Dexmethylphenidate

Dexmethylphenidate Brand Name– Focalin | Focalin XR

What is Dexmethylphenidate

Dexmethylphenidate is a central nervous system (CNS) stimulant used to treat attention-deficit hyperactivity disorder (ADHD).

It consists of the d-threo-enantiomer of methylphenidate, which is primarily responsible for the beneficial effects of racemic methylphenidate (the l-enantiomer appears to have negligible activity).

Dexmethylphenidate is considered twice as potent as racemic methylphenidate.

Researchers originally postulated that this increase in CNS potency might improve the adverse reaction profile when compared to racemic methylphenidate; however, actual clinical differences are uncertain. Stimulant medications, such as dexmethylphenidate, are considered first-line agents for ADHD.

When compared to amphetamines, methylphenidate stimulants have equal efficacy and a similar adverse reaction profile.

Peripheral pharmacologic activities are milder than those of the amphetamines, slightly decreasing the likelihood of appetite suppression and tic exacerbation.

As a class, stimulants have been associated with sudden death, stroke, and myocardial infarction in adult patients receiving recommended doses and sudden death in pediatric patients with structural cardiac abnormalities; they should be avoided in patients with structural heart defects, cardiomyopathy, or heart-rhythm disturbances as these patients may be at risk for adverse cardiac events.

The American Heart Association (AHA) recommends careful screening of all children and adolescents prior to initiating pharmacologic therapy for ADHD.

Indications

• attention-deficit hyperactivity disorder (ADHD)

For the treatment of attention-deficit hyperactivity disorder (ADHD)

Side Effects

1. abdominal pain
2. agitation
3. alopecia
4. anaphylactoid reactions
5. anemia
6. angina
7. angioedema
8. anorexia
9. anxiety
10. arrhythmia exacerbation
11. arthralgia
12. blurred vision
13. bradycardia
14. chest pain (unspecified)
15. coma
16. confusion
17. constipation
18. cough
19. delirium
20. depression
21. diarrhea
22. diplopia
23. dizziness
24. drowsiness
25. dyskinesia
26. dyspepsia
27. dyspnea
28. elevated hepatic enzymes
29. emotional lability
30. erythema multiforme
31. euphoria
32. exfoliative dermatitis
33. fatigue
34. fever
35. flushing
36. growth inhibition
37. gynecomastia
38. hallucinations
39. headache
40. hematuria
41. hepatic failure
42. hostility
43. hyperbilirubinemia
44. hyperhidrosis
45. hyperreflexia
46. hypertension
47. hyperthermia
48. hypotension
49. insomnia
50. irritability
51. leukopenia
52. libido decrease
53. libido increase
54. mania
55. migraine
56. muscle cramps
57. myalgia
58. mydriasis
59. myocardial infarction
60. nasal congestion
61. nausea
62. ocular hypertension
63. ocular pain
64. palpitations
65. pancytopenia
66. peripheral vasoconstriction
67. pharyngitis
68. physiological dependence
69. priapism
70. pruritus
71. psychological dependence
72. psychosis
73. purpura
74. rash
75. restlessness
76. rhabdomyolysis
77. seizures
78. sinus tachycardia
79. skin ulcer
80. stroke
81. suicidal ideation
82. syncope
83. thrombocytopenia
84. tolerance
85. tremor
86. urticaria
87. vasculitis
88. visual impairment
89. vomiting
90. weight loss
91. withdrawal
92. xerostomia

Monitoring Parameters

• blood pressure
• CBC with differential
• growth rate
• heart rate
• platelet count
• weight

Contraindications

• abrupt discontinuation
• acute myocardial infarction
• alcoholism
• anorexia nervosa
• aortic stenosis
• arteriosclerosis
• bipolar disorder
• breast-feeding
• bulimia nervosa
• cardiac arrhythmias
• cardiac disease
• cardiomyopathy
• cerebrovascular disease
• congenital heart disease
• coronary artery disease
• depression
• driving or operating machinery
• geriatric
• growth inhibition
• heart failure
• hypertension
• hyperthyroidism
• mania
• MAOI therapy
• myocardial infarction
• neonates
• obesity treatment
• peripheral vascular disease
• pregnancy
• prosthetic heart valves
• psychosis
• Raynaud’s phenomenon
• schizophrenia
• stroke
• substance abuse
• suicidal ideation
• surgery
• tachycardia
• thyrotoxicosis
• valvular heart disease
• ventricular arrhythmias
• ventricular dysfunction

