dexmethylphenidate

Contraindicated in:

Hypersensitivity;
Hyperexcitable states (marked anxiety, agitation, or tension);
Hyperthyroidism;
Psychotic personalities or 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;
History of substance abuse
;
Continual use (may produce psychological dependence or physical addiction)
;
Seizure disorders (may ↓ seizure threshold);
Open-angle glaucoma or elevated intraocular pressure;
Tics or family history/diagnosis of Tourette 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 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, may ↑ 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.
Risperidone may ↑ risk of extrapyramidal symptoms.

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].

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Produces CNS and respiratory stimulation with weak sympathomimetic activity.

Therapeutic effects:

Increased attention span in ADHD.

Classifications ⬆ ⬇

Therapeutic Classification: central nervous system stimulants

Pharmacokinetics ⬆ ⬇

Absorption: Readily absorbed following oral administration.

Distribution: Unknown.

Metabolism/Excretion: Mostly metabolized by the liver; inactive metabolites are renally excreted.

Half-Life: 2.2 hr.

Contr. Subst. Schedule ⬆ ⬇

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
PO	7 days	1 mo	unknown

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. If more than prescribed amount is taken, notify health care provider 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 provider. 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.
- Advise patient that dexmethylphenidate is a drug with known potential for abuse, misuse, and/or addiction. Store in safe place, protect it from theft, and never give to anyone other than the individual for whom it was prescribed.
- Inform patients starting therapy of risk of peripheral vasculopathy. Instruct patients to notify health care provider 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 to 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 provider.
- Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider 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 provider 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 caregivers to notify health care provider of behavioral changes.
- Inform patient that health care provider may order periodic holidays from the drug to assess progress and to decrease dependence.
- May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or and to avoid breastfeeding during therapy. May ↑ risk or premature birth and low birth weight. Monitor infants born to mothers taking amphetamines for symptoms of withdrawal (feeding difficulties, irritability, agitation, excessive drowsiness). Encourage patients exposed to amphetamines during pregnancy to join the registry. Health care providers may call the National Pregnancy Registry for Psychiatric Medications at 1-866-961-2388 or online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/othermedications/ to register patients.
- 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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Indications ⬇

Contraind./Precautions ⬆ ⬇