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 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.
