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Monthly NewsNote
August 2006
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NEW DELIVERY SYSTEMS FOR METHYLPHENIDATE
As you may know, methylphenidate is a stimulant we use regularly for the treatment
of ADD. The best known medication in the group is Ritalin. Recently, several
new ways to dispense the medication have been introduced. It is these new entries
into the methylphenidate treatment program that will be the focus of this August
NewsNote.
First, let me review the current delivery forms of this medication. Ritalin,
a tablet, is the oldest treatment form and is effective for three or four hours.
It is usually taken three times a day. Lasting longer are Metadate CD and RitalinLA.
These work for about 7 hours. FocalinXR and Concerta are considered long lasting,
which for many is about 10 hours. RitalinLA and FocalinXR can be swallowed or
opened and sprinkled into applesauce if they can’t be swallowed.
There are many young children and a few adults who can’t swallow pills.
Some in this group do not like the sprinkle method, and they do create a problem.
This problem is now solved by Methylin, which comes in a flavored liquid or
a chewable tablet. These forms of methylylphenidate, like Ritalin, last about
4 hours and need to be used three times a day.
An example is Marie, a 6 year old child who was helped by the liquid form.
She could not swallow a pill. We tried to train her to take a pill, using mini
M & M’s and then Nerds. We were not successful and moved to the liquid.
She takes a teaspoon three times daily with excellent results and no morning
battles with her mother.
The most recent entry is Daytrana, a patch that releases methylphenidate. It
is applied to the outer thigh, alternating sides daily. The patch works for
nine hours while in place, and the medication continues to be effective three
hours after it is removed. If you apply the patch at 7AM and leave it on until
4 PM, there should continue to be effective treatment until 7 PM.
The starting dose for the patch is 10 mg and this can be increased quickly
if it is not effective. But because of the different method of absorption, even
if a child has been on a higher dose of another form, we go back and start with
the 10 mg patch.
There are no samples of controlled medications, but the company has supplied
a redeemable card that can be used to get patches at no cost. The doctor chooses
the dose and writes a prescription, which is then taken to the pharmacy with
the card for the patches. The card is good again if the dose is changed, up
to a total of 40 patches.
I hope to try it with the high school athletes who don’t get home until
about 5 PM. They could take the patch off then and continue to focus for 3 more
hours. This might get around the current problems of the student forgetting
a second dose, or perhaps having trouble sleeping because it was taken too late.
To date I have no first hand experience with the patch. It does sound like
a good addition to our medical arsenal, but we’ll see how it works as
we get some experience in the near future. I’ll report back in a few months
As you can see, there are always new dispensing methods being developed, though
the actual medication remains the same. Each has a special feature and it often
takes trial and error to find out which is best for a specific child or adult.
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