From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Lately, parents and Pediatricians have had a lot of options when choosing medications to treat children with ADHD. In addition to short acting stimulants, they could choose among long acting stimulants, like Adderall XR, Ritalin LA, Concerta, Daytrana (the Ritalin patch), and Metadate CD, or they could use Strattera, a non-stimulant.

However, when you consider that Daytrana, Ritalin LA, Concerta, and Metadate CD are all long acting forms of methylphenidate or Ritalin, the number of choices seem much more limiting.

Fortunately, a new ADHD medication was recently approved. Focalin XR (dexmethylphenidate hydrochloride) is a long acting form of Focalin and can be used to treat children, teens, and adults with ADHD. Like other once-a-day or extended release ADHD medications, Focalin XR is reported to last through the entire school day.

Since, like Ritalin LA, it uses the SODAS drug delivery system, Focalin XR is an extended release capsule that can be opened and sprinkled on food, which is helpful for kids who can't swallow pills.

Focalin

The theory about the superiority of Focalin is that it is made of just one part of Ritalin, and leaves another part, which is inactive and may contribute to side effects, out. This is supposed to work because medicines are made of two isomers or parts and you really only need one of those parts for the medicine to work. Xopenex, one isomer of racemic (mixed) albuterol, which is used to treat asthma, is made the same way.

In addition to supposedly being more effective and having less side effects, making a medicine by taking away one isomer often allows you to use a lower dose of the medicine. And in fact, Focalin is often prescribed at half the dose that someone taking Ritalin might take.

Unfortunately, there haven't been any convincing research studies that show that Focalin is better or safer than Ritalin or Adderall. There has been a head to head study between Focalin and Ritalin, but it concluded that Focalin was 'as efficacious and safe' as Ritalin.¹

The study mentioned above did show that Focalin could be used at half the dose of Ritalin and they felt that there was 'some suggestion of a slightly longer duration,' so hopefully Focalin XR will be shown to work a little longer than the current extended release forms of Ritalin.

Focalin XR

Focalin XR is available is 4 strengths, including 5, 10, and 20mg capsules. A 15mg capsule has just been approved and is now available too, which is a nice addition and makes fine tuning a child's dose much easier.

As with most ADHD medications, depending on your child's age and while watching for side effects, your Pediatrician may have to go up on your child's dose of Focalin XR to reach an effective dose though, which may reach as high as 30mg to 40mg and would be the equivalent of about 54mg to 72mg of Concerta.

Your Pediatrician may have a voucher for a free trial of Focalin XR if you would like to try it.

Focalin References

¹Wigal S - J Am Acad Child Adolesc Psychiatry - 01-NOV-2004; 43(11): 1406-14
²Focalin XR Prescribing Information Sheet. May 2005.