Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder Medications

Last Updated

Medications listed in the tables and non-FDA approved indications included in these retrospective criteria are not indicative of Texas Vendor Drug Program formulary coverage.

  • Revision history
    • October 21, 2022; September 2020; September 2018; December 2016; March 2015; February 2013; December 2012; May 2011; April 2011; March 2011; July 2008.
  • Initially developed
    • Oct. 2007

1.1. Adults

The maximum adult recommended doses for available psychostimulants used in ADD/ADHD management are summarized in Table 1.

Table 1. Maximum Recommended Adult Dosages for Stimulant ADHD Medications1-26
Drug Name Dosage Form/Strength Maximum Recommended Dosage
amphetamine salts (mixed)*(Adderall®, generic) 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg tablets 60 mg/day
amphetamine salts (mixed)*(Adderall XR®, generic) 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg ER capsules 20 mg/day
amphetamine salts, mixed* (Mydayis®) 12.5 mg, 25 mg, 37.5 mg, 50 mg ER capsules 50 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 (ER) orally disintegrating tablets 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 20 mg once daily
dexmethylphenidate (Focalin®, generic) 2.5 mg, 5 mg, 10 mg tablets 20 mg/day
dexmethylphenidate (Focalin® XR, generic) 5mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg ER tablets 40 mg/day
dextroamphetamine (Xelstrym®) 4.5 mg/9 hours, 9 mg/9 hours, 13.5 mg/ 9 hours, 18 mg/9 hours transdermal system 18 mg/9 hours daily
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 70 mg/day
methylphenidate (Adhansia XR®) 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, 85 mg ER capsules 100 mg/ day
methylphenidate (Aptensio XR®) 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg ER capsules 60 mg/day
methylphenidate (Concerta®, generic) 18 mg, 27 mg, 36 mg, 54 mg ER tablets 72 mg/day
methylphenidate (Jornay PM®) 20 mg, 40 mg, 60 mg, 80 mg, 100 mg ER capsules 100 mg/ day
methylphenidate (Metadate® CD, generic) 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg ER capsules 60 mg/day
methylphenidate (generic) 10 mg, 20 mg ER tablets 60 mg/day
methylphenidate (Methylin®, generic) 5 mg/5 mL (500 mL); 10 mg/5 mL (500 mL) IR oral solution 60 mg/day
methylphenidate (generic) 2.5 mg, 5 mg, 10 mg immediate-release (IR) chewable tablets 60 mg/day
Methylphenidate (Relexxii®) 18 mg, 27 mg, 36 mg, 45 mg, 54 mg, 63 mg, 72 mg ER tablets 72 mg/day
methylphenidate (Ritalin®, generic) 5 mg, 10 mg, 20 mg IR tablets 60 mg/day
methylphenidate (Ritalin® LA, generic) 10 mg, 20 mg, 30 mg, 40 mg, 60 mg (generic only) ER capsules 60 mg/day
methylphenidate (generic) 20 mg sustained-release tablets 60 mg/day
methylphenidate (QuilliChew ER®) 20 mg, 30 mg, 40 mg ER chewable tablets 60 mg/day
methylphenidate (Quillivant XR®) 300 mg/60 ml, 600 mg/120 ml, 750 mg/150 ml, 900 mg/180 ml ER suspension 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 52.3 mg/10.4 mg/ day

Legend:

  • * Mixed amphetamine salts are a 1:1:1:1 combination of dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine aspartate monohydrate and amphetamine sulfate
Table 2. Maximum Recommended Adult Dosages for Non-Stimulant ADHD Medications: Selective Norepinephrine Reuptake Inhibitors1,2,27,28
Drug Name Dosage Form/Strength Maximum Recommended Dosage 
atomoxetine (Strattera®, generics) 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg capsules 100 mg/day
viloxazine (Qelbree®) 100 mg, 150 mg, 200 mg ER capsules 600 mg/day
Table 3. Maximum Recommended Adult Dosages for Non-Stimulant ADHD Medications: Selective Alpha2A-Adrenergic Receptor Agonists1,2,29
Drug Name Dosage Form/Strength Maximum Recommended Dosage 
guanfacine (Intuniv®, generics) 1 mg, 2 mg, 3 mg, 4 mg ER tablets 7 mg/day

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

2. Duration of Therapy

Attention-deficit/hyperactivity disorder (ADHD) is defined in DSM-V-TR as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development41 . While many of the approved medications improve inattention, hyperactivity, and impulsivity, symptoms may persist lifelong with less pronounced hyperactivity. Therefore, treatment often lasts well into adulthood, and ADHD is considered a chronic disorder.

