High-Dose Stimulants for Attention-Deficit/Hyperactivity Disorder: A Review of the Clinical Effectiveness, Safety, and Guidelines

( Last Updated : March 3, 2016)
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:



  1. What is the effectiveness and safety of high dose stimulants in children and adolescents (six to 18 years) with attention-deficit/hyperactivity disorder (ADHD)?

  2. What is the comparative effectiveness and safety of high dose stimulants in adults (> 18 years) with ADHD?

  3. What are the evidence-based guidelines regarding the use of high dose stimulants in patients with ADHD?

Key Message

Five relevant studies were included in this review; no evidence-based guidelines were identified. One systematic review regarding methylphenidate use in adults with ADHD was identified; it is uncertain whether high doses of methylphenidate are more effective than low doses of methylphenidate for treating symptoms of ADHD. One randomized controlled trial regarding lisdexamfetamine dimesylate use in adolescents with ADHD was identified; high doses of study medication were more effective than placebo at addressing symptoms, but had uncertain effects on quality of life measures. Three non-randomized studies regarding adverse events for adolescents and adults using high doses of methylphenidate were identified; these doses were generally well tolerated by patients.