Top 300 Pharmacy Drug Cards

DEXMETHYLPHENIDATE: Focalin, Various

Class: CNS Stimulant. C-II

Dosage Forms. Tablet: 2.5 mg, 5 mg, 10 mg; Capsule, Extended Release: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 40 mg

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Common FDA Label Indication, Dosing, and Titration.

1. Attention deficit hyperactivity disorder, methylphenidate-naive patients: Adults, initial 10 mg po daily in a.m., may titrate weekly in 10-mg increments to max of 40 mg/d; Children 6 y and older, 5 mg po daily in a.m.; may titrate weekly in 5-mg increments to max of 30 mg/d

2. Attention deficit hyperactivity disorder currently using methylphenidate: Adults and children 6 y and older, one-half the total daily dose of extended release racemic methylphenidate; patients currently using dexmethylphenidate immediate release may be switched to the same daily dose of dexmethylphenidate extended release

3. Attention deficit hyperactivity disorder, methylphenidate-naive patients: Children 6 y and older, 2.5 mg immediate release po bid; may titrate weekly in 2.5- to 5-mg increments to max of 20 mg/d

Off-Label Uses. None

MOA. Amphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. Amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.

Drug Characteristics: Dexmethylphenidate

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Medication Safety Issues: Dexmethylphenidate

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Drug Interactions: Dexmethylphenidate

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Adverse Reactions: Dexmethylphenidate

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Efficacy Monitoring Parameters. Resolution of signs of ADHD (improved attention span and reduced impulsivity).

Toxicity Monitoring Parameters. Blood pressure, heart rate, and weight. Complete blood count. Seek medical attention if chest pain, seizures, heart palpitations, change in behavior or personality, hostility. Growth rate in children.

Key Patient Counseling Points. Avoid late evening doses due to resulting insomnia. If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as applesauce. Stir this mixture well and swallow it without chewing.

Clinical Pearls. Dexmethylphenidate is the d-enantiomer of methylphenidate. Amphetamines have a high potential for abuse, and administration for prolonged periods of time may lead to drug dependence and should be avoided. Misuse of amphetamines may cause sudden death and serious cardiovascular adverse events.