Generic Name: dexmethylphenidate
Brand Names: Focalin, Focalin XR
Drug Class: Stimulants; ADHD Agents
What is dexmethylphenidate, and what is it used for?
Dexmethylphenidate is a medication used to treat attention deficit hyperactivity disorder (ADHD) in adults and children 6 years and older.
Dexmethylphenidate is the active molecule derived from methylphenidate, a central nervous system (CNS) stimulant. The mechanism of action of dexmethylphenidate in ADHD is not clear, but it is believed to work by increasing the levels of certain chemical messengers (neurotransmitters) in the brain that nerves use to communicate.
Dexmethylphenidate increases the concentration of dopamine and norepinephrine by blocking their reabsorption (reuptake) after the completion of neurotransmission, a natural process in the brain. Dopamine and norepinephrine have multiple functions that include the regulation of movement, attention, memory, motivation and pleasure. Increase in the levels of these neurotransmitters is believed to improve concentration and reduce hyperactive and impulsive behaviors associated with ADHD.
Stimulants including dexmethylphenidate have a high risk for misuse, abuse and dependence. Chronic abuse can lead to psychosis, discontinuation can cause withdrawal symptoms, and overdose can have serious consequences.
Warnings
- Do not use dexmethylphenidate in patients with the following conditions:
- Hypersensitivity to methylphenidate or any of the components of the dexmethylphenidate formulation, can cause severe reactions
- Significant anxiety, tension and agitation, the drug may aggravate these symptoms
- Glaucoma, an eye condition with high intraocular pressure that causes progressive damage to the optic nerve
- Motor tics, or a family history or diagnosis of Tourette’s syndrome
- Do not use dexmethylphenidate concurrently or within 14 days following the administration of monoamine oxidase inhibitors (MAOI), an antidepressant drug, can lead to a hypertensive crisis.
- Concurrent use with drugs that increase serotonin levels, including selective serotonin reuptake inhibitors (SSRIs), MAOIs and others can lead to serotonin syndrome, a potentially life-threatening reaction.
- Dexmethylphenidate has a high potential for abuse and dependence. Chronic abuse can lead to psychotic behavior and withdrawal symptoms upon discontinuation. Following are some points for caution:
- The drug should be used as part of a comprehensive therapy for ADHD
- Patient should be assessed for risk of abuse before prescribing and monitored for signs of abuse while on therapy
- Should be used with caution in patients with a history of drug dependence or alcoholism
- Patient should be evaluated for treatment need every 6 weeks
- The drug should be discontinued if there is no improvement after one month
- Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up
- Do not use dexmethylphenidate in patients with structural cardiac abnormalities or other serious heart conditions. Stroke, heart attack (myocardial infarction), and sudden death have been reported with even recommended doses.
- Stimulants can cause a modest increase in heart rate and blood pressure. Monitor all patients for larger increases.
- Evaluate patient’s cardiovascular status before initiating stimulant treatment. Use with caution in patients with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia and monitor closely.
- Evaluate cardiovascular status promptly in patients who develop symptoms such as exertional chest pain, unexplained fainting, or other symptoms suggestive of cardiac disease during stimulant treatment.
- Dexmethylphenidate can exacerbate symptoms in patients with pre-existing psychotic disorders. Use with caution.
- Use with caution in ADHD patients with comorbid bipolar disorder, stimulants may induce mixed and manic episodes in such patients.
- Consider discontinuing dexmethylphenidate if patients without a history of psychotic disorders develop psychotic or manic symptoms.
- Monitor children and adolescents for development or worsening of aggressive behavior or hostility.
- Dexmethylphenidate may lower seizure threshold. Monitor the patient and discontinue if seizure occurs.
- Stimulants may cause blurry vision or difficulty focusing (accommodation disorder).
- Periodic complete blood count (CBC), differential, and platelet counts are advised during prolonged therapy.
- Dexmethylphenidate may suppress growth in young children, monitor growth in children 7 to 10 years of age and interrupt treatment, if required.