3. Duplicative Therapy

The use of two or more psychostimulants concurrently for ADD/ADHD management is not justified. Additional therapeutic benefit is not realized when ADHD stimulant medications are used in combination. Additionally, guanfacine extended-release tablets should not be prescribed concurrently with other guanfacine-containing products due to increased risks of additive pharmacologic/adverse effects, including hypotension. Extended-release guanfacine and extended-release clonidine have supporting evidence and FDA approval for use as adjunctive therapy with stimulant medications. Additionally, there is limited evidence supporting the efficacy and safety of using atomoxetine as adjunctive therapy to stimulant medications in the management of ADHD.42 Patient profiles documenting receipt of multiple ADHD medications or multiple guanfacine-containing products will be reviewed.

4. Drug-Drug Interactions

Patient profiles will be assessed to identify those drug regimens that may result in clinically significant drug-drug interactions. Drug-drug interactions considered clinically significant for ADD/ADHD medications are summarized in Table 7. Only those drug-drug interactions identified as clinical significance level 1 or those considered life-threatening which have not yet been classified will be reviewed.

Table 7. Drug-Drug Interactions for ADD/ADHD Medications
Target Drug Interacting Drug Interaction Recommendation Clinical Significance Level*
amphetamines, amphetamine-related compounds, dexmethylphenidate, methylphenidate, serdexmethylphenidate antihypertensive agents combined administration decreases hypotensive effect of antihypertensive agents closely monitor blood pressure and adjust antihypertensive therapy doses as necessary 2- major (CP)
amphetamines, amphetamine-related compounds CYP2D6 Inhibitors co-administration results in increased exposure to amphetamine and amphetamine related compounds initiate at lower doses and monitor for signs and symptoms of serotonin syndrome, particularly after initiation and after dose increases. If serotonin syndrome occurs discontinue amphetamine or amphetamine related compound and CYP2D6 inhibitor 3- moderate (CP) major-(Micromedex)
amphetamines, amphetamine-related compounds, dexmethylphenidate, methylphenidate, serdexmethylphenidate monoamine oxidase inhibitors (MAOIs) and drugs with MAOI-like actions (e.g., procarbazine) combined administration increases risk of enhanced vasopressor effects and hypertensive crisis due to increased norepinephrine availability; amphetamines, dexmethyl-phenidate, and methylphenidate potentiate  catecholamine neurotransmitter effects, while MAOIS block catecholamine degradation and increase norepinephrine levels at nerve receptor sites concurrent administration as well as amphetamine, dexmethyl-phenidate, methylphenidate, or serdexmethylphenidate administration within 14 days of MAOI use is contraindicated contraindicated (DrugReax) 1-severe (CP)
amphetamines, amphetamine-related compounds phenothiazines co-administration results in decreased effectiveness of both drug classes avoid combination, if possible 2-major (CP) major (DrugReax)
amphetamines, amphetamine-related compounds SSRIs, SNRIs combined administration may produce additive pharmacologic effects and  increase risk of serotonin syndrome as amphetamines may stimulate serotonin release in central nervous system (CNS) administer cautiously together and observe for signs/ symptoms of serotonin syndrome; discontinue therapy and treat as necessary if serotonin syndrome develops major (DrugReax) 2-major (CP)
amphetamines, amphetamine-related compounds TCAs adjunctive administration may potentiate amphetamine pharmacologic/ adverse effects including hypertension, other cardiac effects, and  CNS stimulation due to additive effects on norepinephrine release/activity administer combination cautiously; observe for increased adverse effects moderate (DrugReax) 2-major (CP)
amphetamines, amphetamine-related compounds urinary alkalinizers combination results in increased renal tubular absorption of amphetamines and amphetamine-related compounds, decreased urinary excretion and the potential for enhanced amphetamine therapeutic/ adverse effects combination should be avoided 2-major (CP) moderate (DrugReax)
atomoxetine albuterol combined administration may produce increased heart rate, blood pressure due to unknown mechanism administer combination cautiously; monitor blood pressure and heart rate major (DrugReax) 3-moderate (CP)
