatic insufficiency: Not suitable. 

Who should not take Concerta?

• Children: Not recommended for children under 6 years old. Younger children had higher plasma exposure and a higher incidence of adverse reactions at the same dosage compared with children aged 6 or above.
• Elderlies: Not recommended for elderly people greater than 65 years old.  
• Pregnant women: The Safety of methylphenidate use during human pregnancy has not yet established.  
• Nursing mothers: It is not known whether Concerta is excreted in human milk. 

Warnings and Precautions:

• Abuse, Misuse, Addiction: Concerta has a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction. Assess each patient’s risk before prescribing and reassess the risk throughout the treatment.  
• Risk to patients with serious cardiac disease: Avoid Concerta in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmias, coronary artery disease, or other serious cardiac disease.  
• Increased Blood Pressure and Heart Rate: Monitor blood pressure and pulse.
• Psychiatric Adverse Reactions: Screen patients for risk factors for developing a mixed/manic episode prior to initiating Concerta.
• Aggression: Patients being initiated on treatment for ADHD should be monitored for signs of aggressive behavior or hostility.
• Seizures: Stimulants may lower the convulsive threshold.
• Priapism: If abnormally sustained or frequent and painful erections occur, patients should seek immediate medical attention.
• Peripheral Vasculopathy, Peripheral Vasculopathy, including Raynaud’s Phenomenon: Carefully observe for digital changes during the treatment course.
• Long-Term Suppression of Growth in Pediatric Patients: Closely monitor growth (height and weight) in paediatric patients.
• Gastrointestinal obstruction with preexisting GI narrowing.
• Haematologic monitoring: Periodic CBC, differential, and platelet counts are advised.
• Acute Angle Closure Glaucoma: patients at risk should be evaluated by an ophthalmologist.  
• Increased Intraocular Pressure and Glaucoma: Prescribe Concerta for open-angle glaucoma or high IOP only if benefits outweigh risks. Closely monitor patients with a history of increased IOP or open angle glaucoma.  
• Motor and Verbal Tics, and Worsening of Tourette’s Syndrome: Before starting Concerta, assess family history and evaluate for tics/Tourette’s. Monitor regularly.  

Interactions and Contraindications of Concerta:

• Interactions: Do not use Concerta during or within 14 days of monoamine oxidase inhibitor (MAOI) therapy due to serious interaction risk such as hypertensive crisis. Avoid concomitant use of halogenated anesthetics and Concerta. Use Concerta cautiously with vasopressor agents due to possible increase in blood pressure. Dosage adjustment and monitoring are needed when Concerta is taken with coumarin anticoagulants, antidepressants, and selective serotonin reuptake inhibitors. When used with risperidone, monitoring for the signs of EPS.  
• Contraindications: Avoid Concerta in patients with known hypersensitivity to the products or any of its ingredients, and in patients taking MAOIs or within 14 days of discontinuing MAOIs. 

Side Effects

The most common side effect of double-blind clinical trials was abdominal pain in children and adolescents. The most common side effects in adults include decreased appetite, headache, dry mouth, nausea, insomnia, anxiety, dizziness, weight decreased, irritability, and hyperhidrosis.

In paediatric and adult trials, the most frequent adverse reactions leading to discontinuation (≥1%) were 

• Anxiety
• Irritability
• Insomnia
• Elevated blood pressure

Pharmacist Tips

• Storage information: Store Concerta at 25°C (77°F), allow 15–30°C excursions. Protect it from humidity. 
• Administration: Take Concerta once daily in the morning with or without food. Swallow it whole with the aids with liquids. Do not chew or crush Concerta.  

Availability

Where is Concerta available in Hong Kong? 

Concerta is a prescription-only medication available through healthcare providers upon doctor’s prescription. 

FAQs

What is the difference between Concerta and Ritalin?

Concerta is an extended‑release form with once‑daily morning dosing. In contrast, Ritalin is an immediate‑release formulation requiring multiple doses throughout the day to maintain benefit. 

How long does Concerta last? 

Concerta is active for 10 to 12 hours.  

How long does it take for Concerta to work? 

Concerta is started at a low dose and gradually increased to find the most effective dose, which may take a few weeks to achieve its full benefit. 

How much does Concerta cost?

Concerta is a prescription-only medicine, and the price varies depending on the healthcare provider.