- Dexmethylphenidate is associated with peripheral vascular diseases such as Raynaud’s phenomenon.
- Dexmethylphenidate may exacerbate phonic and motor tics in Tourette syndrome.
- Dexmethylphenidate may rarely cause prolonged and painful erection (priapism), sometimes requiring surgical intervention.
- Do not use dexmethylphenidate for depression or fatigue.
- Abrupt discontinuation following high doses or prolonged periods may result in symptoms of withdrawal including severe depression. Discontinue gradually.

SLIDESHOW
What Are the Symptoms of ADHD in Kids? Tests, Medication See SlideshowWhat are the side effects of dexmethylphenidate?
Common side effects of dexmethylphenidate include:
- Headache
- Insomnia
- Restlessness
- Anxiety
- Dizziness
- Irritability
- Reduced appetite
- Loss of appetite (anorexia)
- Abdominal pain
- Dry mouth (xerostomia)
- Indigestion (dyspepsia)
- Nausea
- Vomiting
- Throat pain
- Nasal congestion
- Fever
Less common side effects of dexmethylphenidate include:
- Depression
- Mood swings (emotional lability)
- Itching (pruritus)
- Rare side effects of dexmethylphenidate include:
- Hypersensitivity reactions
- Swelling in the tissue below the skin and mucous membranes (angioedema)
- Severe allergic reactions (anaphylaxis)
- Drowsiness
- Breakdown of muscle tissue (rhabdomyolysis)
- Movement disorder (dyskinesia)
- Tourette syndrome, a nervous system disorder that causes tics
- Peripheral vascular disease
- Raynaud’s phenomenon, a condition with reduced blood flow to extremities due to cold or stress
- Toxic psychosis
- Abnormal liver function
- Elevation of liver enzymes
- Severe liver injury
- Growth suppression in pediatric patients
- Prolonged and painful erection (priapism)
- Serotonin syndrome in combination with serotonergic drugs
Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:
- Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
- Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
- Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
- Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
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What are the dosages of dexmethylphenidate?
Tablet
- 2.5 mg
- 5 mg
- 10 mg
Capsule, extended-release
- 5 mg
- 10 mg
- 15 mg
- 20 mg
- 25 mg
- 30 mg
- 35 mg
- 40 mg
Attention Deficit Hyperactivity Disorder
Adult:
Focalin
- Initial: 2.5 orally twice daily; may increase in 2.5- to 5-mg increments every week if warranted
- Not to exceed 20 mg/day
Focalin XR
- Not taking Focalin or methylphenidate: 10 mg orally every day initially; may increase in 10-mg increments every week if warranted; not to exceed 20 mg/day
- Switch from Focalin: Administer the same total daily dose as Focalin but administer every day
- Switch from methylphenidate: Initiate with half total daily dose of methylphenidate and administer every day; 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
Pediatric:
Children below 6 years
- Safety and efficacy not established
Children 6 years and above (Focalin)
- Initial: 2.5 orally twice daily; may increase in 2.5- to 5-mg increments every week if warranted
- Not to exceed 20 mg/day
Children 6 years and above (Focalin XR)
- Not taking Focalin or methylphenidate: 5 mg orally every day initially; may increase in 5-mg increments every week if warranted; not to exceed 30 mg/day
- Switch from Focalin: Administer the same total daily dose as Focalin but administer every day
- Switch from methylphenidate: Initiate with half total daily dose of methylphenidate and administer every day; not to exceed 30 mg/day
Addiction/overdose
- Dexmethylphenidate has a high potential for abuse and dependence that can result in overdose.
- Overdose overstimulates the central nervous system (CNS) and can cause a multitude of symptoms including agitation, confusion, hallucinations, vomiting, headache, high temperature, tremors, convulsions progressing to coma, and serious cardiovascular conditions such as high blood pressure, high heart rate and irregular heart rhythm.
