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Dexmethylphenidate: Difference between revisions

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Created page with "{{MedTemplate | generic = Dexmethylphenidate | brand = Focalin, Focalin XR | structure = Methylphenidate.svg | classes = Psychostimulant, CNS stimulant, NDRI | mechanism = Norepinephrine–dopamine reuptake inhibition (DAT, NET) — d-threo enantiomer of methylphenidate | uses = ADHD | formula = C<sub>14</sub>H<sub>19</sub>NO<sub>2</sub> | routes = Oral | onset = 30–60 min | d..."
 
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'''Conversion from racemic methylphenidate:''' use approximately '''half''' the total daily dose (e.g., Ritalin 20 mg/day → Focalin 10 mg/day).
'''Conversion from racemic methylphenidate:''' use approximately '''half''' the total daily dose (e.g., Ritalin 20 mg/day → Focalin 10 mg/day).
'''Renal/hepatic impairment:''' caution; reduce dose and monitor.
'''Renal/hepatic impairment:''' caution; reduce dose and monitor.
| effects          = ''Therapeutic:'' improved attention, reduced impulsivity and hyperactivity, increased wakefulness, mild appetite suppression. Many patients describe the effect as cleaner or more "focused" compared with racemic methylphenidate at equivalent therapeutic doses, though objective evidence for superiority is modest.
| effects          =  
''Common adverse:'' decreased appetite, insomnia, headache, abdominal pain, mild irritability, dry mouth, mild elevation of heart rate and blood pressure, weight loss.
 
| adverse          = * '''Cardiovascular:''' tachycardia, mild–moderate hypertension; rare sudden cardiac death in structural heart disease (FDA warning)
==== Therapeutic ====
* '''Psychiatric:''' anxiety, agitation, irritability; rarely psychosis, mania, or hallucinations (especially in patients with predisposition)
* <effect slug="attention" label="Attention and focus">Improved attention, executive function, and working memory. Many patients report a cleaner subjective effect than racemic methylphenidate at equivalent therapeutic doses.</effect>
* '''Tics''' — may emerge or worsen; comorbid Tourette is a traditional relative contraindication
* <effect slug="reduced-impulsivity" label="Reduced impulsivity and hyperactivity"/>
* '''Dependence and misuse''' — Schedule II; abuse liability similar to racemic methylphenidate per milligram of active material
* <effect slug="wakefulness" label="Wakefulness"/>
* '''Growth suppression''' — modest reduction in growth velocity in chronically-treated children
 
* '''Priapism''' — rare but documented; FDA warning
==== Common ====
* '''Peripheral vasculopathy''' — Raynaud-like phenomenon, rare digital ischemia
* <effect slug="decreased-appetite" label="Decreased appetite">Often dose-limiting; may produce weight loss over time.</effect>
* '''Lowered seizure threshold'''
* <effect slug="insomnia" label="Insomnia">Especially with late-afternoon dosing.</effect>
* '''Withdrawal / "crash"''' — fatigue, rebound hyperactivity, dysphoria on dose offset
* <effect slug="headache" label="Headache"/>
* <effect slug="abdominal-pain" label="Abdominal pain"/>
* <effect slug="irritability" label="Irritability"/>
* <effect slug="dry-mouth" label="Dry mouth"/>
* <effect slug="hr-bp-elevation" label="Elevated heart rate / blood pressure">Usually mild but dose-dependent.</effect>
* <effect slug="weight-loss" label="Weight loss"/>
 
==== Cardiovascular ====
* <effect slug="palpitations" label="Palpitations / tachycardia"/>
* <effect slug="cardiac-event" label="Serious cardiac event">Rare reports of sudden cardiac death in patients with structural heart disease (FDA warning).</effect>
 
==== Psychiatric ====
* <effect slug="anxiety" label="Anxiety"/>
* <effect slug="agitation" label="Agitation"/>
* <effect slug="psychosis" label="Psychosis">Rare; higher risk in patients with bipolar predisposition.</effect>
* <effect slug="mania" label="Mania">Rare; higher risk in patients with bipolar predisposition.</effect>
* <effect slug="hallucinations" label="Hallucinations">Visual or tactile; rare, more common at higher doses or in predisposed patients.</effect>
 
==== Other adverse ====
* <effect slug="tics" label="Tics">May emerge or worsen; comorbid Tourette syndrome is a traditional relative contraindication.</effect>
* <effect slug="dependence" label="Dependence / misuse">Schedule II controlled substance; abuse liability similar to racemic methylphenidate per milligram of active material. Crushed/insufflated/IV misuse is the major risk pattern.</effect>
* <effect slug="tolerance" label="Tolerance">To therapeutic effects, with chronic high-dose use.</effect>
* <effect slug="growth-suppression" label="Growth suppression">Modest reduction in growth velocity in chronically-treated children.</effect>
* <effect slug="priapism" label="Priapism">Rare but documented; FDA warning, especially in adolescents.</effect>
* <effect slug="vasculopathy" label="Peripheral vasculopathy">Raynaud-like phenomenon, rare digital ischemia.</effect>
* <effect slug="seizure" label="Lowered seizure threshold">Caution in epilepsy.</effect>
* <effect slug="withdrawal" label="Withdrawal / "crash"">Fatigue, rebound hyperactivity, dysphoria on dose offset.</effect>
| contraindications = * Hypersensitivity to dexmethylphenidate or methylphenidate
| contraindications = * Hypersensitivity to dexmethylphenidate or methylphenidate
* Concurrent MAOI use, or within 14 days of MAOI discontinuation
* Concurrent MAOI use, or within 14 days of MAOI discontinuation
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