Focalin

(dexmethylphenidate)

Forms/Strengths

• Tablets: 2.5 mg, 5 mg, 10 mg

Dosing

• Age: ≥ 6 y/o
• Onset: ~ 30 minutes
• Duration: 5-6 hours
• Considerations:  Give approximately 1/2 the methylphenidate dose. Administer orally twice daily, at least 4 hours apart, with or without food.
• Initial Dose:
  • New to methylphenidate: 2.5 mg twice daily
  • Currently taking methylphenidate: Start with half the current total daily dose of methylphenidate (up to 10 mg twice daily)
• Titration: Increase by 2.5-5 mg daily every 3 to 7 days
• Max Dose: 20 mg/day (10 mg twice daily)
  

Quick Facts

• Increases synaptic dopamine and norepinephrine by enhancing presynaptic release
• Improves focus, attention, and impulse control
• Immediate-release formulation for rapid onset
• Unique formulation contains the isolated active dextroisomer (dexmethylphenidate), potentially allowing for lower dosing
• Common side effects: decreased appetite, insomnia, increased blood pressure, headache

Indications

•  ADHD (ICD-10: F90.0)

Off-Label Uses

•  N/A

How to Take

• Take once or twice daily, with doses at least 4 hours apart.
• Can be taken with or without food; high-fat meals may delay absorption.
• Swallow the tablet whole; do not crush, chew, or split.
• Avoid taking late in the day to prevent insomnia.

Side Effects

• Decreased appetite, weight loss
• Abdominal pain
• Nausea
• Insomnia
• Tachycardia, potential elevations in blood pressure
• Possible new or worsened psychiatric symptoms (psychosis, mania)
• Priapism (rare, but serious)

Monitoring / Labs

• Cardiovascular: Baseline and routine monitoring of heart rate and blood pressure.
• Growth in Pediatrics: Regular monitoring of height and weight to detect growth suppression.
• Psychiatric Symptoms: Observe for mood changes, anxiety, or psychosis.
• Abuse Potential: Monitor for misuse or diversion.

Education

• When to Call the Doctor:

  • Severe mood changes, aggression, or suicidal thoughts.
  • Chest pain, rapid heartbeat, shortness of breath (cardiovascular concerns).
  • Uncontrolled movements, tics, or worsening anxiety.
  • Numbness, coldness, or color changes in fingers or toes (circulatory issues).
  • Unexplained weight loss or delayed growth in pediatric patients.

• Safety Tips:

  • Monitor blood pressure and heart rate, especially in patients with cardiovascular risk.
  • Use caution in patients with anxiety, bipolar disorder, or psychosis, as symptoms may worsen.
  • Avoid caffeine and other stimulants, which may amplify side effects.
  • Ensure adequate hydration and nutrition, as appetite suppression is common.
  • Tapering may be required if discontinuing after long-term use.

• Parent Tips for Pediatric Patients:

  • Encourage a nutrient-dense diet to counteract appetite suppression.
  • Administer in the morning before school for optimal effect.
  • Monitor school performance and behavioral changes.
  • Observe for sleep disturbances; adjust timing if necessary.
  • Communicate regularly with teachers and caregivers about medication effects.

Additional Information

• Contraindications:

  • Hypersensitivity to dexmethylphenidate or formulation components.
  • Use within 14 days of MAOI therapy (risk of hypertensive crisis).
  • Symptomatic cardiovascular disease, moderate-to-severe hypertension, hyperthyroidism, glaucoma.
  • History of substance use disorder, unless benefits outweigh risks.

• Pregnancy:

  • Category C; use only if benefits outweigh risks.
  • May cause neonatal withdrawal symptoms or low birth weight.

• Lactation:

  • Excreted in breast milk; not recommended due to potential infant exposure.

• Drug Interactions:

  • Serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs) increase serotonin syndrome risk.
  • Acidifying agents (e.g., ascorbic acid) may reduce drug absorption.
  • Alkalinizing agents (e.g., sodium bicarbonate) may increase dexmethylphenidate levels.
  • May potentiate hypertensive effects of certain medications (e.g., decongestants, beta-agonists).