Focalin, the brand form of Dexmethylphenidate, is a CNS stimulant used to help in the treatment of symptoms associated with Attention Deficit Hyperactivity Disorder (ADHD). Since its FDA approval for medical use in 2001, this medication has become popular among children, adolescents, and adults. However, this drug is associated with many adverse effects and contraindications and carries with it requirements for frequent monitoring for abuse, dependence, overdose, as well as for the development of adverse cardiovascular and psychiatric reactions. That is why people often compare Dexmethylphenidate and other related CNS stimulants, trying to find the option that is safer for themselves or their children.
This article compares Focalin and several other medications that are used in the treatment of ADHD.
Drug Alternatives To Focalin
When searching for alternatives for the treatment of Attention-Deficit/Hyperactivity Disorder patients are confined to the group of central nervous system (CNS) stimulants.
These Stimulants Are Divided Into Three Categories Based on Chemical Structure:
- Amphetamine (dextro-amphetamine and levo-amphetamine)
- Methylphenidate (dextro-methylphenidate and levo-methylphenidate)
From these categories, isomers of each stimulant are combined in varying ratios to offer different medications which aim to increase desired therapeutic effects and to reduce treatment-associated adverse effects.
Currently, There Are Seven Such Formulations Available in the United States for Use in the Treatment of ADHD:
- Amphetamine (Adzenys, Dyanavel, Evekeo)
- Dexmethylphenidate (Focalin)
- Dextroamphetamine (Dexedrine, ProCentra, Zenzedi)
- Dextroamphetamine‐Amphetamine Mixed Salts (Adderall)
- Lisdexamfetamine (Vyvanse)
- Methamphetamine (Desoxyn)
- Methylphenidate (Aptensio, Concerta, Daytrana, Metadate, Methylin QuilliChew, Quillivant)
Although these medication groups are clearly defined, there is a lack of information and evidence comparing the efficacy, safety, and prevalence of adverse events of these drugs during treatment. As such it is impossible to clearly state the superiority of one agent over the other when comparing and contrasting them.
One of the largest medical reviews of the comparative efficacy and safety of different medication classes used in the treatment of Attention-Deficit/Hyperactivity Disorder was done by the Oregon Health and Science University, and their results re-affirm the previous statement and conclude that based on available information all agents are similarly effective for the treatment of ADHD. Furthermore, since all CNS stimulants increase the availability of monoamines (Norepinephrine, Dopamine) their spectrum of side effects is similar as well.
This is not to say that differences do not exist between the medications in use for the treatment of ADHD.
Differences do exist among the preparation, labeled indication, dosing, availability of a generic agent, onset and duration of effect, half-life, and various other pharmacokinetic properties of these CNS stimulants.
As such it is important for patients to understand these peculiarities, including the information on how long Focalin stays in the system, when comparing it to specific alternatives. This will allow them to have all the information they need to make a better judgment in terms of what option they would like to consider. However, choosing the correct treatment option for ADHD must be individualized for each patient, taking into account numerous patient factors, as such, it should only be done through consultation with a medical professional.
Focalin Vs. Adderall
When it comes to comparing Focalin vs Adderall, the first thing that must be stated is that they are both CNS stimulants but from different categories. As already mentioned Focalin is the brand name of Dexmethylphenidate, the d-enantiomer of Methylphenidate. Adderall on the other hand is a 3:1 dextro- to levo- mixture of Amphetamine salts.
Another difference between Focalin vs Adderall is that while Dexmethylphenidate is only indicated for the treatment of ADHD, Adderall can also be prescribed in the treatment of Narcolepsy.
Furthermore, when comparing the strength/efficacy of Focalin vs Adderall, it must be reasserted that both medications are equally efficacious in the treatment of ADHD if prescribed correctly and used as directed.
