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Focalin
Dexmethylphenidate Hydrochloride
NOTE: This preparation may contain one or more substances that are restricted in certain sports competitors should check with the appropriate sports authorities
Drug Profile
Dexmethylphenidate hydrochloride is the d-threo-enantiomer of racemic methylphenidate hydrochloride. It is used as a central stimulant in the treatment of hyperactivity disorders in children.
For patients new to methylphenidate the starting dose of dexmethylphenidate hydrochloride is 2.5 mg twice daily. Each dose should be given at least four hours apart. Dosage may be adjusted in 2.5 to 5 mg increments weekly to a maximum of 10 mg twice daily.
For patients currently using methylphenidate the starting dose of dexmethylphenidate hydrochloride is half the dose of the racemic substance. The maximum recommended dose is 10 mg twice daily. Dexmethylphenidate should be stopped if there is no improvement in symptoms after appropriate adjustments in dosage over one month. It also needs to be stopped from time to time in those who do respond to assess the patient's condition.
As this medication is a preperation of both dexmethylphenidate hydrochloride and methylphenidate hydrochloride :-
Uses and Administration, Adverse Effects, Treatment, and Precautions, Pharmacokinetics and Preparations please check out:- Martindale: The Complete Drug Reference and should be taken as to being appropriate to majority of the medications on this page that have either of the ingredients above - Ed.
Focalin is now available off licence in the UK though only on the same basis as Ritalin SR i.e. your pharmacist has to fax your prescription to BR Pharma on the following number (UK Only), (Tel:020 8238 6770). BR Pharma then deliver to the pharmacist the next day.
The following are sometimes used with the stimulant medications to help with sleep problems or other associated conditions so the information we have here is not that extensive so always speak to the doctor to find out more information about these and ask how these medications will be monitored:
Imipramine - Tofranil
This is one of the tricylic antidepressants.
Imipramine helps with anxiety and depression and is used when stimulant medication fails to get a response or it not appropriate to be given. It is not as effective with the core ADHD symptoms.
Side effects can include:
dry mouth, constipation, rash, raised blood pressure, confusion, seizures, abnormal heart rhythms.
Only the first two are usually seen however this medication should be carefully monitored by the doctor and regular blood pressure and pulse checks should be made. Also if there is a concern EEG recordings can be taken.
Imipramine inhibits re-uptake of norepinephrine.
Clonidine - Catapres - Dixirit
Clonidine is an antihypertensive medication and is often used later in the day to help combat insomnia which can be caused by stimulant medication. Clonidine can help symptoms by: -
Decreasing impulsivity and hyperactivity, decreasing aggression, improving sleep.
Clonidine is usually given in conjunction with Ritalin or Dexedrine,
Side effects can include: -
- Sedation, dry mouth, nausea, dizziness, rash
- There is a very slight concern of heart deaths and Clonidine must be withdrawn gradually.
- Overdose is very dangerous.
- Clonidine blocks norepinephrine auto-receptors.
Clonidine / Catapres Patches are also available, these appear to last for about 5 days in children compared to 7 days in adults. The patch may be cut to adjust doseage. It can take up to 2 - 4 weeks to see any effect and maximum effect can take several months. This can also be the case in tablet form.
Clonidine should only be discontinued under proper guidence for gradual withdrawal to avoid any withdrawal symptoms.
Drug Combinations
If certain medications help only some of the symptoms a combination of medications may be tried, but only in consultation with your physician or medical practitioner.
For example Tricylic Antidepressiants can help with depression but ADHD symptoms remain, Ritalin or Dexedrine can be used in conjunction to enable relief of all symptoms. Likewise Clonidine can be used to combat aggressive behaviour along with Ritalin or Dexedrine for the other ADHD symptoms.
next: Safe Storage and Administration of Methylphenidate
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