Interactions

• Acarbose
• Acebutolol
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Guaifenesin; Phenylephrine
• Albiglutide
• Aliskiren
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Aliskiren; Valsartan
• Alogliptin; Pioglitazone
• Alpha-blockers
• Alpha-glucosidase Inhibitors
• Aluminum Hydroxide
• Aluminum Hydroxide; Magnesium Carbonate
• Aluminum Hydroxide; Magnesium Hydroxide
• Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
• Aluminum Hydroxide; Magnesium Trisilicate
• Amantadine
• Ambrisentan
• Amifampridine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Angiotensin II receptor antagonists
• Angiotensin-converting enzyme inhibitors
• Antacids
• Apomorphine
• Aripiprazole
• Armodafinil
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Omeprazole
• Atenolol
• Atenolol; Chlorthalidone
• Atomoxetine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• atypical antipsychotic
• Azilsartan
• Azilsartan; Chlorthalidone
• Benazepril
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Beta-blockers
• Betaxolol
• Bethanechol
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bosentan
• Bretylium
• Brexpiprazole
• Brimonidine; Timolol
• Bromocriptine
• Brompheniramine; Carbetapentane; Phenylephrine
• Bumetanide
• Bupropion
• Bupropion; Naltrexone
• Caffeine
• Caffeine; Ergotamine
• Calcium Carbonate
• Calcium Carbonate; Magnesium Hydroxide
• Calcium Carbonate; Risedronate
• Calcium Carbonate; Simethicone
• Calcium-channel blockers
• Canagliflozin
• Canagliflozin; Metformin
• Candesartan
• Candesartan; Hydrochlorothiazide, HCTZ
• Captopril
• Captopril; Hydrochlorothiazide, HCTZ
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Phenylephrine
• Cardiac glycosides
• Cariprazine
• Carteolol
• Carvedilol
• Chlophedianol; Guaifenesin; Phenylephrine
• Chlorothiazide
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Phenylephrine
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Cimetidine
• Citalopram
• Clevidipine
• Clomipramine
• Clonidine
• Clozapine
• Cocaine
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Colchicine
• Colchicine; Probenecid
• COMT inhibitors
• Dapagliflozin
• Dapagliflozin; Metformin
• Dapagliflozin; Saxagliptin
• Desflurane
• Desipramine
• Desvenlafaxine
• Dexlansoprazole
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Promethazine
• Digitoxin
• Digoxin
• Diltiazem
• Dipeptidyl Peptidase-4 Inhibitors
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Phenylephrine
• Dopamine
• dopamine agonists
• Dorzolamide; Timolol
• Doxazosin
• Doxepin
• Dronabinol
• Droxidopa
• Dulaglutide
• Duloxetine
• Dyphylline
• Dyphylline; Guaifenesin
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Enalapril, Enalaprilat
• Enalapril; Felodipine
• Enalapril; Hydrochlorothiazide, HCTZ
• Enflurane
• Entacapone
• Ephedrine
• Eplerenone
• Epoprostenol
• Eprosartan
• Eprosartan; Hydrochlorothiazide, HCTZ
• Ertugliflozin
• Ertugliflozin; Metformin
• Ertugliflozin; Sitagliptin
• Escitalopram
• Esketamine
• Esmolol
• Esomeprazole
• Esomeprazole; Naproxen
• Ethacrynic Acid
• Exenatide
• Famotidine
• Famotidine; Ibuprofen
• Felodipine
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvoxamine
• Fosinopril
• Fosinopril; Hydrochlorothiazide, HCTZ
