Dexmethylphenidate extended release (
XR) [Focalin XR] is a
CNS stimulant indicated for the treatment of
attention-deficit hyperactivity disorder (
ADHD) in patients aged > or = 6 years.
Dexmethylphenidate contains the d-threo-enantiomer of
methylphenidate.
Dexmethylphenidate XR capsules have a bimodal release profile, which mimics two doses of
dexmethylphenidate immediate release (IR) given 4 hours apart, and allows once-daily administration. Once-daily
dexmethylphenidate XR was effective and generally well tolerated in the treatment of
ADHD in children, adolescents and adults in placebo-controlled trials. Improvements in
ADHD symptoms were significantly greater for
dexmethylphenidate XR versus placebo throughout the day, from as early as 0.5 hours after
drug administration up to 11-12 hours after administration. Furthermore,
dexmethylphenidate XR showed greater efficacy than osmotic release oral system (OROS)
methylphenidate over the first half of the laboratory classroom day in crossover trials; however, assessments late in the day (10-12 hours post-dose) favoured OROS
methylphenidate. The once-daily administration regimen with
dexmethylphenidate XR avoids the need for a midday dose to be administered at school; administration options are extended in that the contents of the
dexmethylphenidate XR
capsule can be sprinkled on apple sauce for patients unable to swallow the
capsule whole. Although
dexmethylphenidate XR is a
controlled substance in the US, this formulation appears to have a low risk of abuse or misuse. Thus,
dexmethylphenidate XR extends the range of first-line pharmacological treatment options for children, adolescents or adults with
ADHD, particularly for patients who require a rapid onset and prolonged duration of action, including children who require a reduction in
ADHD symptoms throughout the school day.