Dexmethylphenidate

DEA Class; Rx

Common Brand Names; Focalin, Focalin XR

CNS stimulant; d-enantiomer of methylphenidate
Used for attention-deficit hyperactivity disorder (ADHD)
Patients with structural heart defects, cardiomyopathy, or heart-rhythm disturbances may be at risk for adverse cardiac events

Indicated for the treatment of attention-deficit hyperactivity disorder (ADHD).

Hypersensitivity to methylphenidate; reactions may include angioedema and anaphylaxis

Notable tension and agitation, glaucoma, Tourette syndrome, motor tics, anxiety

MAOIs: Risk of severe hypertensive reaction; do not use within 14 days of taking MAOI

• Abdominal pain (15%)
• Headache (25-39%)
• Insomnia (5-17%)
• Restlessness (12%)
• Anxiety (5-11%)
• Anorexia (5-7%)
• Fever (5%)
• Dizziness (6%)
• Mood swings (<3%)
• Nausea (9%)
• Pruritus (<3%)
• Pharyngolaryngeal pain (4-7%)
• Irritability (5%)
• Depression (<3%)
• Dyspepsia (5-9%)
• Anaphylaxis
• Hypersensitivity reactions
• Rhabdomyolysis
• Drowsiness
• Dyskinesia
• Tourette’s syndrome (rare)
• Toxic psychosis
• Serotonin syndrome in combination with serotonergic drugs
• Abnormal liver function, ranging from transaminase elevation to severe hepatic injury

Should be used as part of a comprehensive treatment program of attention deficit disorder

Caution in patients with history of drug dependence or alcoholism, HTN, preexisting structural cardiac abnormalities

Discontinue if no improvement after 1 month

Reevaluate need for treatment q6Week

Associated with peripheral vasculopathy, including Raynaud phenomenon; monitor for digital changes during therapy and seek further evaluation (eg, rheumatology) if necessary

Difficulties with visual accommodation and blurring of vision have been reported with stimulant treatment

Do not use for depression, fatigue

Sudden deaths, stroke, and myocardial infarction reported in adults taking stimulants at usual doses

Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation

Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients

Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported

Monitor growth of children ages 7 to 10 years during treatment with stimulants; may need to interrupt therapy in patients not growing or gaining weight as expected

Stimulants may lower convulsive threshold in patients with prior history of seizure, patients with prior EEG abnormalities in absence of seizures, and very rarely, patients without a history of seizures and no prior EEG evidence of seizures; discontinue therapy in the presence of seizures

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications, during pregnancy

Dexmethylphenidate is the d-threo enantiomer of racemic methylphenidate; Limited published literature, based on milk sampling from seven mothers reports that methylphenidate is present in human milk, which resulted in infant doses of 0.16% to 0.7% of the maternal weight-adjusted dosage and a milk/plasma ratio ranging between 1.1 and 2.7