atomoxetine MAOIs co-administration may result in additive serotonergic effects/ increased risk of serotonin syndrome as atomoxetine inhibits serotonin reuptake and MAOIs inhibit catecholamine breakdown concomitant administration as well as atomoxetine administration within 14 days of MAOI use contraindicated contraindicated (DrugReax) 1-severe (CP)
clonidine mirtazapine co-administration may result in hypertension monitor for signs of intense sweating, facial flushing, frequent headaches, racing, or pounding heartbeat major (DrugReax)
clonidine beta blockers co-administration may result in sinus bradycardia & exaggerated clonidine withdrawal response monitor heart rate when combined with beta blocker therapy. Gradual withdrawal of beta blocker recommended before discontinuing clonidine major (DrugReax)
clonidine calcium channel blockers co-administration may result in sinus bradycardia monitor heart rate when combined with calcium channel blocker therapy major (DrugReax)
dexmethylphenidate, methylphenidate, serdexmethylphenidate risperidone concomitant administration may increase risk of extrapyramidal symptoms during doses changes of either medication monitor for signs of extrapyramidal symptoms major (Micromedex)
dexmethylphenidate, methylphenidate, serdexmethylphenidate halogenated anesthetics Concomitant use may increase risk of sudden blood pressure and heart rate increases during surgery Avoid use in patients being treated with anesthetics on the day of surgery major (Micromedex)
dexmethylphenidate, methylphenidate, serdexmethylphenidate select anticonvulsants [e.g., phenobarbital, hydantoins (e.g., phenytoin) and primidone] adjunctive administration may increase serum anticonvulsant levels of select anticonvulsants due to unknown mechanism; dexmethylphenidate,  methylphenidate may also lower seizure threshold monitor serum anticonvulsant levels closely and monitor patients for increased adverse effects; adjust anticonvulsant doses as needed; also monitor seizure frequency moderate (DrugReax) 2-major, 3-moderate (CP)
dexmethylphenidate, methylphenidate, serdexmethylphenidate warfarin co-administration may increase warfarin serum levels and enhance pharmacologic/adverse effects, including bleeding closely monitor INR with combined therapy and adjust warfarin doses as necessary moderate (DrugReax) 3-moderate (CP)
guanfacine antihypertensive agents combined administration may result in additive hypotensive effects closely monitor blood pressure and adjust doses as necessary 3-moderate (CP)
guanfacine CNS depressants combined administration may result in additive pharmacologic (sedative) effects administer cautiously together 3-moderate (CP)
guanfacine strong CYP3A4 inhibitors (e.g., ketoconazole) adjunctive administration may result in increased guanfacine concentrations and the potential for enhanced pharmacologic/ adverse effects as guanfacine is metabolized by CYP3A4 administer cautiously together and monitor for increased pharmacologic effects (e.g., hypotension, bradycardia, sedation) unknown
guanfacine CYP3A4 inducers (e.g., rifampin, phenytoin) concurrent administration reduces guanfacine AUC by 70% and may result in decreased guanfacine serum levels and reduced pharmacologic/clinical effects (guanfacine metabolized by CYP3A4) monitor for loss of guanfacine clinical effects; increased guanfacine doses may be necessary 3-moderate (CP)
guanfacine valproic acid (VA) combined administration may result in increased VA serum levels, potentially due to competition for glucuronidation metabolic pathway monitor for additive CNS effects; VA dosage adjustments may be required unknown
methylphenidate bupropion concurrent use may result in increased seizure risk if combination is necessary, closely monitor patient major (DrugReax) 2-major (CP)
methylphenidate carbamazepine co-administration may result in reduced methylphenidate serum levels and decreased pharmacologic effects due to unknown mechanism; methylphenidate may also lower seizure threshold closely monitor patient response to methylphenidate therapy, monitor seizure frequency, and adjust methylphenidate doses as necessary with this drug combination moderate (DrugReax) 2-major (CP)
viloxazine CYP1A2 substrates, sensitive or narrow therapeutic range viloxazine is a strong CYP1A2 inhibitor, increasing total exposure to sensitive CYP1A2 substrates concurrent use is contraindicated contraindicated (Micromedex)
viloxazine CYP1A2 substrates, moderate sensitive viloxazine is a strong CYP1A2 inhibitor, increasing total exposure to sensitive CYP1A2 substrates concurrent administration is not recommended. Dose reduction may be warranted if coadministered major (Micromedex)
viloxazine MAOI increased risk of potentially life-threatening hypertensive crisis concurrent administration is contraindicated contraindicated (Micromedex)

Legend:

