dexmethylphenidate

ROUTE	ONSET	PEAK	DURATION
PO	7 days	1 mo	unknown

Contraindicated in:

Hypersensitivity;
Hyperexcitable states (marked anxiety, agitation, or tension);
Hyperthyroidism;
Psychotic personalities, suicidal or homicidal tendencies;
Glaucoma;
Concurrent use or use within 14 days of MAO inhibitors or MAO-like drugs (linezolid or methylene blue);
Psychoses (may exacerbate symptoms).

Use Cautiously in:

Cardiovascular disease (sudden death has occurred in children with structural cardiac abnormalities or other serious heart problems);
Hyperthyroidism;
Hypertension;
Diabetes mellitus;
Continual use (may result in psychological or physical dependence);
Seizure disorders (may lower seizure threshold);
Open-angle glaucoma or elevated intraocular pressure;
Tics or family history/diagnosis of Tourette's syndrome (may worsen condition);
OB: Use during pregnancy only if potential maternal benefit outweighs potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit outweighs potential risk to infant;
Pedi: Children <6 yr (safety not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: peripheral vasculopathy, SUDDEN DEATH, tachycardia

EENT: ↑intraocular pressure, angle closure glaucoma, visual disturbances

GI: abdominal pain, anorexia, nausea

GU: libido changes, priapism

Metab: growth suppression, weight loss (may occur with prolonged use)

MS: RHABDOMYOLYSIS

Neuro: behavioral disturbances, hallucinations, insomnia, mania, nervousness, thought disorder, tics, Tourette's syndrome, twitching

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA), physical dependence, psychological dependence

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with MAO inhibitors or MAO-inhibitor-like drugs, such as linezolid or methylene blue, may result in serious, potentially fatal reactions; wait at least 14 days following discontinuation of MAO inhibitor before initiation of amphetamine mixtures.
Drugs that affect serotonergic neurotransmitter systems, including MAO inhibitors, tricyclic antidepressants, SSRIs, SNRIs, fentanyl, buspirone, tramadol, lithium, and triptans, ↑ risk of serotonin syndrome.
May ↓ effects of antihypertensives.
May ↑ effects of vasopressors.
May ↑ effects of warfarin, phenobarbital, phenytoin, and some antidepressants; dosage adjustments may be necessary.
Concurrent use with risperidone may ↑ risk of extrapyramidal symptoms.

Route/Dosage ⬆ ⬇

Tablets

PO (Adults and Children ≥6 yr): Patients not previously taking methylphenidate: 2.5 mg twice daily; may be ↑ weekly as needed up to 10 mg twice daily; Patients currently taking methylphenidate: starting dose is ½ of the methylphenidate dose, up to 10 mg twice daily.

Extended-Release Capsules

PO (Adults ): Patients not previously taking methylphenidate: 10 mg once daily; may be ↑ by 10 mg up to 40 mg/day; Patients currently taking methylphenidate: starting dose is ½ of the methylphenidate dose, up to 40 mg/day given as a single daily dose; Patients currently taking dexmethylphenidate: give same daily dose as a single dose.
PO (Children ≥6 yr): Patients not previously taking methylphenidate: 5 mg once daily; may be ↑ by 5 mg weekly up to 30 mg/day; Patients currently taking methylphenidate: starting dose is ½ of the methylphenidate dose, up to 30 mg/day, given as a single daily dose; Patients currently taking dexmethylphenidate: give same daily dose as a single dose.

Availability ⬆ ⬇

(Generic available)

Extended-release capsules: 5 mg; 10 mg; 15 mg; 20 mg; 25 mg; 30 mg; 35 mg; 40 mg
Immediate-release tablets: 2.5 mg; 5 mg; 10 mg
In combination with: serdexmethylphenidate (Azstarys). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess child's attention span, impulse control, and interactions with others. Therapy may be interrupted at intervals to determine whether symptoms are sufficient to continue therapy.
Monitor BP, pulse, and respiration before administering and periodically during therapy. Obtain a history (including assessment of family history of sudden death or ventricular arrhythmia), physical exam to assess for cardiac disease, and further evaluation (ECG and echocardiogram), if indicated. If exertional chest pain, unexplained syncope, or other cardiac symptoms occur, evaluate promptly.
Monitor weight biweekly and inform health care professional of significant loss. Pedi: Monitor height periodically in children; report growth inhibition.
Monitor closely for behavior changes.
Assess risk of abuse prior to prescribing. Monitor for signs of abuse and dependence during therapy. Maintain careful prescription records. Re-evaluate need for dexmethylphenidate periodically during therapy. Dexmethylphenidate has the potential for dependence and abuse. Prolonged use may result in tolerance.
Assess patient's fingers periodically for signs of peripheral vasculopathy (digital ulceration, soft tissue breakdown).
Monitor for signs of anaphylaxis (wheezing, shortness of breath, rash) during therapy.

Lab Test Considerations:

Monitor CBC, differential, and platelet count periodically in patients receiving prolonged therapy.

Implementation ⬆ ⬇

Do not confuse dexmethylphenidate with methadone.
PO: Administer twice daily at least 4 hr apart without regard to meals.
- Administer XR tablets once daily in the morning. Swallow capsules whole. For patients with difficulty swallowing, capsules can be opened and sprinkled on a spoonful of applesauce. Consume immediately; do not store for future use.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. If more than prescribed amount is taken, notify health care professional immediately. If a dose is missed, take the remaining doses for that day at regularly spaced intervals; do not double doses. Take the last dose before 6 pm to minimize the risk of insomnia. Instruct patient not to alter dose without consulting health care professional. Abrupt cessation with high doses may cause extreme fatigue and mental depression. Advise patient and parents to read the Medication Guide prior to starting therapy and with each Rx refill.
- Inform patient that sharing this medication may be dangerous. Educate patients about abuse potential and how to monitor for signs of abuse and overdose. Advise patients and parents to keep dexmethylphenidate in a safe place to prevent misuse or abuse.
- Inform patients starting therapy of risk of peripheral vasculopathy. Instruct patients to notify health care professional of any new numbness; pain; skin color change from pale, to blue, to red; or coolness or sensitivity to temperature in fingers or toes, and call if unexplained wounds appear on fingers or toes. May require rheumatology consultation.
- Advise patient to check weight 2–3 times weekly and report weight loss to health care professional.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products.
- May rarely cause dizziness or drowsiness. Caution patient to avoid driving or activities requiring alertness until response to medication is known.
- Advise patient to notify health care professional if nervousness, restlessness, insomnia, dizziness, anorexia, or dry mouth becomes severe. If reduced appetite and weight loss are a problem, advise parents to provide high-calorie meals when drug levels are low (at breakfast and or bedtime).
- Advise patient and/or parents to notify health care professional of behavioral changes.
- Inform patient that health care professional may order periodic holidays from the drug to assess progress and to decrease dependence.
- Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Encourage patients who become pregnant while taking dexmethylphenidate to enroll in registry with the National Pregnancy Registry of ADHD Medications at 1-866-961-2388 or visit online at https://womensmentalhealth.org/adhd-medications/. Registry collects information about the health of females exposed to dexmethylphenidate and their baby.
- Emphasize the importance of routine follow-up exams to monitor progress.
Home Care Issues: Advise parents to notify school nurse of medication regimen.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