1.2. Pediatrics

Many ADHD medications are FDA-approved for use in pediatric patients. In addition to the maximum FDA recommended doses, there is a column with maximum recommended doses from other medical and pharmacological literature sources. This information is obtained through the Psychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (6th Version)30. The Texas Vendor Drug Program’s Prior Authorization Criteria is set to approve maximum daily doses based off the recommendations outlined within this manual. Tables 3-5 summarize pediatric ADD/ADHD recommended daily doses based upon patient-specific characteristics including age and weight.

Table 4. Pediatric (Child and Adolescent) Maximum Recommended Dosages for Stimulant ADHD Medications1-26,30-40
Drug Name Dosage Form/Strength Maximum Recommended Dosage Maximum Recommended Dosage (PMUP#)
amphetamine salts (mixed)* (Adderall®, generic) 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg tablets 3 -17 years of age: 40 mg/day
  • 3-5 years of age: 30 mg/day
  • greater than or equal to 6 years of age and less than or equal to50 kg: 40 mg/day
  • greater than or equal to 6 years of age and greater than 50 kg: 60 mg/day
amphetamine salts, mixed* (Adderall XR®, generic) 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg ER capsules
  • 6-12 years of age: 30 mg/day
  • 13-17 years of age: 20 mg/day
  • greater than or equal to 6 years of age and less than or equal to50 kg: 30 mg/day
  • greater than or equal to 6 years of age and greater than 50 kg: 60 mg/day
amphetamine salts, mixed* (Mydayis®) 12.5 mg, 25 mg, 37.5 mg, 50 mg ER capsules 13-17 years of age: 25 mg/day greater than or equal to 13 years of age: 25 mg/day
amphetamine (Adzenys XR-ODT®) 3.1 mg, 6.3 mg, 9.4 mg, 12.5 mg, 15.7 mg, 18.8 mg extended-release oral disintegrating tablets
  • 6-12 years of age: 18.8 mg once daily
  • 13-17 years of age: 12.5 mg once daily
  • 6-12 years of age: 18.8 mg once daily
  • 13-17 years of age: 12.5 mg once daily
amphetamine (Dyanavel XR®) 5 mg, 10 mg, 15 mg, 20 mg ER tablets; 2.5 mg/mL ER oral suspension 6-17 years of age: 20 mg/day 6-17 years of age: 20 mg/ day
amphetamine sulfate (Evekeo®) 5 mg, 10 mg tablets 3 -17 years of age: 40 mg/day 3 -17 years of age: 40 mg/day
amphetamine sulfate (Evekeo ODT®) 5 mg, 10 mg, 15 mg, 20 mg oral disintegrating tablets 3 -17 years of age: 40 mg/day N/A
dexmethylphenidate (Focalin®, generic) 2.5 mg, 5 mg, 10 mg tablets 6-17 years of age: 20 mg/day greater than or equal to 6 years of age: 50 mg/day
dexmethylphenidate (Focalin® XR, generic) 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg ER tablets 6-17 years of age: 30 mg/day greater than or equal to 6 years of age: 50 mg/day
dextroamphetamine (Dexedrine®, generic) 5 mg, 10 mg tablets 3-16 years of age: 40 mg/day
  • 3-5 years of age: 30 mg/day
  • greater than or equal to 6 years of age and less than or equal to50 kg: 40 mg/day
  • greater than or equal to 6 years of age and greater than 50 kg: 60 mg/day
dextroamphetamine (Dexedrine® Spansules, generic) 5 mg, 10 mg, 15 mg ER capsules 6-17 years of age: 40 mg/day
  • greater than or equal to 6 years of age & less than or equal to50 kg: 40 mg/day
  • greater than or equal to 6 years of age & greater than 50 kg: 60 mg/day
dextroamphetamine (ProCentra®, generic) 5 mg/5 ml oral solution 3-16 years of age: 40 mg/day
  • 3-5 years of age: 30 mg/day
  • greater than or equal to 6 years of age and less than or equal to50 kg: 40 mg/day
  • greater than or equal to 6 years of age and greater than 50 kg: 60 mg/day
dextroamphetamine (Xelstrym®) 4.5 mg/9 hours, 9 mg/9 hours, 13.5 mg/ 9 hours, 18 mg/9 hours transdermal system 6-17 years of age: 18 mg/ 9 hours patch daily N/A
dextroamphetamine (Zenzedi®) 2.5 mg, 5 mg, 7,.5 mg, 10 mg, 15 mg, 20 mg, 30 mg tablets 3-16 years of age: 40 mg/day
  • 3-5 years of age: 30 mg/day
  • greater than or equal to 6 years of age and less than or equal to50 kg: 40 mg/day
  • greater than or equal to 6 years of age and greater than 50 kg: 60 mg/day
lisdexamfetamine (Vyvanse®) 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg capsules; 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg chewable tablets 6-17 years of age: 70 mg/day
  • 3-5 years of age: No data
  • greater than or equal to 6 years of age: 70 mg/day
methamphetamine (Desoxyn®, generic) 5 mg tablets 6-17 years of age: 25 mg/day N/A
methylphenidate (Adhansia XR®) 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, 85 mg ER capsules 6-17 years of age: 85 mg/day N/A
methylphenidate (Aptensio XR®) 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg ER capsules 6-17 years of age: 60 mg/day †
methylphenidate (Concerta®, generic) 18 mg, 27 mg, 36 mg, 54 mg ER tablets 6-12 years of age: 54 mg/day
  • 13-17 years of age: 72 mg/day (max 2 mg/kg/day)
  • 3-5 years of age: 36 mg/ day
  • greater than or equal to6 years of age: 72 mg/day
methylphenidate (Cotempla XR-ODT®) 8.6 mg, 17.3 mg, 25.9 mg orally disintegrating tablets 6-17 years of age: 51.8 mg/day 6-17 years of age: 51.8 mg/day
methylphenidate (Daytrana®) 10 mg/9h, 15 mg/9h, 20 mg/9h, 30 mg/ 9h transdermal patches 6-17 years of age: 30 mg/9 h/day
  • 3-5 years of age: 20 mg/day
  • greater than or equal to 6 years of age: 30 mg/day
methylphenidate (Jornay PM®) 20 mg, 40 mg, 60 mg, 80 mg, 100 mg ER capsules 6-17 years of age: 100 mg/day greater than or equal to6 years of age: 100 mg once daily given in the evening
methylphenidate (Metadate® CD, generic) 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg ER capsules 6-17 years of age: 60 mg/day †
methylphenidate (generic) 10 mg, 20 mg ER tablets 6-17 years of age: 60 mg/day †
methylphenidate (Methylin®, generic) 5 mg/5 mL (500 mL); 10 mg/5 mL (500 mL) IR oral solution 6-17 years of age: 60 mg/day †
methylphenidate (generic) 2.5 mg, 5 mg, 10 mg immediate-release (IR) chewable tablets 6-17 years of age: 60 mg/day †
methylphenidate (Relexxii®) 18 mg, 27 mg, 36 mg, 45 mg, 54 mg, 63 mg, 72 mg ER tablets
  • 6-12 years of age: 54 mg/day
  • 13-17 years of age: 72 mg/day
 N/A
methylphenidate (Ritalin®, generic) 5 mg, 10 mg, 20 mg IR tablets 6-17 years of age: 60 mg/day †
methylphenidate (Ritalin LA®, generic) 10 mg, 20 mg, 30 mg, 40 mg, 60 mg (generic only) ER capsules 6-17 years of age: 60 mg/day †
methylphenidate (generic) 20 mg sustained-release tablets 6-17 years of age: 60 mg/day †
methylphenidate (QuilliChew ER®) 20 mg, 30 mg, 40 mg ER chewable tablets 6-17 years of age: 60 mg/day †
methylphenidate (Quillivant XR®) 300 mg/60 ml, 600 mg/120 ml, 750 mg/150 ml, 900 mg/180 ml ER suspension 6-17 years of age: 60 mg/day †
serdexmethylphenidate & dexmethylphenidate (Azstarys®) 26.1 mg/5.2 mg, 39.2 mg/7.8 mg, 52.3 mg/10.4 mg capsules 6-17 years of age: 52.3 mg/10.4 mg daily N/A
serdexmethylphenidate & dexmethylphenidate (Azstarys®) 26.1 mg/5.2 mg, 39.2 mg/7.8 mg, 52.3 mg/10.4 mg capsules 6-17 years of age: 52.3 mg/10.4 mg daily N/A

