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Attention Deficit Hyperactivity Disorder

Understanding Ritalin Doseage

03/23/2000

Question:

My adult daughter has just been diagnosed as having ADD. Her treatment consists of 10mg of Ritalin 3X day. Can you put the dosage in perspective for me? High? Low? Is it habit forming? She has a history of prescription drug abuse and I am concerned.

Answer:

The dosage of Ritalin has a huge range. One usually begins low (5 or 10 mg in adolescents or adults). For patients who have had full work ups and have no physical or psychologic contraindications (and there are very few such contraindications), most experts in ADD are comfortable going as high as 0.8 mg per kg (.36 mg per lb.). However, it is rare to need this much, perhaps only 3% of persons using Ritalin. How frequently it is dosed is a large range also. The great majority of people need it about every four hours but I have had some who need it every two and some every five. Adults using Ritalin, or other stimulants, for ADD do not build up tolerance, i.e., do not need to keep increasing the dosage once the correct one is initially found. That is one of the reasons we know that Ritalin is not addicting when used for ADD. Children usually need to increase their dosage as they grow and mature. If your daughter received a thorough evaluation from a knowledgable clinician, it is more likely Ritalin will help her to stay away from drug abuse than harm her. Out of about a thousand patients we have seen at Affinity over the last few years, we have only had a couple who misused their medications on themselves. I think that both cases were teens with depression who (because of their or their family`s preference) we were unable to give antidepressants or appropriate counseling to. Stimulants sometimes have a noticable antidepressant quality for the first few weeks. However, tolerance usually develops to that quality of the drug and more would be needed to keep trying to get that effect. Although it sometimes works well for depression at low doses in seniors, without developing tolerance, that`s not usual for other age groups. Although persons involved in the "drug culture" may misuse their medications by selling or sharing them, abusing them themselves when on an appropriate dose is extremely rare.

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati