dexmethylphenidate
Dexmethylphenidate (Focalin, Focalin XR) is a stimulant medication that's used for treating attention deficit-hyperactivity disorder (ADHD) in adults and children. It's thought to work by balancing certain chemicals in your brain to help you focus. This medication is available as an immediate-release tablet that you take twice per day and an extended-release capsule you take once per day. Side effects can include stomach upset and nervousness. It can also cause withdrawal symptoms if it's suddenly stopped after long-term use. Focalin (dexmethylphenidate) is available as both a brand-name and lower-cost generic medication.
What is Focalin (dexmethylphenidate)?
What is Focalin (dexmethylphenidate) used for?
- Attention deficit-hyperactivity disorder (ADHD)
How Focalin (dexmethylphenidate) works
Focalin (dexmethylphenidate) is a stimulant medication. It's not exactly known how the medication helps to improve attention, focus, and wakefulness. But it's thought to work by raising the levels of chemicals in your brain called norepinephrine and dopamine.
Drug facts
More on Focalin (dexmethylphenidate) essentials
Risks and warnings for Focalin (dexmethylphenidate)
Focalin (dexmethylphenidate) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Misuse and dependence
- Risk factors: History of substance or alcohol use disorder | Taking more Focalin (dexmethylphenidate) than prescribed
Focalin (dexmethylphenidate) has risks of misuse and dependence. Misusing this medication can raise your risk for other serious side effects, such as fast heart rate, high blood pressure, anxiety, aggressive behavior, and even thoughts of hurting yourself or others. You can also develop physical dependence to Focalin (dexmethylphenidate) if you take it for a long period of time. This raises your risk for withdrawal symptoms if you suddenly stop taking the medication. Take Focalin (dexmethylphenidate) exactly as prescribed to you. Don't change the dose or how often you take it without talking to your provider first.
Serious heart problems
- Risk factors: History of heart problems
There have been reports of sudden death, stroke, and heart attack in people who took stimulant medications like Focalin (dexmethylphenidate) at usual doses. Focalin (dexmethylphenidate) can also raise your blood pressure and heart rate. Tell your provider if you have a history of heart problems before you start Focalin (dexmethylphenidate) to make sure it's safe for you to take. Your provider will check for heart problems before starting treatment with this medication. Contact your provider if you experience unexplained fainting, chest pain with physical activity, or irregular heartbeat while you're taking Focalin (dexmethylphenidate).
Changes in behavior or thoughts
- Risk factors: History of psychotic episodes | Personal or family history of depression, bipolar disorder, depression, or other mental health or mood-related conditions
Taking a stimulant like Focalin (dexmethylphenidate) can cause mental health problems such as hallucinations (seeing things that aren't really there), abnormal or unclear thinking, and mania. This medication can worsen mood-related problems that you already have. But these changes in mood or behavior can also happen even if you haven't had these problems before. Talk to your provider right away if you have these mood- and behavior-related symptoms while you're taking Focalin (dexmethylphenidate) because you might have to stop taking it.
Prolonged and painful erection
Although rare, some people taking medications similar to Focalin (dexmethylphenidate) have had prolonged and painful erections. Sometimes, this problem might require surgery to treat. This problem was typically reported after the dose was raised, but has also happened when the medication was stopped. Stop taking Focalin (dexmethylphenidate) and get medical attention as soon as possible if you develop a painful erection that lasts longer than 4 hours.
Problems with blood circulation (Raynaud's phenomenon)
Focalin (dexmethylphenidate) might be linked to poor blood circulation problems, such as Raynaud's phenomenon. People with Raynaud's phenomenon can experience episodes of poor blood flow to the fingers and toes, which can cause the skin to turn pale and to feel cold, numb, or painful. If this happens, symptoms are typically mild. But rarely, it can cause sores or ulcers in more serious cases. Let your healthcare provider know if you notice symptoms of circulation problems, such as bouts of numbness or pain in your fingers or toes. Your provider might need to lower your dose of Focalin (dexmethylphenidate) or ask you to consider a different medication.
