Dosing & Uses
Dosage Forms & Strengths
tablet
- 2.5mg
- 5mg
- 10mg
capsule, extended-release
- 5mg
- 10mg
- 15mg
- 20mg
- 25mg
- 30mg
- 35mg
- 40mg
Attention Deficit Hyperactivity Disorder
Focalin
- Initial: 2.5 PO twice daily; may increase in 2.5- to 5-mg increments qWeek if warranted
- Not to exceed 20 mg/day
Focalin XR
- Not taking Focalin or methylphenidate: 10 mg PO qDay initially; may increase in 10-mg increments qWeek if warranted; not to exceed 20 mg/day
- Switch from Focalin: Administer the same total daily dose as Focalin but administer qDay
- Switch from methylphenidate: Initiate with half total daily dose of methylphenidate and administer qDay; not to exceed 40 mg/day
Dosing Modifications
Hepatic impairment: Safety and efficacy not established
Renal impairment: Not studied; expected to have minimal effects on kinetics of dexmethylphenidate considering its extensive metabolism to inactive compounds
Dosage Forms & Strengths
tablet
- 2.5mg
- 5mg
- 10mg
capsule, extended-release
- 5mg
- 10mg
- 15mg
- 20mg
- 25mg
- 30mg
- 35mg
- 40mg
Attention Deficit Hyperactivity Disorder
<6 years
- Safety and efficacy not established
≥6 years (Focalin)
- Initial: 2.5 PO twice daily; may increase in 2.5- to 5-mg increments qWeek if warranted
- Not to exceed 20 mg/day
≥6 years (Focalin XR)
- Not taking Focalin or methylphenidate: 5 mg PO qDay initially; may increase in 5-mg increments qWeek if warranted; not to exceed 30 mg/day
- Switch from Focalin: Administer the same total daily dose as Focalin but administer qDay
- Switch from methylphenidate: Initiate with half total daily dose of methylphenidate and administer qDay; not to exceed 30 mg/day
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (10)
- iobenguane I 123
dexmethylphenidate decreases effects of iobenguane I 123 by receptor binding competition. Contraindicated. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results.
- isocarboxazid
isocarboxazid increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- linezolid
linezolid increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- phenelzine
phenelzine increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- procarbazine
procarbazine increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- rasagiline
rasagiline increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Dexmethylphenidate use is contraindicated during treatment with MAOIs and also within a minimum of 14 days following discontinuation of treatment with an MAOI.
- safinamide
dexmethylphenidate, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.
- selegiline
selegiline increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Dexmethylphenidate use is contraindicated during treatment with MAOIs and also within a minimum of 14 days following discontinuation of treatment with an MAOI.
- selegiline transdermal
selegiline transdermal increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- tranylcypromine
tranylcypromine increases effects of dexmethylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Serious - Use Alternative (29)
- amitriptyline
amitriptyline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- amoxapine
amoxapine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, dexmethylphenidate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- cabergoline
cabergoline, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- clomipramine
clomipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- desflurane
desflurane increases toxicity of dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- desipramine
desipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dihydroergotamine
dihydroergotamine, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dihydroergotamine intranasal
dihydroergotamine intranasal, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- doxapram
doxapram increases effects of dexmethylphenidate by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.
- doxepin
doxepin, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ergoloid mesylates
ergoloid mesylates, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ergotamine
ergotamine, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ether
ether increases toxicity of dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- imipramine
imipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- iobenguane I 131
dexmethylphenidate will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- isoflurane
isoflurane increases toxicity of dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- levomilnacipran
dexmethylphenidate and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.
- lofepramine
lofepramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- maprotiline
maprotiline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methoxyflurane
methoxyflurane increases toxicity of dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- methylergonovine
methylergonovine, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- nortriptyline
nortriptyline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ozanimod
ozanimod increases toxicity of dexmethylphenidate by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- protriptyline
protriptyline, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- sevoflurane
sevoflurane increases toxicity of dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- trazodone
trazodone, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- trimipramine
trimipramine, dexmethylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- yohimbe
yohimbe, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Monitor Closely (169)
- albuterol
albuterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
albuterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - alfentanil
alfentanil increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alprazolam
alprazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amitriptyline
amitriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amobarbital
amobarbital increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amoxapine
amoxapine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- arformoterol
arformoterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
arformoterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - aripiprazole
aripiprazole increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- armodafinil
armodafinil and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
- azelastine
azelastine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- belladonna and opium
belladonna and opium increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benperidol
benperidol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benzphetamine
dexmethylphenidate and benzphetamine both decrease sedation. Use Caution/Monitor.
benzphetamine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - bromocriptine
bromocriptine, dexmethylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.
- brompheniramine
brompheniramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- buprenorphine subdermal implant
dexmethylphenidate, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- buprenorphine, long-acting injection
dexmethylphenidate, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
- butabarbital
butabarbital increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butalbital
butalbital increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butorphanol
butorphanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- caffeine
caffeine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
- captopril
dexmethylphenidate decreases effects of captopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effect of captopril.
- carbinoxamine
carbinoxamine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chloral hydrate
chloral hydrate increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpromazine
chlorpromazine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
chlorpromazine, dexmethylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - cimetidine
cimetidine will increase the level or effect of dexmethylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies only to extended release formulation
- cinnarizine
cinnarizine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- citalopram
dexmethylphenidate increases effects of citalopram by decreasing metabolism. Use Caution/Monitor. Potential risk for serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed during coadministration.
- clemastine
clemastine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clomipramine
clomipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clonazepam
clonazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clonidine
dexmethylphenidate increases toxicity of clonidine by unknown mechanism. Use Caution/Monitor.
- clorazepate
clorazepate increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clozapine
clozapine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- codeine
codeine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclizine
cyclizine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyproheptadine
cyproheptadine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- desipramine
desipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexfenfluramine
dexmethylphenidate and dexfenfluramine both decrease sedation. Use Caution/Monitor.
dexfenfluramine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dexmedetomidine
dexmedetomidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
dexmethylphenidate and dextroamphetamine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextromoramide
dextromoramide increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diamorphine
diamorphine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diethylpropion
dexmethylphenidate and diethylpropion both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - difenoxin hcl
difenoxin hcl increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenhydramine
diphenhydramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dipipanone
dipipanone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dobutamine
dobutamine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
dobutamine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopamine
dexmethylphenidate and dopamine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopexamine
dopexamine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
dopexamine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - doxepin
doxepin increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- droperidol
droperidol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- droxidopa
dexmethylphenidate and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension
- ephedrine
ephedrine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
ephedrine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - epinephrine
epinephrine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
epinephrine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - epinephrine inhaled
dexmethylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- epinephrine racemic
epinephrine racemic and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
epinephrine racemic and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - escitalopram
dexmethylphenidate increases effects of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, dexmethylphenidate. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .
- eslicarbazepine acetate
dexmethylphenidate increases effects of eslicarbazepine acetate by decreasing metabolism. Use Caution/Monitor.
- estazolam
estazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ethanol
ethanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- famotidine
famotidine will increase the level or effect of dexmethylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies only to extended release formulation
- fenfluramine
dexmethylphenidate and fenfluramine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - fluphenazine
fluphenazine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
fluphenazine, dexmethylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - flurazepam
flurazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- formoterol
formoterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
formoterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - haloperidol
haloperidol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydralazine
hydralazine, dexmethylphenidate. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.
- hydromorphone
hydromorphone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydroxyzine
hydroxyzine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen/famotidine
ibuprofen/famotidine will increase the level or effect of dexmethylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies only to extended release formulation
- iloperidone
iloperidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- imipramine
imipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- isavuconazonium sulfate
dexmethylphenidate will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- isoproterenol
isoproterenol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
isoproterenol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ketotifen, ophthalmic
ketotifen, ophthalmic increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levalbuterol
levalbuterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
levalbuterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - levorphanol
levorphanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lisdexamfetamine
dexmethylphenidate and lisdexamfetamine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - lofepramine
lofepramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofexidine
lofexidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loprazolam
loprazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lorazepam
lorazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lormetazepam
lormetazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine
loxapine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- maprotiline
maprotiline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- marijuana
marijuana increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- melatonin
melatonin increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meperidine
meperidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meprobamate
meprobamate increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaproterenol
metaproterenol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
metaproterenol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methadone
methadone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methamphetamine
dexmethylphenidate and methamphetamine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methyldopa
methyldopa increases effects of dexmethylphenidate by unknown mechanism. Use Caution/Monitor.
- methylenedioxymethamphetamine
dexmethylphenidate and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methylphenidate
dexmethylphenidate increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.
- midazolam
midazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midodrine
dexmethylphenidate and midodrine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - mirtazapine
mirtazapine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- modafinil
dexmethylphenidate and modafinil both decrease sedation. Use Caution/Monitor.
- morphine
morphine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- motherwort
motherwort increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moxonidine
moxonidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabilone
nabilone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nalbuphine
nalbuphine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nizatidine
nizatidine will increase the level or effect of dexmethylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. applies only to extended release formulation
- norepinephrine
norepinephrine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
norepinephrine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - nortriptyline
nortriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olanzapine
olanzapine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- opium tincture
opium tincture increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxazepam
oxazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxycodone
oxycodone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxymorphone
oxymorphone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxytocin
oxytocin increases effects of dexmethylphenidate by pharmacodynamic synergism. Use Caution/Monitor.
- paliperidone
paliperidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- papaveretum
papaveretum increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pentazocine
pentazocine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pentobarbital
pentobarbital increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- perphenazine
perphenazine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
perphenazine, dexmethylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - phendimetrazine
dexmethylphenidate and phendimetrazine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenobarbital
phenobarbital increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phentermine
dexmethylphenidate and phentermine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine
dexmethylphenidate and phenylephrine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine PO
dexmethylphenidate and phenylephrine PO both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - pholcodine
pholcodine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pimozide increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pirbuterol
pirbuterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
pirbuterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - primidone
primidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- prochlorperazine
prochlorperazine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
prochlorperazine, dexmethylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - promazine
promazine, dexmethylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
- promethazine
promethazine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
promethazine, dexmethylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - propylhexedrine
dexmethylphenidate and propylhexedrine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - protriptyline
protriptyline increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pseudoephedrine
dexmethylphenidate and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- quazepam
quazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quetiapine
quetiapine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- risperidone
risperidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salmeterol
salmeterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
salmeterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - scullcap
scullcap increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- secobarbital
secobarbital increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- shepherd's purse
shepherd's purse increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sodium zirconium cyclosilicate
sodium zirconium cyclosilicate will increase the level or effect of dexmethylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.
- solriamfetol
dexmethylphenidate and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- sufentanil
sufentanil increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tapentadol
tapentadol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- temazepam
temazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- terbutaline
terbutaline and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
terbutaline and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - thioridazine
thioridazine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
thioridazine, dexmethylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - thiothixene
thiothixene increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- topiramate
topiramate increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- tramadol
tramadol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trazodone
trazodone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triazolam
triazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triclofos
triclofos increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trifluoperazine
trifluoperazine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
trifluoperazine, dexmethylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - trimipramine
trimipramine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triprolidine
triprolidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- xylometazoline
dexmethylphenidate and xylometazoline both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - yohimbine
dexmethylphenidate and yohimbine both decrease sedation. Use Caution/Monitor.
dexmethylphenidate and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ziconotide
ziconotide increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziprasidone
ziprasidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
Minor (61)
- acetazolamide
dexmethylphenidate increases effects of acetazolamide by decreasing metabolism. Minor/Significance Unknown.
- amantadine
amantadine, dexmethylphenidate. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Potential for additive CNS stimulation.
- American ginseng
American ginseng increases effects of dexmethylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.
- amitriptyline
dexmethylphenidate increases effects of amitriptyline by decreasing metabolism. Minor/Significance Unknown.
- amoxapine
dexmethylphenidate increases effects of amoxapine by decreasing metabolism. Minor/Significance Unknown.
- antithrombin alfa
dexmethylphenidate increases effects of antithrombin alfa by decreasing metabolism. Minor/Significance Unknown.
- antithrombin III
dexmethylphenidate increases effects of antithrombin III by decreasing metabolism. Minor/Significance Unknown.
- argatroban
dexmethylphenidate increases effects of argatroban by decreasing metabolism. Minor/Significance Unknown.
- bemiparin
dexmethylphenidate increases effects of bemiparin by decreasing metabolism. Minor/Significance Unknown.
- bivalirudin
dexmethylphenidate increases effects of bivalirudin by decreasing metabolism. Minor/Significance Unknown.
- carbamazepine
dexmethylphenidate increases effects of carbamazepine by decreasing metabolism. Minor/Significance Unknown.
- clomipramine
dexmethylphenidate increases effects of clomipramine by decreasing metabolism. Minor/Significance Unknown.
- clonazepam
dexmethylphenidate increases effects of clonazepam by decreasing metabolism. Minor/Significance Unknown.
- dalteparin
dexmethylphenidate increases effects of dalteparin by decreasing metabolism. Minor/Significance Unknown.
- desipramine
dexmethylphenidate increases effects of desipramine by decreasing metabolism. Minor/Significance Unknown.
- desmopressin
desmopressin increases effects of dexmethylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.
- diazepam
dexmethylphenidate increases effects of diazepam by decreasing metabolism. Minor/Significance Unknown.
- dosulepin
dexmethylphenidate increases effects of dosulepin by decreasing metabolism. Minor/Significance Unknown.
- doxepin
dexmethylphenidate increases effects of doxepin by decreasing metabolism. Minor/Significance Unknown.
- duloxetine
dexmethylphenidate increases effects of duloxetine by decreasing metabolism. Minor/Significance Unknown.
- enoxaparin
dexmethylphenidate increases effects of enoxaparin by decreasing metabolism. Minor/Significance Unknown.
- ethosuximide
dexmethylphenidate increases effects of ethosuximide by decreasing metabolism. Minor/Significance Unknown.
- eucalyptus
eucalyptus increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- felbamate
dexmethylphenidate increases effects of felbamate by decreasing metabolism. Minor/Significance Unknown.
- fluoxetine
dexmethylphenidate increases effects of fluoxetine by decreasing metabolism. Minor/Significance Unknown.
- fondaparinux
dexmethylphenidate increases effects of fondaparinux by decreasing metabolism. Minor/Significance Unknown.
- fosphenytoin
dexmethylphenidate increases effects of fosphenytoin by decreasing metabolism. Minor/Significance Unknown.
- gabapentin
dexmethylphenidate increases effects of gabapentin by decreasing metabolism. Minor/Significance Unknown.
- gabapentin enacarbil
dexmethylphenidate increases effects of gabapentin enacarbil by decreasing metabolism. Minor/Significance Unknown.
- guarana
guarana increases effects of dexmethylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.
- heparin
dexmethylphenidate increases effects of heparin by decreasing metabolism. Minor/Significance Unknown.
- imipramine
dexmethylphenidate increases effects of imipramine by decreasing metabolism. Minor/Significance Unknown.
- lacosamide
dexmethylphenidate increases effects of lacosamide by decreasing metabolism. Minor/Significance Unknown.
- lamotrigine
dexmethylphenidate increases effects of lamotrigine by decreasing metabolism. Minor/Significance Unknown.
- levetiracetam
dexmethylphenidate increases effects of levetiracetam by decreasing metabolism. Minor/Significance Unknown.
- lofepramine
dexmethylphenidate increases effects of lofepramine by decreasing metabolism. Minor/Significance Unknown.
- lorazepam
dexmethylphenidate increases effects of lorazepam by decreasing metabolism. Minor/Significance Unknown.
- maprotiline
dexmethylphenidate increases effects of maprotiline by decreasing metabolism. Minor/Significance Unknown.
- methsuximide
dexmethylphenidate increases effects of methsuximide by decreasing metabolism. Minor/Significance Unknown.
- milnacipran
dexmethylphenidate increases effects of milnacipran by decreasing metabolism. Minor/Significance Unknown.
- nefazodone
dexmethylphenidate increases effects of nefazodone by decreasing metabolism. Minor/Significance Unknown.
- nortriptyline
dexmethylphenidate increases effects of nortriptyline by decreasing metabolism. Minor/Significance Unknown.
- oxcarbazepine
dexmethylphenidate increases effects of oxcarbazepine by decreasing metabolism. Minor/Significance Unknown.
- paroxetine
dexmethylphenidate increases effects of paroxetine by decreasing metabolism. Minor/Significance Unknown.
- phenindione
dexmethylphenidate increases effects of phenindione by decreasing metabolism. Minor/Significance Unknown.
- phenobarbital
dexmethylphenidate increases effects of phenobarbital by decreasing metabolism. Minor/Significance Unknown.
- phenytoin
dexmethylphenidate increases effects of phenytoin by decreasing metabolism. Minor/Significance Unknown.
- primidone
dexmethylphenidate increases effects of primidone by decreasing metabolism. Minor/Significance Unknown.
- protamine
dexmethylphenidate increases effects of protamine by decreasing metabolism. Minor/Significance Unknown.
- protriptyline
dexmethylphenidate increases effects of protriptyline by decreasing metabolism. Minor/Significance Unknown.
- rufinamide
dexmethylphenidate increases effects of rufinamide by decreasing metabolism. Minor/Significance Unknown.
- sage
sage increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- sertraline
dexmethylphenidate increases effects of sertraline by decreasing metabolism. Minor/Significance Unknown.
- tiagabine
dexmethylphenidate increases effects of tiagabine by decreasing metabolism. Minor/Significance Unknown.
- topiramate
dexmethylphenidate increases effects of topiramate by decreasing metabolism. Minor/Significance Unknown.
- trazodone
dexmethylphenidate increases effects of trazodone by decreasing metabolism. Minor/Significance Unknown.
- trimipramine
dexmethylphenidate increases effects of trimipramine by decreasing metabolism. Minor/Significance Unknown.
- valproic acid
dexmethylphenidate increases effects of valproic acid by decreasing metabolism. Minor/Significance Unknown.
- venlafaxine
dexmethylphenidate increases effects of venlafaxine by decreasing metabolism. Minor/Significance Unknown.
- yerba mate
yerba mate increases effects of dexmethylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.
- zonisamide
dexmethylphenidate increases effects of zonisamide by decreasing metabolism. Minor/Significance Unknown.
Adverse Effects
>10%
Abdominal pain (15%)
Headache (25-39%)
Insomnia (5-17%)
Restlessness (12%)
Anxiety (5-11%)
1-10%
Anorexia (5-7%)
Fever (5%)
Dizziness (6%)
Mood swings (<3%)
Nausea (9%)
Pruritus (<3%)
Pharyngolaryngeal pain (4-7%)
Irritability (5%)
Depression (<3%)
Dyspepsia (5-9%)
Postmarketing Reports
Anaphylaxis
Hypersensitivity reactions
Rhabdomyolysis
Drowsiness
Dyskinesia
Tourette’s syndrome (rare)
Toxic psychosis
Serotonin syndrome in combination with serotonergic drugs
Abnormal liver function, ranging from transaminase elevation to severe hepatic injury
Warnings
Black Box Warnings
Chronic abuse can lead to a marked tolerance and psychological dependence with varying degrees of abnormal behavior; frank psychotic episodes can occur, especially with parenteral abuse; withdrawal from abusive use may result in depression.
Assess risk of abuse prior to prescribing and monitor for signs of abuse and dependence while on therapy; give cautiously to patients with a history of drug dependence or alcoholism
Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up
Contraindications
Hypersensitivity to methylphenidate; reactions may include angioedema and anaphylaxis
Notable tension and agitation, glaucoma, Tourette syndrome, motor tics, anxiety
MAOIs: Risk of severe hypertensive reaction; do not use within 14 days of taking MAOI
Cautions
Should be used as part of a comprehensive treatment program of attention deficit disorder
Caution in patients with history of drug dependence or alcoholism, HTN, preexisting structural cardiac abnormalities
Discontinue if no improvement after 1 month
Reevaluate need for treatment q6Week
Associated with peripheral vasculopathy, including Raynaud phenomenon; monitor for digital changes during therapy and seek further evaluation (eg, rheumatology) if necessary
Difficulties with visual accommodation and blurring of vision have been reported with stimulant treatment
Do not use for depression, fatigue
Sudden deaths, stroke, and myocardial infarction reported in adults taking psychiatrics#stimulants at usual doses
Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation
Particular care should be taken in using psychiatrics#stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients
Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported
Monitor growth of children ages 7 to 10 years during treatment with psychiatrics#stimulants; may need to interrupt therapy in patients not growing or gaining weight as expected
Stimulants may lower convulsive threshold in patients with prior history of seizure, patients with prior EEG abnormalities in absence of seizures, and very rarely, patients without a history of seizures and no prior EEG evidence of seizures; discontinue therapy in the presence of seizures
Use with caution in patients who use other sympathomimetic drugs
Amphetamines may exacerbate motor and phonic tics and Tourette’s syndrome; perform clinical evaluation for tics and Tourette’s syndrome in children and their families prior to treating with stimulant medications
Rare instances of prolonged and sometimes painful erections (priapism), sometimes requiring surgical intervention, reported with methylphenidate products; typically not reported during initiation, but often subsequent to an increase in dose; seek immediate medical attention for abnormally sustained or frequent and painful erections
Use with caution in patients with hypertension and other vascular conditions, including heart failure, ventricular arrhythmia; recent myocardial infarction; CNS psychiatrics#stimulants may increase heart rate and blood pressure
Hypersensitivity reactions, including anaphylactic reactions and angioedema reported in patients treated with methylphenidate
Use caution in patients with preexisting psychosis; psychiatrics#stimulants may exacerbate symptoms of behavior and though disorder; use with caution in patients with bipolar disorder; psychiatrics#stimulants may induce mixed/manic episodes; new onset of psychosis or mania may occur in children or adolescents with stimulant use; patients presenting with depressive symptoms should be screened for bipolar disorder, including family history of suicide, bipolar disorder, and depression; consider discontinuation of therapy if symptoms of psychosis develop
Appetite suppression may occur in children; stimulant use is associated with weight loss and slowing growth rate; monitor growth rate and weight during treatment; consider interrupting therapy in patients who are not increasing in height or gaining weight as expected
Abrupt discontinuation following high doses or prolonged periods may result in symptoms of wighdrawal including severe depression
Avoid use in patients with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems that could increase risk of sudden death; evaluate promptly patients who develop exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease
Hypersensitivity reactions, including angioedema and anaphylactic reactions reported in patients treated with methylphenidate
Drug interaction overview
- Therapy may decrease effectiveness of drugs used to treat hypertension; monitor blood pressure and adjust dosage of the antihypertensive drug as needed
- Combined use of methylphenidate with risperidone when there is a change, whether an increase or decrease, in dosage of either or both medications, may increase risk of extrapyramidal symptoms (EPS); monitor for signs of EPS
Pregnancy & Lactation
Pregnancy
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications, during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy registry for ADHD medications at 1-866-961-2388 or visit, https://womensmentalhealth.org/adhdmedications
Dexmethylphenidate is the d-threo enantiomer of racemic methylphenidate; published studies and postmarketing reports on methylphenidate use during pregnancy have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes; there may be risks to fetus associated with use of CNS psychiatrics#stimulants use during pregnancy
CNS psychiatrics#stimulants can cause vasoconstriction and thereby decrease placental perfusion; no fetal and/or neonatal adverse reactions have been reported with the use of therapeutic doses of methylphenidate during pregnancy; however, premature delivery and low birth weight infants have been reported in amphetamine-dependent mothers
Animal data
- Embryo-fetal development studies in rats showed delayed fetal skeletal ossification at doses up to 5 times maximum recommended human dose (MRHD) of 20 mg/day given to adults based on plasma levels
- A decrease in pup weight in males was observed in a pre- and post-natal development study with oral administration of methylphenidate to rats throughout pregnancy and lactation at doses 5 times the MRHD of 20 mg/day given to adults based on plasma levels; plasma levels in adults were comparatively similar to plasma levels in adolescents
Lactation
Dexmethylphenidate is the d-threo enantiomer of racemic methylphenidate; Limited published literature, based on milk sampling from seven mothers reports that methylphenidate is present in human milk, which resulted in infant doses of 0.16% to 0.7% of the maternal weight-adjusted dosage and a milk/plasma ratio ranging between 1.1 and 2.7
There are no reports of adverse effects on breastfed infant and no effects on milk production; long-term neurodevelopmental effects on infants from stimulant exposure are unknown; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed infant from treatment or from underlying maternal condition
Monitor breastfeeding infants for adverse reactions, such as agitation, insomnia, anorexia, and reduced weight
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
The more pharmacologically active CNS stimulant of the d-threo-enantiomers; blocks reuptake of norepinephrine and dopamine, causing an increase of their release into the extraneuronal space
Absorption
Bioavailability: 22-25%
Onset of action: 12hr (extended release)
Peak plasma time: 1-1.5 hr (Focalin XR: 2nd peak at 6.5 hr)
Distribution
Protein bound: 12-25%
Vd: 1.54-3.76 L/kg
Metabolism
Metabolized by deesterification
Metabolites: Inactive
Elimination
Half-life: 2-4.5 hr (adults); 2-3 hr (children)
Excretion: Urine (90%)
Administration
Extended Release
Administer once daily; do not crush, chew, or divide
Capsules may be opened and contents sprinkled over a spoonful of applesause; do not store for future use; consume immediately
Immediate Release
Administer twice daily, not sooner than 4 hours apart; may administer with or without food
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Focalin XR oral - | 35 mg capsule |  | |
| Focalin XR oral - | 25 mg capsule |  | |
| Focalin XR oral - | 15 mg capsule |  | |
| Focalin XR oral - | 40 mg capsule |  | |
| Focalin XR oral - | 30 mg capsule |  | |
| Focalin XR oral - | 20 mg capsule |  | |
| Focalin XR oral - | 10 mg capsule |  | |
| Focalin XR oral - | 5 mg capsule |  | |
| Focalin oral - | 10 mg tablet |  | |
| Focalin oral - | 5 mg tablet |  | |
| Focalin oral - | 2.5 mg tablet |  | |
| dexmethylphenidate oral - | 15 mg capsule |  | |
| dexmethylphenidate oral - | 30 mg capsule |  | |
| dexmethylphenidate oral - | 25 mg capsule |  | |
| dexmethylphenidate oral - | 5 mg tablet | | |
| dexmethylphenidate oral - | 2.5 mg tablet |  | |
| dexmethylphenidate oral - | 5 mg tablet |  | |
| dexmethylphenidate oral - | 15 mg capsule |  | |
| dexmethylphenidate oral - | 10 mg tablet |  | |
| dexmethylphenidate oral - | 10 mg capsule |  | |
| dexmethylphenidate oral - | 35 mg capsule |  | |
| dexmethylphenidate oral - | 25 mg capsule |  | |
| dexmethylphenidate oral - | 20 mg capsule |  | |
| dexmethylphenidate oral - | 35 mg capsule |  | |
| dexmethylphenidate oral - | 25 mg capsule |  | |
| dexmethylphenidate oral - | 35 mg capsule |  | |
| dexmethylphenidate oral - | 10 mg tablet |  | |
| dexmethylphenidate oral - | 5 mg tablet |  | |
| dexmethylphenidate oral - | 40 mg capsule |  | |
| dexmethylphenidate oral - | 10 mg capsule |  | |
| dexmethylphenidate oral - | 5 mg tablet |  | |
| dexmethylphenidate oral - | 2.5 mg tablet |  | |
| dexmethylphenidate oral - | 30 mg capsule |  | |
| dexmethylphenidate oral - | 2.5 mg tablet | | |
| dexmethylphenidate oral - | 40 mg capsule |  | |
| dexmethylphenidate oral - | 35 mg capsule |  | |
| dexmethylphenidate oral - | 30 mg capsule |  | |
| dexmethylphenidate oral - | 25 mg capsule |  | |
| dexmethylphenidate oral - | 20 mg capsule |  | |
| dexmethylphenidate oral - | 15 mg capsule |  | |
| dexmethylphenidate oral - | 10 mg capsule |  | |
| dexmethylphenidate oral - | 5 mg capsule |  | |
| dexmethylphenidate oral - | 10 mg tablet |  | |
| dexmethylphenidate oral - | 5 mg tablet |  | |
| dexmethylphenidate oral - | 2.5 mg tablet |  | |
| dexmethylphenidate oral - | 20 mg capsule | | |
| dexmethylphenidate oral - | 10 mg capsule | | |
| dexmethylphenidate oral - | 20 mg capsule |  | |
| dexmethylphenidate oral - | 15 mg capsule |  | |
| dexmethylphenidate oral - | 5 mg capsule |  | |
| dexmethylphenidate oral - | 40 mg capsule |  | |
| dexmethylphenidate oral - | 15 mg capsule |  | |
| dexmethylphenidate oral - | 10 mg capsule |  | |
| dexmethylphenidate oral - | 5 mg capsule |  | |
| dexmethylphenidate oral - | 25 mg capsule | | |
| dexmethylphenidate oral - | 30 mg capsule |  | |
| dexmethylphenidate oral - | 40 mg capsule | | |
| dexmethylphenidate oral - | 40 mg capsule |  | |
| dexmethylphenidate oral - | 35 mg capsule |  | |
| dexmethylphenidate oral - | 30 mg capsule |  | |
| dexmethylphenidate oral - | 25 mg capsule |  | |
| dexmethylphenidate oral - | 20 mg capsule |  | |
| dexmethylphenidate oral - | 15 mg capsule |  | |
| dexmethylphenidate oral - | 10 mg capsule |  | |
| dexmethylphenidate oral - | 5 mg capsule |  | |
| dexmethylphenidate oral - | 5 mg capsule |  | |
| dexmethylphenidate oral - | 30 mg capsule |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
dexmethylphenidate oral
DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULE - ORAL
(dex-METH-il-FEN-i-date)
COMMON BRAND NAME(S): Focalin XR
WARNING: Misuse or abuse of dexmethylphenidate may result in serious (possibly fatal) heart and blood pressure problems.This medication can be habit-forming and should be used cautiously by people who have mental/mood disorders or a substance use disorder (such as overuse of or addiction to drugs/alcohol). Before using this medication, tell your doctor if you have a personal or family history of a substance use disorder. Do not increase your dose, use it more often, or use it for a longer time or in a different way than prescribed. Doing so may result in a decrease in the effect of this drug, drug dependence, or abnormal thoughts/behavior.Your doctor may monitor you for a while after the medication is stopped, especially if you have taken this drug for a long time or in high doses. (See also How to Use section.)