- Treatment for dexmethylphenidate overdose is symptomatic and supportive therapy, with respiratory support, intravenous fluids and other intensive care measures, as needed. Undigested drug from the gastrointestinal tract may be eliminated with gastric lavage and administration of activated charcoal and purgative.
What drugs interact with dexmethylphenidate?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Severe interactions of dexmethylphenidate include:
- iobenguane I 123
- isocarboxazid
- linezolid
- phenelzine
- procarbazine
- rasagiline
- safinamide
- selegiline
- selegiline transdermal
- tranylcypromine
- Dexmethylphenidate has serious interactions with at least 30 different drugs.
- Dexmethylphenidate has moderate interactions with at least 176 different drugs.
- Dexmethylphenidate has mild interactions with at least 69 different drugs.
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.
Pregnancy and breastfeeding
- There are no adequate and well-controlled studies of dexmethylphenidate use in pregnant women, however, animal reproductive studies indicate it can cause fetal harm. Use during pregnancy only if maternal benefits outweigh potential risks to the fetus.
- It is not known if dexmethylphenidate is excreted in breast milk, however, many drugs are present in breast milk. Use with caution in nursing mothers.
What else should I know about dexmethylphenidate?
- Dexmethylphenidate is a Schedule II controlled substance, diversion of Schedule II products is subject to criminal penalty.
- Take dexmethylphenidate exactly as prescribed, do not take larger or more frequent doses.
- Dexmethylphenidate has a high risk for addiction and dependency, and can lead to overdose, exercise caution.
- In case of overdose, immediately seek medical help or contact Poison Control.
- Store dexmethylphenidate safely out of reach of children.
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Summary
Dexmethylphenidate is a medication used to treat attention deficit hyperactivity disorder (ADHD) in adults and children 6 years and older. Stimulants including dexmethylphenidate have a high risk for misuse, abuse, and dependence. Chronic abuse can lead to psychosis, discontinuation can cause withdrawal symptoms, and overdose can have serious consequences. Common side effects of dexmethylphenidate include headache, insomnia, restlessness, anxiety, dizziness, irritability, reduced appetite, loss of appetite (anorexia), abdominal pain, dry mouth (xerostomia), indigestion (dyspepsia), nausea, vomiting, throat pain, nasal congestion, and fever. Consult your doctor if pregnant or breastfeeding.
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How Can Parents Encourage Independence and Learning in Their Children?
While there are general guidelines for developmental milestones, each child will progress through them at their own rate. Encourage independence and learning in your child by establishing predictable routines, letting your child help you, giving your child chores, and employing other methods.
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What Are 3 Types of ADHD?
Attention deficit hyperactivity disorder (ADHD) is classified into the following 3 types, which include inattentive ADHD, hyperactive ADHD, and combined ADHD.
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What It's Like Being an Adult With ADHD?
ADHD in adults results in mental and physical problems that eventually impact relationships and cause difficulty in daily life.
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How Can Parents Relieve the Stress of a Caring for a Newborn Baby?
Welcoming a newborn baby into the world is an exciting and stressful time. Use the following tips to help manage your stress.
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What Does ADHD Look Like in Preschoolers?
ADHD symptoms in kids can be difficult to recognize, especially in preschoolers. Here’s how you can tell if your preschooler has ADHD.
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When Should Parents Tell Their Kids the Truth About Santa Claus and Other Holiday Mascots?
You may celebrate different holidays and events with your children by sharing stories about pretend holiday mascots like Santa Claus, the Easter Bunny, and the Tooth Fairy. Telling your children the truth about these may be difficult, but should be gentle, and happen when they start realizing the truth themselves.
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What Are ADHD Behaviors?
Attention deficit hyperactivity disorder (ADHD) behaviors involve inattention, hyperactivity, and impulsivity. Learn about each group of symptoms.
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What Mistakes Do New Parents Make?
All new parents do their best to take care of their babiesĀ and toddlers. But no matter how prepared you feel, you’re still learning along the way. Use these tips to avoid nine common mistakes new parents make.