Slowed growth in children
In studies, children taking stimulants like Focalin (dexmethylphenidate) daily throughout the year had a temporary slowing of growth. On average, the children in these studies had about 2 cm less growth in height and about 6 pounds less growth in weight over 3 years. Your child's provider will track your child's growth progress closely. Your child's provider might pause or stop treatment if the provider suspects slowed growth. Talk to your child's provider if you have concerns.
Serotonin syndrome
- Risk factors: Taking monoamine oxidase inhibitors (MAOIs) 14 days before starting Focalin (dexmethylphenidate) | Taking other medications that raise serotonin levels in your brain
Serotonin syndrome is a rare, but potentially life-threatening condition that happens when there's too much serotonin in the brain. Serotonin is one of the chemicals in your brain responsible for your mood. Most people who report having serotonin syndrome while taking Focalin (dexmethylphenidate) are also taking other medications that affect serotonin levels. These medications can include antidepressants, MAOIs, linezolid (Zyvox), and migraine medications called triptans.
Tell your provider about all the medications you take or plan to take before you start Focalin (dexmethylphenidate). Be aware of symptoms of serotonin syndrome, such as fast heart rate, sweating, muscle stiffness or spasms, high fever, and confusion. Get medical help right away if you have any of these symptoms.
Drug interactions
Focalin (dexmethylphenidate) can interact with many medications. For example, it counteracts (works against) the effects of many blood pressure medications. This means your blood pressure medications might not work as well for you if you take them with Focalin (dexmethylphenidate). Additionally, avoid taking Focalin (dexmethylphenidate) with monoamine oxidase inhibitors (MAOIs). This combination can raise your risk of having severely high blood pressure. Discuss with your provider and pharmacist about all the medications you take (including over-the-counter medications and supplements) before and during treatment with Focalin (dexmethylphenidate).
Side effects of Focalin (dexmethylphenidate)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Immediate-release tablet Age 6 to 17 years:
- Stomach pain (15%)
- Nausea (9%)
- Low appetite (6%)
Extended-release capsule Age 6 to 17 years:
- Difficulty sleeping (up to 17%)
- Vomiting (up to 9%)
- Low appetite (up to 7%)
Age 17 to 60 years:
- Headache (up to 39%)
- Dry mouth (up to 20%)
- Anxiety (up to 11%)
- Indigestion (up to 9%)
- Throat pain (up to 7%)
Less Common Side Effects
- Fast heart rate or racing heart
- High blood pressure
- Blurry vision
- Irritability in children
Focalin (dexmethylphenidate) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reactions: rash; hives; difficulty breathing; swelling of face, lips, tongue, or throat
- Heart problems: heart attack, fast heart rate, high blood pressure
- Stroke: sudden headache, weakness or numbness on one side of the body, trouble speaking or walking, drooping face
- Mental health-related problems: manic episodes, changes in thoughts or behavior, hallucinations
- Serotonin syndrome: fast heart rate, sweating, muscle stiffness or spasms, fever, confusion
More on Focalin (dexmethylphenidate) side effects
The following Focalin (dexmethylphenidate) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Less common
Discouragement
fast, pounding, or irregular heartbeat or pulse
feeling sad or empty
irritability
lack of appetite
loss of interest or pleasure
mood swings
tiredness
trouble concentrating
trouble sleeping
Incidence not known
Agitation
arm, back or jaw pain
black, tarry stools
bleeding gums
blood in the urine
bloody nose
blurred vision
chest pain or discomfort
chest tightness or heaviness
chills
confusion
dark urine
difficulty in speaking
difficulty swallowing
dizziness
double vision
drowsiness
fainting
feeling that others are watching you or controlling your behavior
feeling that others can hear your thoughts
feeling, seeing, or hearing things that are not there
headache
heavier menstrual periods
inability to move the arms, legs, or facial muscles
inability to speak
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
muscle cramps, pain, stiffness, or spasms
nervousness
overactive reflexes
painful or difficult urination
pale skin
pinpoint red spots on the skin
poor coordination
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