USES: This medication is used to treat attention deficit hyperactivity disorder - ADHD. It works by changing the amounts of certain natural substances in the brain. Dexmethylphenidate belongs to a class of drugs known as stimulants. It can help increase your ability to pay attention, stay focused on an activity, and control behavior problems. It may also help you to organize your tasks and improve listening skills.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking dexmethylphenidate and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually once daily in the morning, with or without food. Taking this medication late in the day may cause trouble sleeping (insomnia).The dosage is based on your medical condition and response to treatment. Your doctor may direct you to gradually increase or decrease your dose. Also, if you have used it for a long time, do not suddenly stop using this drug without consulting your doctor.Do not break, crush, or chew this medication. Doing so can release all of the drug at once, increasing the risk of side effects. Swallow the capsules whole. If you have trouble swallowing the capsule, you may open the capsule and carefully sprinkle its contents on a spoonful of cool applesauce. Swallow all of the mixture right away without chewing it. Then drink a glass of cool liquid to make sure you have swallowed all of the dose. Do not prepare the mixture ahead of time.Methylphenidate and dexmethylphenidate are different medications and do not provide the same amount of medicine. Do not switch between products unless your doctor tells you to.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.If you suddenly stop using this medication, you may have withdrawal symptoms (such as depression, suicidal thoughts, or other mental/mood changes). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used dexmethylphenidate for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.Tell your doctor if your condition does not improve or if it worsens.
SIDE EFFECTS: Trouble sleeping, nervousness, dizziness, dry mouth, heartburn, nausea, stomach pain, headache, loss of appetite, or weight loss may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: signs of blood flow problems in the fingers or toes (such as coldness, numbness, pain, or skin color changes), unusual wounds on the fingers or toes, fast/pounding/irregular heartbeat, mental/mood/behavior changes (such as agitation, aggression, mood swings, abnormal thoughts, thoughts of suicide), uncontrolled muscle movements (such as twitching, shaking), sudden outbursts of words/sounds that are hard to control, vision changes (such as blurred vision).Get medical help right away if you have any very serious side effects, including: fainting, seizure, symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating), symptoms of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion).Rarely, males (including young boys and teens) may have a painful or prolonged erection lasting 4 or more hours while using this medication. Caregivers/parents should also be watchful for this serious side effect in boys. If a painful or prolonged erection occurs, stop using this drug and get medical help right away, or permanent problems could occur. Ask your doctor or pharmacist for more details.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: See also Warning section.Before taking dexmethylphenidate, tell your doctor or pharmacist if you are allergic to it; or to methylphenidate; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: high blood pressure, blood circulation problems (such as Raynaud's disease), glaucoma, heart problems (such as irregular heartbeat, heart failure, previous heart attack, problems with heart structure), family history of heart problems (such as sudden cardiac death, irregular heartbeat), mental/mood conditions (especially anxiety, tension, agitation), personal/family history of mental/mood disorders (such as bipolar disorder, depression, psychosis, suicidal thoughts), personal/family history of uncontrolled muscle movements (motor tics, Tourette's syndrome), overactive thyroid (hyperthyroidism), seizure disorder.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).If used for a long time, this drug may affect a child's growth rate, weight, and final adult height. To reduce the risk, the doctor may recommend briefly stopping the medication from time to time. Check the child's weight and height regularly, and consult your doctor or pharmacist for more details.Older adults may be more sensitive to the side effects of this drug, especially trouble sleeping, weight loss, or chest pain.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.Dexmethylphenidate is very similar to methylphenidate. Do not use medications containing methylphenidate while using dexmethylphenidate.This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson's disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: vomiting, agitation, confusion, sweating, flushing, muscle twitching, hallucinations, seizures, loss of consciousness.
NOTES: Do not share this medication with others. Sharing it is against the law.Lab and/or medical tests (such as blood pressure, complete blood count, height/weight monitoring in children) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near bedtime or near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised November 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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