Dexmethylphenidate (Focalin): dosage, uses, side effects

If you have attention deficit hyperactivity disorder (ADHD), it can be a struggle to focus and complete tasks each day at work or school. Fortunately, effective treatment options are available, including dexmethylphenidate (Focalin). 

Keep reading to learn more about dexmethylphenidate.

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Dexmethylphenidate is approved by the Food and Drug Administration (FDA) for the treatment of attention deficit hyperactivity disorder (ADHD) in adults and children ages six years and older. 

It is available by prescription in generic and brand-name versions: Focalin, an immediate-release tablet, and Focalin XR, an extended-release capsule. Immediate-release medications deliver their active ingredient into your bloodstream all at once, while extended-release medications release their contents over a period of time. Extended-release drugs take longer to wear off, which offers advantages, like once-daily dosing (Novartis, 2021-a; Novartis, 2021-b).

Dexmethylphenidate belongs to a class of medications known as central nervous system (CNS) stimulants or simply “stimulants.” CNS stimulants are the most commonly prescribed medications for ADHD, and research estimates that they work well for about 70% of people (Magnus, 2021). 

Some examples of other CNS stimulants are amphetamine salts (Adderall) and methylphenidate (Ritalin). CNS stimulants work by increasing the availability of two brain chemicals: norepinephrine and dopamine. This is thought to speed up brain activity (Farzam, 2021). Stimulants like dexmethylphenidate reduce impulsive behavior and improve concentration in adults and children with ADHD (Novartis, 2021-a; Novartis, 2021-b). 

The United States Drug Enforcement Administration (DEA) classifies dexmethylphenidate as a schedule II controlled substance. Some examples of other medications in this category are hydrocodone (Vicodin), oxycodone (OxyContin), and methylphenidate (Ritalin). Schedule II controlled substances have legitimate medical purposes but carry risks of high potential for abuse, dependence, and addiction. As such, healthcare professionals must follow additional rules when prescribing and dispensing schedule II controlled substances (DEA, n.d.).

As you might guess from their names, dexmethylphenidate (Focalin) and methylphenidate (Ritalin) are similar medications. 

Methylphenidate, one of the first ADHD drugs, contains pairs of molecules that are mirror images of one another, sort of like your left and right hands. And because of their opposite structures, they cause different effects in the body, some of which are unwanted (e.g. side effects like insomnia). Dexmethylphenidate contains only the “right-hand” version of the methylphenidate molecule— a difference designed to make Focalin more potent with fewer potential side effects (Novartis, 2021-a; Novartis, 2021-b; Magnus, 2021). 

Because of this difference, healthcare providers typically prescribe Focalin at half the dose of Ritalin. If you have been taking Ritalin and it works well for your ADHD symptoms, but you have side effects from it, your healthcare provider may prescribe Focalin for you instead. Treating ADHD may take trial and error, working with your healthcare provider to find an optimal treatment plan for you (Novartis, 2021-a; Novartis, 2021-b; Magnus, 2021). 

Not everyone who takes dexmethylphenidate gets side effects. The drug’s clinical trial results list these side effects as the most common (Novartis, 2021-a; Novartis, 2021-b):

• Dry mouth

• Indigestion

• Abdominal pain

• Nausea

• Headache

• Sore throat

• Anxiety

• Loss of appetite

Less commonly, some people may develop other side effects while taking dexmethylphenidate, such as (Novartis, 2021-a; Novartis, 2021-b): 

• Insomnia

• High blood pressure

• Fast heart rate

• Depression or mood changes

• Twitching, tics, or other movements that you can’t control

While rare, there are reports of serious side effects occurring after taking dexmethylphenidate, including (Novartis, 2021-a; Novartis, 2021-b):

• Serious heart problems like heart attack, chest pain, or stroke

• Psychosis or other severe changes in mental health

• Priapism: a prolonged, painful erection that lasts for hours and can be damaging to the penis

• Raynaud’s syndrome or other circulation problems which can affect your hands or fingers in rare cases

• Growth problems in children

If you develop side effects that don’t go away or become severe, tell your healthcare provider. They may adjust your dosage or recommend other changes to your treatment plan.

Dexmethylphenidate is available in the following forms and strengths (Novartis, 2021-a; Novartis, 2021-b):

• Focalin tablets, also called dexmethylphenidate hydrochloride or dexmethylphenidate HCl, are immediate-release (IR) tablets. They come in three strengths: 2.5 milligrams (mg), 5 mg, and 10 mg. You usually take Focalin tablets twice daily. The first dose is typically taken in the morning, with a second dose four hours later.

• Focalin XR (extended-release) capsules: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, and 40 mg. The usual dosage of Focalin XR is once daily in the morning. One capsule keeps working for up to 12 hours to improve ADHD symptoms (Moen, 2009).

You can take the tablets or capsules with or without food. If you or your child have trouble swallowing Focalin XR, you can open the capsule and sprinkle the contents onto a spoonful of applesauce and take it that way (Novartis, 2021-a; Novartis, 2021-b).

Some healthcare providers may recommend that you temporarily stop taking stimulants like dexmethylphenidate so that they can assess your ADHD symptoms and evaluate your need for continued treatment. But, you should not stop treatment without first discussing it with your healthcare provider (Novartis, 2021-a; Novartis, 2021-b).

The FDA requires stimulants like dexmethylphenidate to carry specific boxed warnings, the strongest type of FDA warnings. They alert patients and healthcare professionals about serious risks before starting a medication. These boxed warnings state (Novartis, 2021-a; Novartis, 2021-b):

• Dexmethylphenidate and other CNS stimulants have a high potential for abuse and dependence. 

• Abusing this medication or taking it differently from how it’s prescribed can lead to harmful side effects like a heart attack or stroke.

Dexmethylphenidate may interact with other medications. Here are a few interactions to know about (Novartis, 2021-a; Novartis, 2021-b):  

MAO Inhibitors

If you’re taking a type of drug called a monoamine oxidase inhibitor (MAOI), your healthcare provider won’t prescribe dexmethylphenidate to you. The same goes if you’ve taken an MAOI in the last two weeks. The combination can cause a dangerous increase in blood pressure that requires urgent medical treatment.

Blood pressure medications

Dexmethylphenidate can make blood pressure medications less effective. If you take blood pressure medications, your healthcare provider may check your blood pressure more often while taking dexmethylphenidate. They’ll likely have you monitor your blood pressure at home as well.

Risperidone 

Taking risperidone (brand name: Risperdal), a medication that healthcare providers prescribe for bipolar disorder, among other uses, can cause unwanted side effects like uncontrollable movements if taken along with dexmethylphenidate. 

Anesthesia

Dexmethylphenidate can interact with certain anesthesia drugs given for surgeries. Ask your healthcare provider about temporarily stopping your medication before a planned surgery.

Other drug interactions are possible. To help prevent adverse reactions, tell your healthcare provider about all of your medications before starting dexmethylphenidate. And while taking the drug, it’s best to consult your pharmacist or healthcare provider before adding new medicines, including over-the-counter medications or herbal supplements. 

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Current version

October 12, 2021

Written by

Patricia Weiser, PharmD

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.