Legend:

  • # Psychotropic Medication Utilization Parameters
  • * Mixed amphetamine salts are a 1:1:1:1 combination of dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine aspartate monohydrate and amphetamine sulfate
  • † PMUP recommends the following literature based maximum methylphenidate dosing:
    • 3-5 years of age: 22.5 mg/day
    • Greater than or equal to 6 years of age & less than or equal to50 kg: 60 mg/day
    • Greater than or equal to 6 years of age & greater than 50 kg: 100 mg/day
    • Any dose of methylphenidate exceeding 60 mg/day should be used with caution, and with attentive monitoring
Table 5. Pediatric (Child and Adolescent) Maximum Recommended Dosages for Non-Stimulant ADHD Medications: Selective Norepinephrine Reuptake Inhibitors1,2,27,28,30
Drug Name Dosage Form/Strength Maximum Recommended Dosage Maximum Recommended Dosage (PMUP#)
atomoxetine (Strattera®, generics) 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg 100 mg capsules
  • 6-17 years of age (less than or equal to 70 kg): 1.4 mg/kg/day (up to 100 mg/day)
  • 6-17 years of age (greater than 70 kg): 100 mg/day
 greater than or equal to 6 years of age: 1.8 mg/kg/day or 100 mg/day, whichever is less
viloxazine (Qelbree®) 100 mg, 150 mg, 200 mg 6-17 years of age: 400 mg/day N/A

Legend:

  • # Psychotropic Medication Utilization Parameters
Table 6. Pediatric (Child and Adolescent) Maximum Recommended Dosages for Non-Stimulant ADHD Medications: Selective Alpha2A-Adrenergic Receptor Agonists1,2,29,30,41
Drug Name Dosage Form/Strength Maximum Recommended Dosage Maximum Recommended Dosage (PMUP#)
clonidine (Kapvay®) 0.1 mg ER tablets 6-17 years of age: 0.4 mg/ day Greater than 6 years of age: 0.4 mg/ day
guanfacine (Intuniv®, generic) 1 mg, 2 mg, 3 mg, 4 mg ER tablets
  • 6-12 years of age: 4 mg/day
  • 13-17 years of age: 7 mg/day
  • Doses greater than 4mg/ day have not been studied in adjunctive trials
  • 6-12 years of age: 4 mg/day
  • 13-17 years of age: 7 mg/day

Legend:

  • # Psychotropic Medication Utilization Parameters