Description
Generic Name:
Dextro-methylphenidate
Advantages
Less side effects than other methylphenidate meds because levo- methylphenidate is not included as
it is in most other methylphenidate medications.
Disadvantages
Covered by some insurance plans, but many others do not cover. Focalin is relatively inexpensive, but Focalin XR is much more expensive. Significant reduction in cost through a GoodRx coupon. Novartis does have a program for reducing the cost of Focalin XR to a $10 co-pay (FocalinXR.com).
Excerpt from the book: ADHD Medications: Does It Work and Is It Save? Available on Amazon
In the previous chapter, I discussed the presence of mirror-image molecules in both methylphenidate and amphetamine. All the methyl- phenidate medications are a mixture of 50 percent dextro-methylpheni- date and 50 percent levo-methylphenidate, with two exceptions: Focalin (and Focalin XR) and Azstarys.
Dextro-methylphenidate is responsible for most or all of the posi- tive, therapeutic effects of methylphenidate, whereas levo-methylphe- nidate is next to useless and might actually increase the probability of side effects. So, the thinking goes, what if we removed the levo-meth- ylphenidate and treated ADHD children with dextro-methylphenidate alone? You would expect the same benefit as with the 50 percent–50 percent combination, but by removing the molecule that does not produce benefit, you might reduce the side effects as well. This was the thinking behind Focalin.
And there do appear to be fewer side effects with Focalin, although the difference is not large. I have found that the irritability often seen with methylphenidate is reduced with Focalin and Focalin XR com- pared to most other forms of methylphenidate. Focalin XR does not last as long as other preparations of methylphenidate (Concerta, Daytrana), but it is often a good place to start.
Focalin XR is the extended-release preparation of dextro-meth- ylphenidate. Focalin is also available in a short-acting form that can be used at the end of the day, to extend the effects into the early evening, if needed for homework, sports, or tutoring.
Focalin XR uses the SODAS® (spheroidal oral drug absorption system) technology, exactly like Ritalin LA, Metadate CD, Adhansia XR, and Aptensio XR, with the exception that Focalin XR is only dextro-methylphenidate. Focalin XR comes in a capsule with a mixture of immediate release beads lasting 3½–4 hours and extended-release beads that are more slowly absorbed and last longer (7–8 hours). The pharmaceutical company that produces Focalin XR claims that the therapeutic effects can be seen for 11–12 hours, but research (and my experience) indicate that the true therapeutic affects begin to wear off at eight hours, and little benefit is seen after nine hours. One study compared Focalin XR to Concerta and found that Focalin XR began to take effect more quickly (25–30 minutes for Focalin XR and 30–60 minutes for Concerta). However, Concerta lasted longer (10–12 hours) than Focalin XR (8–9 hours).16 The combination of these two beads produces a smoother curve than two doses of Focalin, avoiding the “ups and downs” of regular methylphenidate and, thus, significantly reduces the emotional lability.
