dexmethylphenidate (Oral route)

Pronunciation

dex-meth-il-FEN-i-date

Oral route(Capsule, Extended Release;Tablet)

Give cautiously to patients with a history of drug dependence or alcoholism. Chronic, abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral abuse. Careful supervision is required during drug withdrawal from abusive use since severe depression may occur .

Commonly used brand name(s)

In the U.S.

  • Focalin
  • Focalin XR

Available Dosage Forms:

  • Tablet
  • Capsule, Extended Release

Therapeutic Class: CNS Stimulant

Chemical Class: Amphetamine Related

Uses For dexmethylphenidate

Dexmethylphenidate is used to treat attention deficit hyperactivity disorder (ADHD). It belongs to the group of medicines called central nervous system (CNS) stimulants.

Dexmethylphenidate increases attention and decreases restlessness in patients who are hyperactive, cannot concentrate, or are easily distracted. It is used as part of a total treatment program that also includes social, educational, and psychological therapy.

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dexmethylphenidate is available only with a doctor's prescription. Prescriptions cannot be refilled. A new prescription must be obtained from your doctor each time you need dexmethylphenidate.

Before Using dexmethylphenidate

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For dexmethylphenidate, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to dexmethylphenidate or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of dexmethylphenidate in children. However, safety and efficacy have not been established in children younger than 6 years of age.

Geriatric

Appropriate studies on the relationship of age to the effects of dexmethylphenidate have not been performed in the geriatric population.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking dexmethylphenidate, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using dexmethylphenidate with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Brofaromine
  • Clorgyline
  • Furazolidone
  • Iproniazid
  • Isocarboxazid
  • Lazabemide
  • Linezolid
  • Moclobemide
  • Nialamide
  • Pargyline
  • Phenelzine
  • Procarbazine
  • Rasagiline
  • Selegiline
  • Toloxatone
  • Tranylcypromine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of dexmethylphenidate. Make sure you tell your doctor if you have any other medical problems, especially:

  • Agitation, severe or
  • Anxiety, severe or
  • Glaucoma or
  • Motor tics (repeated muscle movements), history of or
  • Tension, severe or
  • Tourette syndrome (tics), or a family history of—Should not be used in patients with these conditions.
  • Alcohol abuse, history of or
  • Drug abuse and dependence, history of—Dependence may be more likely to develop.
  • Bipolar disorder (manic-depressive illness), history of or
  • Coronary artery disease or
  • Depression, or a family history of or
  • Heart disease (eg, cardiomyopathy) or
  • Heart rhythm problems (eg, arrhythmia), or a family history of or
  • Hypertension (high blood pressure) or
  • Priapism (painful or prolonged erection of the penis) or
  • Psychosis (mental illness), history of or
  • Raynaud disease or
  • Seizures, history of or
  • Tachycardia (increased heart rate)—Use with caution. May make these conditions worse.

Proper Use of dexmethylphenidate

Take dexmethylphenidate only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If you take too much, the medicine may become habit-forming (causing mental or physical dependence).

dexmethylphenidate should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.

If you think dexmethylphenidate is not working properly after you have taken it for several weeks, do not increase the dose and check with your doctor.

dexmethylphenidate may be taken with or without food.

If you are using the extended-release capsule:

  • Take the capsule in the morning. If you take it in the afternoon or evening, you may have trouble falling asleep at night.
  • Swallow the capsule whole. Do not crush, divide, or chew it.
  • If you cannot swallow the capsule, carefully open it and sprinkle the small beads over a spoonful of applesauce. Swallow the mixture right away without chewing. Do not store the mixture for future use. Do not crush or chew the beads from the capsule.

Dosing

The dose of dexmethylphenidate will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of dexmethylphenidate. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For ADHD:
    • For oral dosage form (extended-release capsules):
      • Adults—At first, 10 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 40 mg per day.
      • Children 6 years of age and older—At first, 5 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 30 mg per day.
      • Children younger than 6 years of age—Use and dose must be determined by your doctor.
    • For oral dosage form (tablets):
      • Adults, teenagers, and children 6 years of age and older—At first, 2.5 milligrams (mg) two times a day, at least 4 hours apart. Your doctor may adjust your dose as needed. However, the dose is usually not more than 10 mg two times a day.
      • Children younger than 6 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of dexmethylphenidate, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using dexmethylphenidate

It is very important that your doctor check your progress at regular visits to make sure the medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for any unwanted effects.

Do not take dexmethylphenidate together with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking dexmethylphenidate during the 2 weeks after you stop a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, headaches, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.

Dexmethylphenidate may cause serious heart or blood vessel problems. This may be more likely to occur in patients who have a family history of heart disease. Check with your doctor right away if you have chest pain, trouble breathing, or fainting while taking dexmethylphenidate.

dexmethylphenidate may cause some people to have vision changes or to become drowsy, dizzy, or less alert than they are normally. Make sure you know how you react to dexmethylphenidate before you drive, use machines, or do anything else that could be dangerous if you are dizzy, not alert, or not able to see well.

Tell your doctor right away if you or your family notice any unusual changes in behavior, such as an increase in aggression, hostility, agitation, irritability, or suicidal thinking or behavior. Also tell your doctor if you or your child have hallucinations or any unusual thoughts, especially if they are new or getting worse quickly.

If you have been using dexmethylphenidate for a long time and you think you may have become mentally or physically dependent on it, check with your doctor. Some signs of dependence may be:

  • A strong desire or need to continue taking the medicine.
  • A need to increase the dose to receive the same effects.
  • Withdrawal effects after stopping the medicine such as mental depression, nausea or vomiting, stomach cramps or pain, trembling, or unusual tiredness or weakness.

dexmethylphenidate may cause slow growth. If your child is using dexmethylphenidate, the doctor will need to keep track of your child's height and weight.

If you or your child experience a prolonged or painful erection of the penis for more than 4 hours, check with your doctor right away.

dexmethylphenidate may cause Raynaud phenomenon, which is a problem with blood circulation in the fingers or toes. Tell your doctor if you have tingling or pain, a cold feeling, paleness, or skin color changes in the fingers or toes, especially when exposed to cold. Call your doctor right away if you have unexplained sores or ulcers on your fingers or toes.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter (OTC)) medicines, and especially those for appetite control, asthma, colds, cough, hay fever, allergies, or sinus problems.

dexmethylphenidate Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common
  • Fast, pounding, or irregular heartbeat
Rare
  • Blurred vision
  • vision changes
Incidence not known
  • Convulsions
  • jerking of the arms and legs
  • muscle spasm
  • sudden loss of consciousness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Acid or sour stomach
  • belching
  • heartburn
  • indigestion
  • loss of appetite
  • nausea
  • stomach discomfort, upset, or pain
  • throat pain
  • weight loss
Less common
  • Twitching

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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