Dexmethylphenidate

Introduction

  • Generic Name: Dexmethylphenidate
  • Brand Names: Focalin, Focalin XR
  • Pharmacological Class: Central nervous system (CNS) stimulant
  • Mechanism of Action: Increases dopamine and norepinephrine levels in the brain, enhancing attention and controlling behavior.

Indications

  • Primary Use: Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in both children and adults.
  • Other Uses: Occasionally used off-label to manage narcolepsy.

Dosage

  • Adults: Typically 10 mg once or twice daily. May increase based on response and tolerability up to a maximum of 40 mg/day.
  • Elderly: Not generally recommended due to potential for increased side effects.
  • Children: Starting dose for children aged 6 and above is 5 mg once or twice daily, adjustable based on response and tolerability.

Administration

  • Method: Oral intake.
  • Precautions: Take in the morning to avoid insomnia. Capsules (Focalin XR) can be swallowed whole or the contents sprinkled on a small amount of applesauce.

Forms Available

  • Immediate-Release Tablets: 2.5 mg, 5 mg, 10 mg
  • Extended-Release Capsules (Focalin XR): 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg

Side Effects

  • Common: Decreased appetite, dry mouth, anxiety, nausea.
  • Less Common: Palpitations, insomnia, increased blood pressure.
  • Rare but Serious: Cardiac issues, psychiatric problems such as new or worsened behavior and thought problems, circulation problems in fingers and toes.

Warnings

  • Substance Abuse: High potential for dependence and abuse; schedule II controlled substance.
  • Contraindications: Known hypersensitivity to methylphenidate or other ingredients, glaucoma, anxiety disorders, history of substance abuse.

Precautions

  • General: Monitor growth in children and blood pressure and heart rate in all patients.
  • Health Conditions: Use cautiously in patients with a history of seizures or cardiac abnormalities.

Interactions

  • Medications: MAO inhibitors, antihypertensive drugs, and other CNS stimulants may have interactions.
  • Food: Avoid caffeine, which may increase side effects.

Monitoring Parameters

  • Cardiac Function: Monitor heart rate and blood pressure regularly.
  • Growth: Track height and weight in children.
  • Mental Health: Regularly assess for behavioral changes or signs of psychosis or mania.

Use in Children

  • Guidelines: Approved for use in children 6 years and older for ADHD.
  • Monitoring: Regular monitoring of side effects and effectiveness, with adjustments as needed.

Use in Pregnancy

  • FDA Category: C. Should be used only if the potential benefit justifies the potential risk to the fetus.

Use in Elderly

  • Recommendations: Generally not recommended due to increased likelihood of side effects, particularly cardiovascular and nervous system effects.

Use in Kidney Disease

  • Adjustments: May require dose adjustments or increased monitoring.

Use in Liver Disease

  • Caution: Use with caution; may require dose adjustments depending on liver function.

Patient Counselling Points

  • Medication Use: Take exactly as prescribed, at the same time each day.
  • Side Effects: Be alert to any cardiac symptoms or signs of psychological changes.
  • Lifestyle: Discuss the impact of dietary choices, such as caffeine intake, on medication effectiveness.

Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
FocalinNovartis10 mg Tablet$3.00
Focalin XRNovartis20 mg Capsule$5.50

15 FAQs with Answers

  1. What is Dexmethylphenidate used for? – Primarily to treat ADHD in children and adults.
  2. Can Dexmethylphenidate cause addiction? – Yes, it has a high potential for abuse and dependence.
  3. How should Dexmethylphenidate be taken? – Swallow tablets or capsules whole, or sprinkle XR capsules on applesauce.
  4. What are the common side effects of Dexmethylphenidate? – Includes anxiety, decreased appetite, and dry mouth.
  5. Is Dexmethylphenidate safe during pregnancy? – Category C; discuss potential risks with your healthcare provider.
  6. Can Dexmethylphenidate be taken with alcohol? – Alcohol can increase the risk of side effects; it’s best avoided.
  7. What does Dexmethylphenidate interact with? – Interacts with MAO inhibitors and may enhance the effects of other stimulants.
  8. What should I avoid while taking Dexmethylphenidate? – Avoid caffeine and activities that require alertness until you know how Dexmethylphenidate affects you.
  9. What are signs of Dexmethylphenidate overdose? – Symptoms include vomiting, agitation, tremors, and irregular heartbeat.
  10. Is Dexmethylphenidate addictive? – Yes, it is classified as a Schedule II controlled substance due to its potential for abuse.
  11. Should I stop taking Dexmethylphenidate suddenly? – No, discontinuation should be done under medical supervision to avoid withdrawal symptoms.
  12. What are the rare but serious side effects of Dexmethylphenidate? – Severe psychiatric symptoms and heart problems.
  13. What other medications interact with Dexmethylphenidate? – Antihypertensive drugs and CNS stimulants can have significant interactions.
  14. Who should not take Dexmethylphenidate? – Individuals with glaucoma, severe anxiety, or a history of drug abuse.
  15. How does Dexmethylphenidate work to treat ADHD? – It increases the levels of brain neurotransmitters, improving attention and reducing impulsivity and hyperactivity.