PAD Refills

Last updated on April 1, 2026

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April 2026

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ADHD drug table update

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The BC Provincial Academic Detailing (PAD) service’s topic Medications for ADHD: Focus on drug information looks at the evidence for methylphenidate, amphetamines, atomoxetine and guanfacine.This is an update for the ADHD drug table. For administration information, please refer to our June 2025 PAD Refill on ADHD formulations.

Visit www.bcpad.ca to book a session with an academic detailing pharmacist in your area.

Marketed products¹	Dosing & cost considerations^1-3
Methylphenidate IR RITALIN generics 5, 10, 20 mg IR tablets Methylphenidate ER RITALIN SR generics 20 mg film-coated SR tablets	Initial	IR tablets: 5 to 10 mg BID or TID with or without food
	Initial	SR tablets: when 8-hour dosage corresponds to titrated 8-hour dosage of IR
	Titration	5 to 10 mg/day at weekly intervals
	Maximum	60 mg/day
	30-day cost	IR $10 to $30, SR $25 to $70 (brand names discontinued)
	Coverage	regular benefit
Methylphenidate ER CONCERTA, generics 18, 27, 36, 54 mg ER tablets brand: OROS^® in a non-absorbable shell, biphasic: IR 22%, ER 78% generic: film-coated tablets	Initial	18 mg once a day in the morning with or without food
	Titration	at weekly intervals
	Maximum	ages 6 to 18 years: 54 mg/day; adults > 18 years: 72 mg/day
	30-day cost	generic: $35 to $90; brand: $110 to $280
	Coverage	Limited coverage: generics; brand reimbursed up to cost of generic
Methylphenidate ER QUILLIVANT ER 300, 600, 750, 900 mg / bottle powder for oral suspension (reconstitute: 5 mg/ml), biphasic: 20% IR, 80% ER 20, 30, 40 mg chewable tablets biphasic: 30% IR, 70% ER	Initial	20 mg once a day in the morning with or without food
	Titration	weekly by 10 or 20 mg (suspension); 10, 15, or 20 mg (chewable tabs)
	Maximum	60 mg/day (doses above have not been studied and are not recommended)
	30-day cost	brand (no generics): suspension $70 to $200; chewable tablets $90 to $195
	Coverage	non benefit
Methylphenidate DR and ER JORNAY PM 20, 40, 60, 80, 100 mg initial onset delay of ~ 8 to 10 hours	Initial	20 mg once a day at 8:00 pm with or without food; adjust timing between 6:30 to 9:30 pm to optimize tolerability and efficacy the next day
	Titration	weekly up or down in increments of 20 mg
	Maximum	100 mg/day and/or 3.7 mg/kg
	30-day cost	brand: $130 to $160
	Coverage	non benefit
Methylphenidate CR BIPHENTIN, generics 10, 15, 20, 30, 40, 50, 60, 80 mg CR capsules multi-layer release (MLR^TM) beads biphasic: 40% IR, 60% CR	Initial	10 to 20 mg once a day in the morning with or without food
	Titration	10 mg/day at weekly intervals
	Maximum	60 mg/day (6 to 18 years), 80 mg/day (adults)
	30-day cost	generic: $25 to $140; brand: $35 to $200
	Coverage	non benefit
Methylphenidate CR FOQUEST 25, 35, 45, 55, 70, 85, 100 mg CR capsules multi-layer release (MLR®) beads biphasic: 20% IR, 80% CR	Initial	25 mg once a day in the morning with or without food
	Titration	at intervals of no less than 5 days
	Maximum	70 mg/day (6 to 17 years), 100 mg/day (≥ 18 years)
	30-day cost	brand: $95 to $165 (no generics)
	Coverage	Limited coverage
Dextroamphetamine IR DEXEDRINE, generics 5 mg IR tablets Dextroamphetamine SR DEXEDRINE SPANSULE, generics 10, 15 mg SR capsules Pellets, biphasic: 40% IR, 60% SR	Initial	IR tablets: 2.5 to 5 mg once or twice a day; Spansules for once daily dosing
	Initial	concomitant use of CYP2D6 inhibitors: ↓ dose, monitor for serotonin toxicity
	Titration	5 mg/day at weekly intervals; may give additional IR tablet every 4 to 6 hours
	Maximum	40 mg/day; GFR < 30 mL/min, dialysis: ↓ dose
	30-day cost	generic: IR $10 to $135, SR $30 to $115; brand: IR $15 to $215, SR $40 to $160
	Coverage	regular benefit: brand reimbursed up to cost of generic