  • * CP = Clinical Pharmacology, Micromedex, product labeling

5. References

  1. Clinical Pharmacology [database online]. Tampa, FL: Gold Standard, Inc.; 2022. Available at:  http://clinicalpharmacology-ip.com.ezproxy.lib.utexas.edu/. Accessed September 21, 2022.
  2. IMB Micromedex® DRUGDEX® (electronic version). Truven Health Analytics, Greenwood Village, Colorado, USA. Available at: http://www.micromedexsolutions.com.libproxy.uthscsa.edu. Accessed September 21, 2022.
  3. Amphetamine mixed salts tablets (Adderall®) package insert. Teva Pharmaceuticals USA, Inc., February 2022.
  4. Amphetamine mixed salts extended-release capsules (Adderall XR®) package insert.  Takeda Pharmaceuticals America, Inc., March 2022.
  5. Amphetamine mixed salts extended-release capsules (Mydayis®) package insert. Takeda Pharmaceuticals America, Inc., March 2022.
  6. Amphetamine extended-release orally disintegrating tablets (Adzenys XR-ODT®) package insert. Neos Therapeutics, Inc., March 2022.
  7. Amphetamine extended-release oral suspension (Dyanavel® XR) package insert. Nextwave Pharmaceuticals, Inc., May 2022.
  8. Dexmethylphenidate tablets (Focalin®) package insert. Novartis Pharmaceuticals Corp., June 2022.
  9. Dexmethylphenidate extended-release capsules (Focalin® XR) package insert. Novartis Pharmaceuticals Corp., June 2021.
  10. Dextroamphetamine transdermal system (Xelstrym®) package insert. Noven Therapeutics, LLC., March 2022.
  11. Lisdexamfetamine capsule and chewable tablets (Vyvanse®) package insert. Takeda Pharmaceuticals America, Inc., March 2022.
  12. Methylphenidate extended release capsules (Adhansia XR®) package insert. Adlon Therapeutics LP, July 2022.
  13. Methylphenidate extended-release capsules (Aptensio XR®) package insert.  Rhodes Pharmaceuticals, June 2021.
  14. Methylphenidate extended-release tablets (Concerta®) package insert. Janssen Pharmaceuticals, Inc., April 2022.
  15. Methylphenidate extended-release capsules (Jornay PM®) package insert. Ironshore Pharmaceuticals, Inc., March 2022.
  16. Methylphenidate extended-release capsules (Metadate CD®) package insert. Lannett Company, Inc., April 2022.
  17. Methylphenidate extended-release tablets package insert. KVK-Tech, Inc., April 2021.
  18. Methylphenidate oral solution (Methylin®) package insert. Shionogi Pharma, Inc., July 2021.
  19. Methylphenidate chewable tablets package insert. Camber Pharmaceuticals, Inc., August 2021. 
  20. Methylphenidate extended-release tablets (Relexxii®) package insert. Vertical Pharmaceuticals, LLC. November 2021.
  21. Methylphenidate tablets (Ritalin®) package insert. Novartis Pharmaceuticals Corp., June 2021.
  22. Methylphenidate extended-release capsules (Ritalin LA®) package insert.  Novartis Pharmaceuticals Corp., June 2021.
  23. Methylphenidate tablets, extended-release tablets package insert. Ascend Laboratories, LLC., December 2019. 
  24. Methylphenidate extended-release chewable tablets (QuilliChew® XR) package insert. NextWave Pharmaceuticals, Inc. June 2021.
  25. Methylphenidate extended-release oral suspension (Quillivant® XR) package insert. NextWave Pharmaceuticals, Inc. June 2021.
  26. Serdexmethylphenidate and dexmethylphenidate capsules (Azstarys®) package insert. Corium, Inc., May 2022.
  27. Atomoxetine (Strattera®) package insert. Eli Lilly and Company, January 2022.
  28. Viloxazine extended-release capsules (Qelbree®) package insert. Supernus Pharmaceuticals, Inc., May 2022.
  29. Guanfacine extended-release tablets (Intuniv®) package insert. Takeda Pharmaceuticals America Inc., January 2021.
  30. Texas Health and Human Services. Psychotropic medication utilization parameters for children and youth in Texas Public Behavioral Health (6th version). June 2019. Accessed September 22, 2022. Available at: https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/facilities-regulation/psychiatric/psychotropic-medication-utilization-parameters.pdf.
  31. Amphetamine sulfate tablets (Evekeo®) package insert. Arbor Pharmaceuticals. January 2022.
  32. Amphetamine sulfate oral disintegrating tablets (Evekeo ODT®) package insert. Arbor Pharmaceuticals. March 2022.
  33. Dextroamphetamine tablets package insert. Aurolife Pharma, LLC., January 2022.
  34. Dextroamphetamine extended-release capsules (Dexedrine® Spansule) package insert. Amneal Pharmaceuticals, LLC., January 2022.
  35. Dextroamphetamine oral solution (ProCentra®) package insert.  Independence Pharmaceuticals, June 2022.
  36. Dextroamphetamine tablets (Zenzedi®) package insert. Arbor Pharmaceuticals, LLC, January 2022.
  37. Methamphetamine tablets (Desoxyn®) package insert. Key Therapeutics, September 2022.
  38. Methylphenidate extended-release orally disintegrating tablets (Cotempla XR-ODT®) package insert. Neos Therapeutics, Inc., July 2021.
  39. Methylphenidate transdermal system (Daytrana®) package insert. Noven Pharmaceuticals, June 2021.
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