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How Do Family Members Cope With Autism?
Autism is a developmental disorder that encompasses a variety of symptoms like communication difficulties, behavioral challenges, and social interaction problems. Families cope with autism by managing stress, maintaining energy levels, sticking to a schedule, nurturing other relationships and managing financial stress.
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How Do You Deal With Parenting Differences?
If you and your partner have different parenting styles, it’s important to learn to compromise, communicate, and present a united front. This can ease a lot of stress for you and your family.
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What Should Parents Expect in the Tween Years?
The tween years are the ages between 8 and 12 years old. Parents can expect physical, emotional, and social changes in their kids during the tween years.
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When and How Should Parents Talk to Their Kids About Death?
When you start a conversation about death with your child, keep their stage of development in mind.
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How Can I Be a Better Parent to My Preschooler?
Being a better parent to your preschooler is about leading by example, creating routines and rituals for your child, and dedicating time to play with them.
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11 Tips for Parents Who Work from Home and Virtual School Kids
It’s quite challenging adjusting to working from home, especially when your kids are schooling virtually. Here are 11 ways you can ease the process and make sure you and your kids gain the most from working from home.
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How Do You Know If You Have ADHD as an Adult?
Adults with ADHD often have difficulty paying attention and exhibit impulsive behavior. Learn about symptoms and types of adult ADHD and what treatment options are available.
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How Do You Discipline a Tween With ADHD?
ADHD generally causes inattention, impulsivity, and hyperactivity. Discipline a tween with ADHD by setting clear rules, having reasonable expectations, and reinforcing positive behavior.
Treatment & Diagnosis
- Autism
- ADHD (Attention Deficit Hyperactivity Disorder)
- Parenting: Positive Parenting with John Gray
- Parenting: Changing Your Child's Attitude
- ADHD in Teens
- Parenting: Naughty or Nice: Kids at the Holidays
- Parenting: Welcome to Parenthood
- Parenting: Setting Priorities With Your Children
- Sleep: Every New Parent's Dream
- Parent's Guide: Kids and Friendship
- Parenting: Will you still love me if I don't win?
- Parenting Your Preemie
- Parenting Life
- Parenting: How To Be a Positive Parent
- Pregnancy and Parenting: Expecting Triplets
- Parenting: Children are from Heaven
- Parenting: Talk To Your Kids
- Parenting Medical Questions Answers with Burton H. Goldman, M.D.
- Parenting: New Babies, New Parents
- ADHD FAQs
- Autism Spectrum Disorder FAQs
- Childhood Obesity Overweight FAQs
- Adult ADHD FAQs
- What's the Difference Between ADHD and ADD?
- Parenting with Love and Logic
- Childhood and Obesity
- Vaccine Not a Risk for Autism
- Autism Drug Secretin Found Ineffective
- Kid's Early TV = Poor Attention Later
- 8 Tips for Parents of Kids with Asperger's Syndrome
- How Should a Family Respond to a New Down Syndrome Baby?
- If Both Parents Died of Cancer, Will I Get It?
- What Are the Risks of Childhood Obesity?
- How Do You Prevent Childhood Obesity?
- Can You Outgrow ADHD?
- Are ADHD Rates Increasing?
- Can I Treat ADHD Without Medication?
- What Are the Symptoms of ADHD?
- Does My Child Have ADHD?
- What are The Advantages of the Daytrana Patch for ADHD?
- Could Gluten Make ADHD Worse?
- Adult ADHD Diagnosis and Treatment
- Autism: Early Symptoms and Screening Tests
- Early Red Flags and Warning Signs of Autism
- Ask the Experts - Childhood Obesity
- Parenting: Don't Let Food Poisoning Spoil Your Party
- Childhood Obesity: A Growing Problem
- Parenting: Help Your Kids Grow Up Healthy
Medications & Supplements
Prevention & Wellness
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