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

Introduction:

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.

Objective:

Small doses of MPH-IR may be added to sustained release preparations when its effect wears off.

Aims/Method:

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.

Results:

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]

Conclusions:

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.