dexmethylphenidate

dexmethylphenidate

Focalin

Focalin XR

Indications

Action

Pharmacokinetics

Time/action profile (improvement in symptoms)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• behavioral disturbances
• hallucinations
• insomnia
• mania
• nervousness
• thought disorder

Ear, Eye, Nose, Throat

• visual disturbances

Cardiovascular

• sudden death (life-threatening)
• peripheral vasculopathy
• tachycardia

Gastrointestinal

• abdominal pain (most frequent)
• anorexia
• nausea

Metabolic

• growth suppression
• weight loss (may occur with prolonged use)

Neurologic

• twitching

Miscellaneous

• anaphylaxis (life-threatening)
• angioedema (life-threatening)
• fever

Interactions

Drug-Drug interaction

Route/Dosage

Tablets

Extended-release capsules

Availability (generic available)

Nursing implications

Nursing assessment

• Assess child's attention span, impulse control, and interactions with others. Therapy may be interrupted at intervals to determine whether symptoms are sufficient to continue therapy.
• Monitor BP, pulse, and respiration before administering and periodically during therapy. Obtain a history (including assessment of family history of sudden death or ventricular arrhythmia), physical exam to assess for cardiac disease, and further evaluation (ECG and echocardiogram), 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. Pediatric: 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 of breath, rash) during therapy.
• Lab Test Considerations: Monitor CBC, differential, and platelet count periodically in patients receiving prolonged therapy.

Potential Nursing Diagnoses

Implementation

• Do not confuse dexmethylphenidate with methadone.
• Oral: 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 sprinkled 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 remaining doses for that day at regularly spaced intervals; do not double doses. Take the last dose before 6 pm to minimize the risk of insomnia. Instruct patient not to alter dose without consulting health care professional. Abrupt cessation with high doses may cause extreme fatigue and mental depression. Advise patient and parents 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 patients 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 fingers or toes, and call if unexplained wounds appear on fingers or toes. May require 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, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products.
  • May rarely cause dizziness or drowsiness. Caution patient to avoid driving or activities requiring alertness until response to medication is known.
  • Advise patient to notify health care professional if nervousness, restlessness, insomnia, dizziness, anorexia, or dry mouth becomes severe. Pediatric: If reduced appetite 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 suspected, 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.