dexmethylphenidate hydrochloride

(decks meth ill fen' i date)

Focalin

Pregnancy Category C
Controlled Substance C-II

Drug class
CNS stimulant

Therapeutic actions
Mild cortical stimulant with CNS actions similar to those of the amphetamines; is thought
to block the reuptake of norephinephrine and dopamine, increasing their concentration in
the synaptic cleft; mechanism of effectiveness in hyperkinetic syndromes is not
understood.

Indication
Treatment of attention deficit-hyperactivity disorder in patients > 6 yr as part of a total
treatment program

Contraindications and cautions

• Contraindicated with hypersensitivity to dexmethylphenidate or methylphenidate;
marked anxiety, tension, and agitation; glaucoma; motor tics, family history or
diagnosis of Tourette's syndrome; use of MAOIs within the past 14 days.
• Use cautiously with psychosis, seizure disorders; CHF, recent MI,
hyperthyroidism; drug dependence, alcoholism, severe depression of endogenous
or exogenous origin; as treatment of normal fatigue states; pregnancy, lactation.

Available forms
Tablets—2.5, 5, 10 mg

Dosages
ADULTS AND CHILDREN > 6 YR
Individualize dosage. Administer orally twice a day, at least 4 hr apart, without regard to
meals. Starting dose, 2.5 mg PO bid; may increase as needed in 2.5- to 5-mg increments
to a maximum dose of 10 mg PO bid.
• Patients already on methylphenidate: Start dose at one-half the methylphenidate
dose with a maximum dose of 10 mg PO bid.
PEDIATRIC PATIENTS < 6 YR
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak
Oral Varies 1–1.5 hr

Metabolism: Hepatic; T1/2: 2.2 hr

Distribution: Crosses placenta; may enter breast milk
Excretion: Urine

Adverse effects
• CNS: Nervousness, insomnia, dizziness, headache, dyskinesia, chorea,
drowsiness, Tourette's syndrome, toxic psychosis, blurred vision, accommodation
difficulties
• CV: Increased or decreased pulse and blood pressure; tachycardia, angina,
arrhythmias, palpitations
• Dermatologic: Skin rash, loss of scalp hair
• GI: Anorexia, nausea, abdominal pain; weight loss, abnormal liver function
• Hematologic: Leukopenia, anemia
• Other: Fever, tolerance, psychological dependence, abnormal behavior with
abuse

Interactions
Drug-drug
• Possible increased serum levels of coumarin anticoagulants, phenobarbital,
phenytoin, primidone, TCAs, some SSRIs; if any of these drugs are used with
dexmethylphenidate, monitor the patient closely and decrease dose of the other
drugs as needed
• Risk of severe hypertensive crisis if combined with MAOIs; do not administer
dexmethylphenidate with or within 14 days of an MAOI
• Risk of adverse effects if combined with pressor agents (dopamine, epinephrine)
or antihypertensives; monitor patients closely

Nursing considerations
Assessment
• History: Hypersensitivity to dexmethylphenidate or methylphenidate; marked
anxiety, tension, and agitation; glaucoma; motor tics, family history or diagnosis
of Tourette's syndrome; severe depression of endogenous or exogenous origin;
seizure disorders; hypertension; drug dependence, alcoholism, emotional
instability; pregnancy, lactation
• Physical: Body weight, height, body temperature, skin color, lesions, orientation,
affect, ophthalmic exam (tonometry), P, BP, auscultation, R, adventitious sounds,
bowel sounds, normal output, CBC with differential, platelet count, baseline ECG
(as indicated)

Interventions
• Ensure proper diagnosis before administering to children for behavioral
syndromes. Drug should not be used until other causes and concomitants of
abnormal behavior (learning disability, EEG abnormalities, neurologic deficits)
are ruled out.
• Arrange to interrupt drug dosage periodically in children being treated for
behavioral disorders to determine if symptoms recur at an intensity that warrants
continued drug therapy.
 • Monitor growth of children on long-term dexmethylphenidate therapy.
• Arrange to dispense the least feasible amount of drug at any one time to minimize
risk of overdose.
• Administer drug before 6 PM to prevent insomnia if that is a problem.
• Arrange to monitor CBC, platelet counts periodically in patients on long-term
therapy.
• Monitor blood pressure frequently early in treatment.
• Arrange for consult with school nurse of school-age patients receiving this drug.

Teaching points
• Take this drug exactly as prescribed. It is taken two times a day, at least 4 hr apart.
• Take drug before 6 PM to avoid night-time sleep disturbance.
• Store this drug in a safe place, out of the reach of children.
• Avoid the use of alcohol and over-the-counter drugs, including nose drops, cold
remedies, while taking this drug; some over-the-counter drugs could cause
dangerous effects. If you feel that you need one of these preparations, consult
your health care provider.
• These side effects may occur: Nervousness, restlessness, dizziness, insomnia,
impaired thinking (these effects may become less pronounced after a few days;
avoid driving a car or engaging in activities that require alertness if these occur;
notify your health care provider if these are pronounced or bothersome);
headache, loss of appetite, dry mouth.
• Report nervousness, insomnia, palpitations, vomiting, skin rash, depression.

Adverse effects in Italic are most common; those in Bold are life-threatening.