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.
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 Name
Manufacturer
Strength/Dosage Form
Price (USD)
Focalin
Novartis
10 mg Tablet
$3.00
Focalin XR
Novartis
20 mg Capsule
$5.50
15 FAQs with Answers
What is Dexmethylphenidate used for? – Primarily to treat ADHD in children and adults.
Can Dexmethylphenidate cause addiction? – Yes, it has a high potential for abuse and dependence.
How should Dexmethylphenidate be taken? – Swallow tablets or capsules whole, or sprinkle XR capsules on applesauce.
What are the common side effects of Dexmethylphenidate? – Includes anxiety, decreased appetite, and dry mouth.
Is Dexmethylphenidate safe during pregnancy? – Category C; discuss potential risks with your healthcare provider.
Can Dexmethylphenidate be taken with alcohol? – Alcohol can increase the risk of side effects; it’s best avoided.
What does Dexmethylphenidate interact with? – Interacts with MAO inhibitors and may enhance the effects of other stimulants.
What should I avoid while taking Dexmethylphenidate? – Avoid caffeine and activities that require alertness until you know how Dexmethylphenidate affects you.
What are signs of Dexmethylphenidate overdose? – Symptoms include vomiting, agitation, tremors, and irregular heartbeat.
Is Dexmethylphenidate addictive? – Yes, it is classified as a Schedule II controlled substance due to its potential for abuse.
Should I stop taking Dexmethylphenidate suddenly? – No, discontinuation should be done under medical supervision to avoid withdrawal symptoms.
What are the rare but serious side effects of Dexmethylphenidate? – Severe psychiatric symptoms and heart problems.
What other medications interact with Dexmethylphenidate? – Antihypertensive drugs and CNS stimulants can have significant interactions.
Who should not take Dexmethylphenidate? – Individuals with glaucoma, severe anxiety, or a history of drug abuse.
How does Dexmethylphenidate work to treat ADHD? – It increases the levels of brain neurotransmitters, improving attention and reducing impulsivity and hyperactivity.