redness, soreness, or itching skin
restlessness
right upper quadrant tenderness
seizures
severe mood or mental changes
shivering
slow speech
slowed growth in children
sores, ulcers, or white spots on the lips or in the mouth
sores, welts, or blisters
stuffy or runny nose
sweating
swollen glands
talking or acting with excitement you cannot control
trembling or shaking
troubled breathing with exertion
twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
unusual behavior
unusual bleeding or bruising
unusual tiredness or weakness
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Agitation
bigger, dilated, or enlarged pupils (black part of the eye)
dry eyes, mouth, nose, or throat
false or unusual sense of well-being
feeling of warmth
holding false beliefs that cannot be changed by fact
increased sensitivity of the eyes to light
loss of consciousness
muscle twitching
overactive reflexes
redness of the face, neck, arms, and occasionally, upper chest
unusual excitement, nervousness, or restlessness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Focalin (dexmethylphenidate)
Pros
- Works well to treat ADHD in children and adults
- Available as immediate-release tablets and extended-release capsules for a more flexible dosing schedule
- Available as a lower-cost generic
Cons
- A controlled substance because of the risk for misuse and dependency
- Might cause trouble sleeping if you take too late in the day
- Not the best option if you have heart problems
- Not available as a liquid
Pharmacist tips for Focalin (dexmethylphenidate)
- It's best to take your first dose of Focalin (dexmethylphenidate) in the morning. Try to avoid taking your dose(s) too late in the day so you don't have trouble sleeping later at night.
- Swallow the immediate-release tablets and extended-release capsules whole. Don't crush or chew them.
- For the extended-release capsules: If you're having trouble swallowing the capsules, you can open them and sprinkle all of the small beads inside the capsule over a spoonful of applesauce. Once the medication is sprinkled on top, swallow the applesauce right away without chewing. Don't save it for a later time.
- Take Focalin (dexmethylphenidate) exactly as prescribed. Don't change your dose or stop taking the medication without talking to your provider first. Doing so can lead to bothersome withdrawal symptoms, such as daytime sleepiness, large appetite, trouble sleeping, irritation, and depression.
- You can take Focalin (dexmethylphenidate) with or without food. Some people who take this medication might have a lower appetite, so try to follow a healthy and balanced diet. Tell a provider if you or your child appears to have a lower appetite or have had concerning weight changes during treatment.
- You might want to avoid driving during the first few days after you start Focalin (dexmethylphenidate) and after dose changes until you know how the medication affects you. Focalin (dexmethylphenidate) might cause dizziness and blurry vision, which might affect your ability to drive safely.
- Make sure your provider knows about the medications you're taking before you start Focalin (dexmethylphenidate). And don't start any new medications without talking to your provider or pharmacist first once you start treatment. Focalin (dexmethylphenidate) can have harmful drug interactions, so your providers can check that all your medications are safe for you to take.
- Accidentally taking too much Focalin (dexmethylphenidate) can lead to an overdose. Symptoms of an Focalin (dexmethylphenidate) overdose include restlessness, quick breathing, fast heartbeat, irritability, aggression, and fever. It's important for you and your loved ones to know how to recognize an overdose. Call 911 if you think an overdose has happened.
Common questions about Focalin (dexmethylphenidate)
The immediate-release tablet of Focalin (dexmethylphenidate) takes about 30 to 45 minutes to work. The extended-release capsule of dexmethylphenidate (Focalin XR) starts to work within 30 minutes.
Studies show that the immediate-release tablet of Focalin (dexmethylphenidate) can last for up to 6 hours. Studies also show that the extended-release capsule of dexmethylphenidate (Focalin XR) can last for about 11 to 12 hours.
Yes, Focalin (dexmethylphenidate) is a stimulant medication that's used for ADHD. Other stimulants that are used for ADHD include methylphenidate and Adderall (dextroamphetamine / amphetamine salts).
