Adult ADD

Methylphenidates and Focalin
Dosing of methylphenidates is about the same for all medications in this class except Focalin.  Here’s why: methylphenidate is made of equal amounts of two mirror image (methylphenidate) molecules.  The chemical structure of the two molecules are identical except they differ the way your right hand and hand differ.  Only the right handed molecule works to treat ADD.  Focalin is made of only this right handed molecule, so 5 mg of Focalin has the same effect on ADD as 10 mg of methylphenidate. In the paragraph that follow this, the doses specified are methylphenidate doses; Focalin doses are half the size of those doses.

Common Adult Dosages:
Doses of methylphenidate may start at 5 mg two to three times daily, with small periodic increases until the desired effect is obtained. It is recommended that the tablets be taken 30 to 45 minutes before meals, with doses no later than 6 p.m. as the medication can interfere with sleep. Some people who tend to think too much at bedtime, can benefit from an evening dose. The dose range for adults is anywhere from 20 mg a day to over 120 mg per day with most patients falling in the 40 – 60 mg per day range. Take tablets whole, never chew and swallow them. Dosing should always be explored under a doctor’s supervision.

For more information about dosing, click here.

Side Effects:
Most commonly occurring side effects are difficulty sleeping, nervousness, tenseness of jaw, loss of appetite, weight loss, heart palpitations, fast heart beat, and increase in blood pressure. Occasional side effects include nausea, dizziness, and stomach upset. Not infrequently, patient experience a mild “crash” when the effects of methylphenidate wear off. It’s best to have the effect of the following dose overlap that of the previous dose to minimize this effect. That is, take each dose about a half hour before the previous dose is expected to wear off.

For a more detailed list of side and adverse effects, click here.

Medical contraindications:
This drug is contraindicated for use in patients with glaucoma, uncontrolled hypertension, heart problems, or a history of Tourette’s syndrome. Patients with a history of seizure disorders may experience an increase in the number, duration, and/or severity of seizures. Some patients have experienced paranoia (suspiciousness) and psychotic symptoms from taking methylphenidate.

For a more extensive list of medical issues to be considered before taking stimulants, see the Medical History Questionnaire

Interactions with Other Medications
Alcohol: Taking with alcohol will reduce coordination, speed of reflexes.
Blood pressure medications: Methylphenidate may increase the blood pressure and heart rate in spite of these medications.
MAOIs: Do not take with an MAOI antidepressant medication such as Parnate or Nardil.
Antidepressants: Patients taking tricyclic antidepressants such as amitriptyline (Elavil) or imipramine (Tofranil) etc. may require some dosage adjustments for these medications.
Other medications: Warfarin (Coumadin), Phenobarbital, phenytoin (Dilantin), primidone (Mysoline).

Over the counter cough and cold preparations and diet aids. Avoid medications that contain ingredients such as phenylephrine (nose sprays and eye drops), pseudoephedrine (Sudafed, Actifed, and others), and phenylpropanolamine (Dimetapp, Dexatrim, and others), and health food store preparations containing Ma Huang. These may increase the side effects of nervousness and insomnia with further increases in blood pressure and heart rate and in some cases cause a major psychotic episode or even a stroke.

Missed doses should be taken as soon as possible, but not closer than 4 hours apart. Do not double up doses.

Discontinuation symptoms:
Aside from some temporary tiredness and the return of ADD symptoms that had been controlled by the medication, discontinuation or withdrawal symptoms are very rare.

Storage:
Always keep tablets dry, tightly capped, and at room temperature. Keep away from direct heat, light, and moisture. Keep out of reach of children and pets. Discontinued medication must be carefully discarded.