Name /bks_53161_deglins_md_disk/dexmethylphenidate 02/12/2014 01:21PM Plate # 0-Composite pg 1 # 1

1 thyroidism; Hypertension; Diabetes mellitus; Geri: Geriatric/debilitated patients;

Continual use (may result in psychological or physical dependence); Seizure disor-
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dexmethylphenidate (dex-meth-ill-fen-i-date) ders (may lower seizure threshold); OB, Lactation, Pedi: Pregnancy, lactation, or
Focalin, Focalin XR children ⬍6 yr (safety not established; use in pregnancy only if clearly needed).
Classification Adverse Reactions/Side Effects
Therapeutic: central nervous system stimulants CNS: behavioral disturbances, hallucinations, insomnia, mania, nervousness,
Schedule II thought disorder. EENT: visual disturbances. CV: SUDDEN DEATH, peripheral vascu-
Pregnancy Category C lopathy, tachycardia. GI: abdominal pain, anorexia, nausea. Metab: growth sup-
pression, weight loss (may occur with prolonged use). Neuro: twitching. Misc: AN-
APHYLAXIS, ANGIOEDEMA, fever.
Indications
Adjunctive treatment of ADHD. Interactions
Drug-Drug: Concurrent use with or use within 14 days following discontinuation
Action of MAO inhibitors may result in hypertensive crisis and is contraindicated. Mayp
Produces CNS and respiratory stimulation with weak sympathomimetic activity. effects of antihypertensives. Mayqeffects of vasopressors. Mayqeffects of war-
Therapeutic Effects: Increased attention span in ADHD. farin, phenobarbital, phenytoin, some antidepressants; dose adjustments may
be necessary.
Pharmacokinetics
Absorption: Readily absorbed following oral administration. Route/Dosage
Distribution: Unknown. Tablets
Metabolism and Excretion: Mostly metabolized by the liver; inactive metabo-
PO (Adults and Children ⱖ6 yr): Patients not previously taking methylpheni-
lites are renally excreted.
date— 2.5 mg twice daily, may beqweekly as needed up to 10 mg twice daily; Pa-
Half-life: 2.2 hr. tients currently taking methylphenidate— starting dose is 1/2 of the methylpheni-
TIME/ACTION PROFILE (improvement in symptoms) date dose, up to 10 mg twice daily.
ROUTE ONSET PEAK DURATION Extended-release capsules
PO 7 days 1 mo unknown PO (Adults): Patients not previously taking methylphenidate— 10 mg once
daily, may beqby 10 mg up to 40 mg/day; Patients currently taking methylpheni-
Contraindications/Precautions date— starting dose is 1/2 of the methylphenidate dose, up to 40 mg/day given as a
Contraindicated in: Hypersensitivity; Hyperexcitable states (marked anxiety, agi- single daily dose; Patients currently taking dexmethylphenidate— give same daily
tation, or tension); Hyperthyroidism; Psychotic personalities, suicidal or homicidal dose as a single dose.
tendencies; Glaucoma; Motor tics, family history or diagnosis of Tourette’s syn- PO (Children ⱖ6 yr): Patients not previously taking methylphenidate— 5 mg
drome; Concurrent use of MAO inhibitors; Should not be used to treat depression or once daily, may beqby 5 mg weekly up to 30 mg/day; Patients currently taking
prevent/treat normal fatigue; Psychoses (may exacerbate symptoms). methylphenidate— starting dose is 1/2 of the methylphenidate dose, up to 30 mg/
Use Cautiously in: Cardiovascular disease (sudden death has occurred in chil- day, given as a single daily dose; Patients currently taking dexmethylphenidate—
dren with structural cardiac abnormalities or other serious heart problems); Hyper- give same daily dose as a single dose.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/dexmethylphenidate 02/12/2014 01:21PM
2 maining doses for that day at regularly spaced intervals; do not double doses. Take
NURSING IMPLICATIONS
Assessment
● Assess child’s attention span, impulse control, and interactions with others. Ther-
apy may be interrupted at intervals to determine whether symptoms are sufficient
to continue therapy.
