View this email in your browser

BHIPP Bulletin

FAQs about Stimulant Dosing
Volume 2, Issue 7
January, 2017

 

Happy New Year from the BHIPP Team!

In this article, we review a number of Frequently Asked Questions about stimulants and dosing.  

  • How do you determine the starting dose?
    •  It is always best to start at a low dose and titrate the dose over time. This prevents “overshooting” the dose and potentially causing unwanted side effects. The goal is to achieve the lowest effective dose.
  • How quickly can the dose be titrated? 
    • You may titrate stimulants fairly quickly, but it is important to evaluate the child to monitor for efficacy and tolerability prior to titrating. Generally, we recommend that stimulants be titrated every 1-2 weeks during an office visit.
  •  When do you stop titrating? 
    • Stimulant medications are one of the few psychiatric medications that are dosed by weight. 
    • Generally, most children respond to:
      • 0.5 mg/kg/day of amphetamine-based stimulants
      • 0.5 mg/kg/day of dexmethylphenidate*
      • 1 mg/kg/day of methylphenidate (MPH)                           *Dexmethylphenidate (Focalin) is twice as potent as MPH!
    • However, some children may respond to lower doses.
    • Additionally, the Teacher and Parent Vanderbilts, along with an in-office assessment, are helpful in order to determine efficacy.
  • What is the maximum dose for stimulant medications?
    • We recommend not to exceed:
      • 1 mg/kg/day of amphetamine 
      • 1 mg/kg/day of dexmethylphenidate*
      • 2 mg/kg/day of methylphenidate (MPH)
      • Weight based guidelines do not apply if they exceed the maximum recommended dosage for a particular stimulant medication
  • How do you convert between stimulants? 
    • Converting between stimulants is not always a straight forward 1:1 conversion
    • Here are some useful conversions to keep in mind:
      • Focalin 5mg = MPH 10mg 
      • Adderall 5mg = MPH 10mg
      • Concerta 18mg = MPH 5mg given TID
      • Concerta 27mg = MPH 7.5mg given TID
      • Concerta 36mg = MPH 10mg given TID
      • Concerta 54mg = MPH 15mg given TID
        *Note: these are ballpark approximations
 
Additional Resources on Stimulants
Printer Friendly PDF
Meet the BHIPP Team
BHIPP recently welcomed a new consultant, Shauna P. Reinblatt, M.D. to the team.        
Dr. Reinblatt is a Clinical Assistant Professor in the Division of Child and Adolescent Psychiatry at the University of Maryland School of Medicine. She is a board-certified psychiatrist in adult and child psychiatry, in addition to psychosomatic medicine. She has clinical and research experience in pediatric eating disorders (particularly binge eating disorder) as well as the adverse events of psychotropic medication in children.  Dr. Reinblatt began her career as a family physician, which has influenced her interest in consultative work with primary care providers.

 

Upcoming BHIPP Events

BHIPP Conference: Mental Health Training for Primary Care


Saturday, January 21, 2017 from 8:00 AM - 12:00 PM

MedStar Franklin Square Medical Center, Baltimore, MD

Registration is open! 


Designed for all clinicians caring for children and adolescents, this course presents evidence-based communication strategies to evaluate and manage emotional and psychosocial problems commonly seen in primary care practice with children, adolescents, and their families. Each course provides short didactic presentations, active discussion of case simulations, and an overview of services offered to clinicians by Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP).

Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending.
 

Event Flyer

BHIPP Bulletin Newsletter Archive

December 2016: Bullying
November 2016: Learning Disorders and Intellectual Disability
October 2016: Educational Services: Know Your Rights and Resources
September 2016: Goodbye Summer, Hello School (Refusal)
August 2016: College Students and ADHD
July 2016: It's Summertime! ADHD and "Drug Holidays"
June 2016: Understanding Vyvanse
May 2016: Children's Mental Health Awareness Week, May 1-7, 2016
April 2016: "Universal" approaches for child mental health problems
March 2016: Pharmacological interventions for sleep concerns
February 2016: Behavioral interventions for sleep concerns
January 2016: Assessment of sleep disorders
November 2015: 5S's: Key questions for consultation
October 2015: Case discussion regarding school refusal
Copyright © 2017 Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP), All rights reserved.


Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list

Email Marketing Powered by Mailchimp