• Furosemide
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Green Tea
• Guaifenesin; Phenylephrine
• Guanabenz
• Guanfacine
• H2-blockers
• Halogenated Anesthetics
• Haloperidol
• Halothane
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone; Phenylephrine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Iloperidone
• Iloprost
• Imipramine
• Incretin Mimetics
• Indacaterol
• Indacaterol; Glycopyrrolate
• Indapamide
• Insulin Degludec; Liraglutide
• Insulin Glargine; Lixisenatide
• Insulins
• Iobenguane I 131
• Iohexol
• Iopamidol
• Iopromide
• Ioversol
• Irbesartan
• Isocarboxazid
• Isoflurane
• Isosulfan Blue
• Isradipine
• Labetalol
• Lansoprazole
• Lansoprazole; Naproxen
• Lasmiditan
• Levobetaxolol
• Levobunolol
• Levodopa
• Levomilnacipran
• Levothyroxine
• Levothyroxine; Liothyronine (Porcine)
• Levothyroxine; Liothyronine (Synthetic)
• Linezolid
• Liothyronine
• Liraglutide
• Lisinopril
• Lithium
• Lixisenatide
• Loop diuretics
• Losartan
• Loxapine
• Lumateperone
• Lurasidone
• Macitentan
• Magnesium Hydroxide
• Maprotiline
• Mecamylamine
• Meglitinides
• Meperidine; Promethazine
• Mesoridazine
• Metformin; Pioglitazone
• Metformin; Rosiglitazone
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methyclothiazide
• Methyldopa
• Methylene Blue
• Methylphenidate
• Metoclopramide
• Metolazone
• Metoprolol
• Midodrine
• Miglitol
• Milnacipran
• Mirtazapine
• Modafinil
• Moexipril
• Molindone
• Monoamine oxidase inhibitors
• Nabilone
• Nadolol
• Nebivolol
• Nebivolol; Valsartan
• Nefazodone
• Nicardipine
• Nifedipine
• Nimodipine
• Nisoldipine
• Nitrates
• Nizatidine
• Non-Ionic Contrast Media
• Norepinephrine
• Nortriptyline
• Olanzapine
• Olmesartan
• Omeprazole
• Omeprazole; Amoxicillin; Rifabutin
• Omeprazole; Sodium Bicarbonate
• Paliperidone
• Pantoprazole
• Paroxetine
• Penbutolol
• Pergolide
• Perindopril
• Perindopril; Amlodipine
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenothiazines
• Phenoxybenzamine
• Phentolamine
• Phenylephrine
• Phenylephrine; Promethazine
• Pimozide
• Pindolol
• Pioglitazone
• Potassium-sparing diuretics
• Pramipexole
• Pramlintide
• Prazosin
• Procarbazine
• Prochlorperazine
• Promethazine
• Propranolol
• Proton pump inhibitors
• Protriptyline
• Quetiapine
• Quinapril
• Rabeprazole
• Ramipril
• Ranitidine
• Rasagiline
• Reserpine
• Riociguat
• Risperidone
• Ropinirole
• Rosiglitazone
• Sacubitril; Valsartan
• Safinamide
• Selective serotonin reuptake inhibitors
• Selegiline
• Selexipag
• Semaglutide
• Serotonin norepinephrine reuptake inhibitors
• Sertraline
• Sevoflurane
• SGLT2 Inhibitors
• Sibutramine
• Sodium Bicarbonate
• Sodium Oxybate
• Solriamfetol
• Sotalol
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Sulfonylureas
• Tedizolid
• Telmisartan
• Terazosin
• Theophylline, Aminophylline
• Thiazide diuretics
• Thiazolidinediones
• Thiethylperazine
• Thioridazine
• Thiothixene
• Thyroid hormones
• Timolol
• Tolcapone
• Torsemide
• Trandolapril
• Trandolapril; Verapamil
• Tranylcypromine
• Treprostinil
• Triamterene
• Tricyclic antidepressants
• Trifluoperazine
• Trimipramine
• Umeclidinium; Vilanterol
• Valsartan
• Vasodilators
• Vasopressors
• Venlafaxine
• Verapamil
• Vilazodone
• Vortioxetine
• Ziprasidone