Yes. Focalin (dexmethylphenidate) is a schedule II controlled substance because it has a risk of misuse and dependence. Misuse is when a medication is used for non-medical reasons for its physical or emotional effects (e.g., a "high" feeling). People can also misuse the medication when they take it even though it's not prescribed for them (e.g., for its effects on mental focus). Misuse can lead to serious symptoms like fast heart rate, high blood pressure, trouble sleeping, anxiety, and aggression. Dependence can lead to having withdrawal symptoms like irritation, sleep problems, and distress if you suddenly stop taking the medication after long-term use. Only take Focalin (dexmethylphenidate) as prescribed by your provider to lower your risks for misuse and dependence. Speak with your provider if you're concerned about these risks.
Yes, there's a risk for addiction when Focalin (dexmethylphenidate) gets misused for its physical or emotional effects (e.g., a "high" feeling, mental focus). Not only can misuse lead to changes in behavior and serious heart problems, it can also lead to substance use disorder, which in severe cases can lead to addiction. To lower your risk for misuse and addiction, only take Focalin (dexmethylphenidate) as prescribed by your provider. Discuss with your provider about the risk for addiction with Focalin (dexmethylphenidate) if you're concerned.
Focalin (dexmethylphenidate) and Adderall (dextroamphetamine / amphetamine salts) are different stimulant medications that treat ADHD. The two medications have similar side effects and potential risks, and they both have immediate-release and extended-release forms. But ADHD experts might recommend Focalin (dexmethylphenidate) and Adderall for different age groups based on research about how well the medications work and how safe they are for adults and children. For example, Adderall might be the preferred choice for adults, whereas Focalin (dexmethylphenidate) might be the preferred choice for children and adolescents. Speak with your provider about the appropriate choice for you if you need medication to treat your ADHD.
Some people taking Focalin (dexmethylphenidate) have reported weight loss during clinical studies. Note that Focalin (dexmethylphenidate) can lower your appetite, which might contribute to any weight loss that you might experience. Keep in mind that this medication isn't approved or recommended to be used as a primary way to lose weight. Intentionally using Focalin (dexmethylphenidate) for this purpose is considered substance misuse and can be unsafe. Talk to your provider about currently available options if you're looking for safe weight loss methods.
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Focalin (dexmethylphenidate) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 5mg | 30 tablets | $12.90 | $0.43 |
| 2.5mg | 30 tablets | $9.97 | $0.33 |
| 10mg | 60 tablets | $29.92 | $0.50 |
Typical dosage for Focalin (dexmethylphenidate)
Your dose will depend on your age and whether you were previously taking other stimulant medications. Your provider will adjust your dose based on how well Focalin (dexmethylphenidate) is working for you and whether you're having side effects.
-
Immediate-release tablet (Focalin and generic): The typical starting dose is 2.5 mg by mouth twice a day (at least 4 hours apart). The maximum dose is 20 mg per day.
-
Extended-release capsule (Focalin XR and generic)
- Adults: The typical starting dose is 10 mg by mouth once a day in the morning. The maximum dose is 40 mg per day.
- Children: The typical starting dose is 5 mg mouth once a day in the morning. The maximum dose is 30 mg per day.
-
People who are currently taking a methylphenidate medication: The dose of Focalin (dexmethylphenidate) depends on the dose of methylphenidate you were previously taking. In general, the typical starting dose of Focalin (dexmethylphenidate) is half of your total daily dose of methylphenidate.
More on Focalin (dexmethylphenidate) dosage
Interactions between Focalin (dexmethylphenidate) and other drugs
More on Focalin (dexmethylphenidate) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Methylene Blue
- Moclobemide
- Nialamide
- Ozanimod
- Phenelzine
- Procarbazine
- Rasagiline
- Safinamide
- Selegiline
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Desflurane
- Enflurane
- Halothane
- Iobenguane I 131
- Isoflurane
- Methoxyflurane
- Risperidone
- Sevoflurane
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Focalin (dexmethylphenidate) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Focalin (dexmethylphenidate) will not be safe for you to take.
- Severe allergy to methylphenidate-containing products
- Currently take or have taken a monoamine oxidase inhibitors (MAOI) in the last 14 days
What are alternatives to Focalin (dexmethylphenidate)?
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