Amphetamine mixed salts XR ADDERALL XR, generics 5, 10, 15, 20, 25, 30 mg ER capsules Pellets, biphasic: 50% IR, 50% DR 3:1 dextroamphetamine/ levo-amphetamine salts	Initial	5 to 10 mg once a day in the morning with or without food
	Initial	concomitant use of CYP2D6 inhibitors: ↓ dose, monitor for serotonin toxicity
	Titration	5 to 10 mg/day at weekly intervals
	Maximum	30 mg/day; GFR < 30 mL/min: maximum 20 mg/day - further reduce in dialysis
	30-day cost	generic: $20 to $30; brand: $85 to $140
	Coverage	Limited coverage: generic only, brand name not a benefit
Amphetamine XR DYANAVEL XR 5, 10, 15, 20 mg XR tablets LiquiXR^® delivery technology (free drug, resin-bound uncoated IR drug and resin-bound coated ER drug)	Initial	2.5 to 5 mg once a day in the morning with or without food
	Titration	2.5 to 5 mg/day every 4 to 7 days
	Maximum	20 mg/day; GFR 15 to < 30 mL/min: ↓ dose
	30-day cost	not yet available
	Coverage	non benefit; not yet marketed
Lisdexamfetamine VYVANSE, generics 10, 20, 30, 40, 50, 60 mg capsules (70 mg capsules for Binge Eating Disorder) 10, 20, 30, 40, 50, 60 mg chewable tablets	Initial	20 to 30 mg once a day in the morning with or without food
	Titration	10 to 20 mg/day at weekly intervals
	Maximum	60 mg/day; GFR < 30 mL/min: maximum 50 mg/day - further reduce in dialysis
	30-day cost	generic: capsules $25 to $45, chew tabs $80 to $140; brand: both $95 to $165
	Coverage	Limited coverage: capsules only; brand reimbursed up to cost of generic
Atomoxetine STRATTERA generics 10, 18, 25, 40, 60, 80, 100 mg capsules	Initial	step 1: ~0.5 mg/kg/day for 7 to 14 days; body weight should be at least 20 kg
		take as a single daily dose in the morning or divided BID, with or without food
		Child-Pugh Class B or C: ↓ initial and target doses by 50% or 75%
	Titration (if tolerated)	step 2: ↑ to ~0.8 mg/kg/day for 7 to 14 days, and then to
		step 3: ↑ to ~1.2 mg/kg/day for 30 days (2 to 4 weeks if > 70 kg) and reassess
		concomitant strong CYP2D6 inhibitor: ↓ dose
	Maximum	1.4 mg/kg/day or 100 mg/day, whichever is less
	30-day cost	generic: $20 to $45; brand name discontinued
	Coverage	Limited coverage
Guanfacine XR INTUNIV XR, generics 1, 2, 3, 4 mg tablets	Initial	1 mg once a day in the morning or evening with a small amount of liquid
	Initial	do not take with high fat meal, grapefruit, grapefruit juice or grapefruit extract
	Titration	by no more than 1 mg/week; target dose range: 0.05 to 0.12 mg/kg/day
	Titration	monitor blood pressure, heart rate and for sedation
	Maximum	ages 6 to 12 years: 4 mg/day; ages 13 to 17 years: 7 mg/day
		as an adjunct with stimulants: 4 mg/day
		significant renal and/or hepatic impairment, concomitant moderate/strong CYP3A4/3A5 inhibitors: ↓ dose
		concomitant strong CYP3A4 inducers: ↑ dose up to a maximum of 7 mg
	Tapering	taper total daily dose by no more than 1 mg every 3 to 7 days
	30-day cost	generic: $85 to $260; brand: $100 to $310
	Coverage	non benefit
IR: immediate release; SR: sustained release; BID: twice a day; TID: three times a day; ER/XR: extended release; OROS^®: Osmotic Controlled-Release Oral Delivery system; CR: controlled release; CYP: Cytochrome P450; GFR: glomerular filtration rate; DR: delayed release

¹Health Canada Drug Product Database; ²Cost per 30 days: does not include mark-up or professional fee; provided as a range which includes approximate cost for initial to maximum doses calculated from McKesson Canada, March 6, 2026;³BC PharmaCare

Please visit www.bcpad.ca to book a session with the academic detailing pharmacist in your area

Previous newsletters

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2023

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2020

December: Asthma Inhaled Medication Table Update (PDF, 216KB)
November: COPD inhaled medication table update (PDF, 307KB) – updated in November 2024

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