● Monitor BP, pulse, and respiration before administering and periodi-
cally during therapy. Obtain a history (including assessment of family
history of sudden death or ventricular arrhythmia), physical exam to as-
sess for cardiac disease, and further evaluation (ECG and echocardio-
gram), if indicated. If exertional chest pain, unexplained syncope, or
other cardiac symptoms occur, evaluate promptly.
● Monitor weight biweekly and inform health care professional of significant loss.
Pedi: Monitor height periodically in children; report growth inhibition.
● Monitor closely for behavior change.
● Dexmethylphenidate has the potential for dependence and abuse. Prolonged use
may result in tolerance.
● Assess patient’s fingers periodically for signs of peripheral vasculopathy (digital
ulceration, soft tissue breakdown).
● Monitor for signs of anaphylaxis (wheezing, shortness or breath, rash)
during therapy.
● Lab Test Considerations: Monitor CBC, differential, and platelet count period-
ically in patients receiving prolonged therapy.
Potential Nursing Diagnoses
Disturbed thought process (Side Effects)
Implementation
● Do not confuse dexmethylphenidate with methadone.
● PO: Administer twice daily at least 4 hr apart without regard to meals.
● Administer XR tablets once daily in the morning. Capsules should be swallowed
whole. For patients with difficulty swallowing, capsules can be opened and sprin-
kled on a spoonful of applesauce. Mixture should be consumed immediately; do
not store for future use.
Patient/Family Teaching
● Instruct patient to take medication as directed. If more than prescribed amount is
taken, notify health care professional immediately. If a dose is missed, take the re-
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the last dose before 6PM to minimize the risk of insomnia. Instruct patient not to
alter dose without consulting health care professional. Abrupt cessation with high PDF Page #2
doses may cause extreme fatigue and mental depression. Advise patient and par-
ents to read the Medication Guide prior to starting therapy and with each Rx refill.
● Inform patient that sharing this medication may be dangerous.
● Inform patients starting therapy of risk of peripheral vasculopathy. Instruct pa-
tients to notify health care professional of any new numbness; pain; skin color
change from pale, to blue, to red; or coolness or sensitivity to temperature in fin-
gers or toes, and call if unexplained wounds appear on fingers or toes. May re-
quire rheumatology consultation.
● Advise patient to check weight 2– 3 times weekly and report weight loss to health
care professional.
● Instruct patient to notify health care professional of all Rx or OTC medications, vi-
tamins, or herbal products being taken and to consult health care professional be-
fore taking other Rx, OTC, or herbal products.
● May rarely cause dizziness or drowsiness. Caution patient to avoid driving or activ-
ities requiring alertness until response to medication is known.
● Advise patient to notify health care professional if nervousness, restlessness, in-
somnia, dizziness, anorexia, or dry mouth becomes severe. Pedi: If reduced ap-
petite and weight loss are a problem, advise parents to provide high calorie meals
when drug levels are low (at breakfast and or bedtime).
● Advise patient and/or parents to notify health care professional of behavioral
changes.
● Inform patient that health care professional may order periodic holidays from the
drug to assess progress and to decrease dependence.
● Caution patients to inform health care professional if they have ever abused or
been dependent on alcohol or drugs, or if they are now abusing or dependent on
alcohol or drugs.
● Advise patient to notify health care professional if pregnancy is planned or sus-
pected, or if breast feeding.
● Emphasize the importance of routine follow-up exams to monitor progress.
● Home Care Issues: Advise parents to notify school nurse of medication regimen.
Evaluation/Desired Outcomes
● Improved attention span, decreased impulsiveness and hyperactivity in ADHD. If
improvement is not seen within 1 mo, discontinue dexmethylphenidate.
Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company