Bottom Line:
There are many long-acting methylphenidate options. Concerta and Ritalin LA are both good choices and now available as generics.

FDA Indications:
Attention-deficit/hyperactivity disorder in adults and children age 6 and older; narcolepsy.

Off-Label Uses:
Obesity; treatment-resistant depression; fatigue or cognitive enhancement in medical conditions.

Dosage Forms (more commonly used):

• Extended-release tablets:
  • Ritalin SR, Metadate ER, Methylin ER, (G): 10 mg, 20 mg.
• Extended-release capsules:
  • Concerta, Relexxii, (G): 18 mg, 27 mg, 36 mg, 54 mg, 63 mg, 72 mg (22% immediate-release/78% extended-release).
  • Ritalin LA, (G): 10 mg, 20 mg, 30 mg, 40 mg, 60 mg (50% immediate-release/50% extended-release).
  • Metadate CD, (G): 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg (30% immediate-release/70% extended-release).
  • Aptensio XR: 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg (40% immediate-release/60% extended-release).
  • Adhansia XR: 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, 85 mg (20% immediate-release/80% extended-release).
  • Jornay PM: 20 mg, 40 mg, 60 mg, 80 mg, 100 mg (onset delayed 10 hours).
• Extended-release oral solution (Quillivant XR): 25 mg/5 mL (20% immediate-release/80% extended-release).
• Extended-release chewable tablets (Quillichew XR): 20 mg, 30 mg (scored), 40 mg (scored) (30% immediate-release/70% extended-release).
• Extended-release orally disintegrating tablets (Cotempla XR-ODT): 8.6 mg, 17.3 mg, 25.9 mg (25% immediate-release/75% extended-release).

Dosage Guidance:

• Intermediate-acting (Ritalin SR, Metadate ER, Methylin ER):
  • Titrate to effective daily dose with immediate-release, then switch to equivalent eight-hour sustained-release or extended-release dose once daily in the morning to twice daily.
• Long-acting (Aptensio XR, Metadate CD, Ritalin LA, Quillivant XR, Quillichew ER):
  • Start 10–20 mg once daily in the morning; increase by 10–20 mg/day weekly. Maximum 60 mg/day.
• Long-acting (Adhansia XR):
  • Start 25 mg once daily in the morning; increase by 10–15 mg/day weekly. Maximum 70 mg/day in children and 85 mg/day in adults.
• Long-acting (Cotempla XR-ODT):
  • Start 17.3 mg once daily in the morning; increase by 8.6–17.3 mg/day weekly. Maximum 51.8 mg/day.
  • 8.6 mg, 17.3 mg, 25.9 mg are equivalent to 10 mg, 20 mg, 30 mg of other methylphenidate formulations, respectively.
• Long-acting (Concerta, Relexxii):
  • Start 18–36 mg once daily in the morning; increase by 18 mg/day weekly. Maximum 72 mg/day.
  • For children ages 6–12, maximum 54 mg/day; for age 13 and older, maximum 72 mg/day.
• Jornay PM:
  • Start 20 mg daily in the evening and increase by 20 mg/day weekly. Maximum 100 mg/day.
  • Adjust timing between 6:30 and 9:30 pm.
• Narcolepsy:
  • Start 10–20 mg extended-release once daily in the morning; increase by 10 mg/day weekly. Maximum 60 mg/day.

Monitoring: Electrocardiogram if history of cardiac disease.

Cost: Generic: $; Concerta, Aptensio XR, Cotempla XR-ODT, Jornay PM, Quillivant XR, Quillichew ER, Relexxii: $$$$

Side Effects and Mechanism, Pharmacokinetics, and Drug Interactions:
See methylphenidate immediate-release fact sheet.