Dexmethylphenidate: Difference between revisions
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MDElliottMD (talk | contribs) Migrated 52 effect tag(s) to global ref= |
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==== Therapeutic ==== | ==== Therapeutic ==== | ||
* <effect | * <effect ref="attention">Improved attention, executive function, and working memory. Many patients report a cleaner subjective effect than racemic methylphenidate at equivalent therapeutic doses.</effect> | ||
* <effect | * <effect ref="reduced-impulsivity"/> | ||
* <effect | * <effect ref="wakefulness"/> | ||
==== Common ==== | ==== Common ==== | ||
* <effect | * <effect ref="decreased-appetite">Often dose-limiting; may produce weight loss over time.</effect> | ||
* <effect | * <effect ref="insomnia">Especially with late-afternoon dosing.</effect> | ||
* <effect | * <effect ref="headache"/> | ||
* <effect | * <effect ref="abdominal-pain"/> | ||
* <effect | * <effect ref="irritability"/> | ||
* <effect | * <effect ref="dry-mouth"/> | ||
* <effect | * <effect ref="hr-bp-elevation">Usually mild but dose-dependent.</effect> | ||
* <effect | * <effect ref="weight-loss"/> | ||
==== Cardiovascular ==== | ==== Cardiovascular ==== | ||
* <effect | * <effect ref="palpitations"/> | ||
* <effect | * <effect ref="cardiac-event">Rare reports of sudden cardiac death in patients with structural heart disease (FDA warning).</effect> | ||
==== Psychiatric ==== | ==== Psychiatric ==== | ||
* <effect | * <effect ref="anxiety"/> | ||
* <effect | * <effect ref="agitation"/> | ||
* <effect | * <effect ref="psychosis">Rare; higher risk in patients with bipolar predisposition.</effect> | ||
* <effect | * <effect ref="mania">Rare; higher risk in patients with bipolar predisposition.</effect> | ||
* <effect | * <effect ref="hallucinations">Visual or tactile; rare, more common at higher doses or in predisposed patients.</effect> | ||
==== Other adverse ==== | ==== Other adverse ==== | ||
* <effect | * <effect ref="tics">May emerge or worsen; comorbid Tourette syndrome is a traditional relative contraindication.</effect> | ||
* <effect | * <effect ref="dependence">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 | * <effect ref="tolerance">To therapeutic effects, with chronic high-dose use.</effect> | ||
* <effect | * <effect ref="growth-suppression">Modest reduction in growth velocity in chronically-treated children.</effect> | ||
* <effect | * <effect ref="priapism">Rare but documented; FDA warning, especially in adolescents.</effect> | ||
* <effect | * <effect ref="vasculopathy">Raynaud-like phenomenon, rare digital ischemia.</effect> | ||
* <effect | * <effect ref="seizure">Caution in epilepsy.</effect> | ||
* <effect | * <effect ref="withdrawal">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 | ||
| Line 114: | Line 114: | ||
'''Renal/hepatic impairment:''' caution; reduce dose and monitor.<h2 id="Effects">Effects</h2><span></span> | '''Renal/hepatic impairment:''' caution; reduce dose and monitor.<h2 id="Effects">Effects</h2><span></span> | ||
====Therapeutic==== | ====Therapeutic==== | ||
*<effect | *<effect ref="attention">Improved attention, executive function, and working memory. Many patients report a cleaner subjective effect than racemic methylphenidate at equivalent therapeutic doses.</effect> | ||
*<effect | *<effect ref="reduced-impulsivity"/> | ||
*<effect | *<effect ref="wakefulness"/> | ||
<span></span> | <span></span> | ||
====Common==== | ====Common==== | ||
*<effect | *<effect ref="decreased-appetite">Often dose-limiting; may produce weight loss over time.</effect> | ||
*<effect | *<effect ref="insomnia">Especially with late-afternoon dosing.</effect> | ||
*<effect | *<effect ref="headache"/> | ||
*<effect | *<effect ref="abdominal-pain"/> | ||
*<effect | *<effect ref="irritability"/> | ||
*<effect | *<effect ref="dry-mouth"/> | ||
*<effect | *<effect ref="hr-bp-elevation">Usually mild but dose-dependent.</effect> | ||
*<effect | *<effect ref="weight-loss"/> | ||
<span></span> | <span></span> | ||
====Cardiovascular==== | ====Cardiovascular==== | ||
*<effect | *<effect ref="palpitations"/> | ||
*<effect | *<effect ref="cardiac-event">Rare reports of sudden cardiac death in patients with structural heart disease (FDA warning).</effect> | ||
<span></span> | <span></span> | ||
====Psychiatric==== | ====Psychiatric==== | ||
*<effect | *<effect ref="anxiety"/> | ||
*<effect | *<effect ref="agitation"/> | ||
*<effect | *<effect ref="psychosis">Rare; higher risk in patients with bipolar predisposition.</effect> | ||
*<effect | *<effect ref="mania">Rare; higher risk in patients with bipolar predisposition.</effect> | ||
*<effect | *<effect ref="hallucinations">Visual or tactile; rare, more common at higher doses or in predisposed patients.</effect> | ||
<span></span> | <span></span> | ||
====Other adverse==== | ====Other adverse==== | ||
*<effect | *<effect ref="tics">May emerge or worsen; comorbid Tourette syndrome is a traditional relative contraindication.</effect> | ||
*<effect | *<effect ref="dependence">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 | *<effect ref="tolerance">To therapeutic effects, with chronic high-dose use.</effect> | ||
*<effect | *<effect ref="growth-suppression">Modest reduction in growth velocity in chronically-treated children.</effect> | ||
*<effect | *<effect ref="priapism">Rare but documented; FDA warning, especially in adolescents.</effect> | ||
*<effect | *<effect ref="vasculopathy">Raynaud-like phenomenon, rare digital ischemia.</effect> | ||
*<effect | *<effect ref="seizure">Caution in epilepsy.</effect> | ||
*<effect | *<effect ref="withdrawal">Fatigue, rebound hyperactivity, dysphoria on dose offset.</effect><h2 id="Contraindications">Contraindications</h2> | ||
*Hypersensitivity to dexmethylphenidate or methylphenidate | *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 | ||