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Monday, February 7, 2011

dexmethylphenidate hydrochloride

Posted by Sampil 5:20 PM, under | No comments

dexmethylphenidate hydrochloride
(decks meth ill fen' i date)
Focalin, Focalin XR

Pregnancy Category C
Controlled Substance C-II

Drug class
CNS stimulant

Therapeutic actions
Mild cortical stimulant with CNS actions similar to those of the amphetamines; is thought to block the reuptake of norephinephrine and dopamine, increasing their concentration in the synaptic cleft; mechanism of effectiveness in hyperkinetic syndromes is not understood.

Indication
·        Treatment of attention-deficit hyperactivity disorder in patients > 6 yr as part of a total treatment program

Contraindications and cautions
·        Contraindicated with hypersensitivity to dexmethylphenidate or methylphenidate; marked anxiety, tension, and agitation; glaucoma; motor tics, family history or diagnosis of Tourette's syndrome; use of MAOIs within the past 14 days.
·        Use cautiously with psychosis, seizure disorders; CHF, recent MI, hyperthyroidism; drug dependence, alcoholism, severe depression of endogenous or exogenous origin; as treatment of normal fatigue states; pregnancy, lactation.

Available forms
Tablets—2.5, 5, 10 mg; ER capsules—5, 10 mg

Dosages
ADULTS AND PATIENTS > 6 YR
Individualize dosage. Administer orally twice a day, at least 4 hr apart, without regard to meals. Starting dose, 2.5 mg PO bid; may increase as needed in 2.5- to 5-mg increments to a maximum dose of 10 mg PO bid. ER capsules, initially 5 mg/day for children; increase in 5-mg increments to 20 mg/day; start adults at 10 mg/day; increase in 10-mg increments to 20 mg/day.
·        Patients already on methylphenidate: Start dose at one-half the methylphenidate dose with a maximum dose of 10 mg PO bid.
PEDIATRIC PATIENTS < 6 YR
Safety and efficacy not established.

Pharmacokinetics
Route
Onset
Peak
Oral
Varies
1–1.5 hr

Metabolism: Hepatic; T1/2: 2.2 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine

Adverse effects
·        CNS: Nervousness, insomnia, dizziness, headache, dyskinesia, chorea, drowsiness, Tourette's syndrome, toxic psychosis, blurred vision, accommodation difficulties
·        CV: Increased or decreased pulse and blood pressure; tachycardia, angina, arrhythmias, palpitations
·        Dermatologic: Skin rash, loss of scalp hair
·        GI: Anorexia, nausea, abdominal pain; weight loss, abnormal liver function
·        HematologicLeukopenia, anemia
·        Other: Fever, tolerance, psychological dependence, abnormal behavior with abuse

Interactions
·        WARNING: Risk of severe hypertensive crisis if combined with MAOIs; do not administer dexmethylphenidate with or within 14 days of an MAOI
·        Possible increased serum levels of coumarin anticoagulants, phenobarbitalphenytoinprimidoneTCAs, some SSRIs; if any of these drugs are used withdexmethylphenidate, monitor the patient closely and decrease dose of the other drugs as needed
·        Risk of adverse effects if combined with pressor drugs (dopamine, epinephrine) or antihypertensives; monitor patients closely

Nursing considerations
Assessment
·        History: Hypersensitivity to dexmethylphenidate or methylphenidate; marked anxiety, tension, and agitation; glaucoma; motor tics, family history or diagnosis of Tourette's syndrome; severe depression of endogenous or exogenous origin; seizure disorders; hypertension; drug dependence, alcoholism, emotional instability; pregnancy, lactation
·        Physical: Body weight, height, T, skin color, lesions, orientation, affect, ophthalmic examination (tonometry), P, BP, auscultation, R, adventitious sounds, bowel sounds, normal output, CBC with differential, platelet count, baseline ECG (as indicated)

Interventions
·        Ensure proper diagnosis before administering to children for behavioral syndromes. Drug should not be used until other causes and concomitants of abnormal behavior (learning disability, EEG abnormalities, neurologic deficits) are ruled out.
·        Arrange to interrupt drug dosage periodically in children being treated for behavioral disorders to determine if symptoms recur at an intensity that warrants continued drug therapy.
·        Monitor growth of children on long-term dexmethylphenidate therapy.
·        WARNING: Arrange to dispense the least feasible amount of drug at any one time to minimize risk of overdose.
·        Administer drug before 6 PM to prevent insomnia if that is a problem.
·        Arrange to monitor CBC, platelet counts periodically in patients on long-term therapy.
·        Monitor BP frequently early in treatment.
·        Arrange for consult with school nurse of school-age patients receiving this drug.

Teaching points
·        Take this drug exactly as prescribed. It is taken two times a day, at least 4 hours apart.
·        Take drug before 6 PM to avoid night-time sleep disturbance.
·        Swallow extended-release capsules whole; do not cut, crush, or chew. Capsules can be opened and contents sprinkled over applesauce and taken immediately.
·        Store this drug in a safe place, out of the reach of children.
·        Avoid the use of alcohol and over-the-counter drugs, including nose drops, cold remedies, while taking this drug; some over-the-counter drugs could cause dangerous effects. If you feel that you need one of these preparations, consult your health care provider.
·        You may experience these side effects: Nervousness, restlessness, dizziness, insomnia, impaired thinking (these effects may become less pronounced after a few days; avoid driving a car or engaging in activities that require alertness if these occur; notify your health care provider if these are pronounced or bothersome); headache, loss of appetite, dry mouth.
·        Report nervousness, insomnia, palpitations, vomiting, skin rash, depression.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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