Below are offered some main points that patients may be curious about when comparing and contrasting Focalin vs Adderall.
|DRUG BRAND NAME||FOCALIN||ADDERALL|
|GENERIC NAME||The generic name of Focalin is Dexmethylphenidate||The generic name of Adderall is Dextroamphetamine‐
|DRUG CLASS||Central Nervous System Stimulant; d-isomer of Methylphenidate||Central Nervous System Stimulant; Amphetamine|
|AVAILABILITY OF GENERIC VERSIONS||Yes||Yes|
|APPROVED AGE OF USE||Approved for use in children ≥6 years, Adolescents, and Adults.||Approved for use in children ≥3 years, adolescent and adults|
|TREATMENT LENGTH||Variable, months to years||Variable, months to years|
|Oral Capsule, extended-release: 5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg
Oral tablet: 2.5 mg, 5 mg, 10 mg
|Oral capsule, extended-release: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
Oral tablet: 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg
Duration: ~12 hours
|RISK OF WITHDRAWAL OR OVERDOSE||It is not recommended to discontinue Focalin abruptly especially if you have used or misused it for a prolonged period.
Dexmethylphenidate overdose can occur as it has a very narrow therapeutic range. Acute overdose can occur if more than 1 mg/kg of Dextroamphetamine is ingested and is characterized by restlessness, sweating, tremors, agitation, psychosis, seizures, coma, and hypertension potentially leading to heart attack or stroke.
|The risk of withdrawal and overdose in Adderall is similar to that of Dexmethylphenidate.|
Additionally, when comparing Focalin vs Adderall, information about side effects have to be mentioned. Most of the side effects are similar due to Focalin and Adderall together having the same mechanism of action. The Central Nervous System Effects of both of these agents are similar, however, Adderall has slightly more adverse effects in the form of speech disturbance, twitches/tics, Euphoria, Formication, Paraesthesia, and Psychosis. The cardiovascular adverse effects are much more serious with the use of Methamphetamines. As such when comparing the cardiovascular side effects of Adderall vs Focalin, it is clear that Adderall use is associated with life-threatening arrhythmias and even sudden cardiac death, whereas the latter medication is only associated with mild to moderate hypertension.
The dermatologic side effects of both of these medications are comparable, with hypersensitivity to sunlight, rash, urticaria, and itching.
Both of these medications are associated with weight loss and growth suppression, especially in children.
Taking these two medications is associated with a similar spectrum of gastrointestinal side effects, however, unique features of Adderall include Teeth clenching, grinding, and infections, and of Dexmethylphenidate include throat pain. Genitourinary side effects are similarly comparable with prolonged painful erections associated with both agents. The side effects of the respiratory system are only slightly different, the first agent is associated with mild dyspnea/difficulty with breathing and the second agent is associated with mild to moderate nasal congestion.
Lastly in the comparison of Adderall vs Focalin, one more consideration warrants a mention. Adderall and other Methamphetamines are issues with a black box warning for serious cardiovascular events including sudden death.
Focalin Vs. Ritalin
When it comes to comparing Focalin vs Ritalin, it is essential to know what Focalin is and what the drug is composed of. While Focalin uses Dexmethylphenidate HCI isomer to help improve ADHD symptoms, Ritalin instead utilizes an active ingredient that is known as Methylphenidate.
When comparing Focalin vs. Ritalin, Dexmethylphenidate is considered to be slightly more potent. Due to the increased potency, a lower dose of the drug would be needed to experience a similar level of relief that a person would be able to achieve with Ritalin. This yields a lower risk of side effects, of course.
Another difference between Focalin vs Ritalin would be their side effects. When comparing these two, Ritalin also has more side effects associated with it – including weight loss, irritability, lightheadedness, constipation, skin rash, and vomiting.
Focalin Vs. Vyvanse
Vyvanse is another relatively common drug that is used in the treatment of ADHD symptoms. Both of these drugs act upon the central nervous system and are classified as stimulants. The main difference in the comparison between Focalin vs. Vyvanse is the active chemicals that are present in these medications. Focalin, as mentioned previously, uses Dexmethylphenidate to produce a reduction in ADHD symptoms, whereas Vyvanse utilizes an active ingredient known as Lisdexamfetamine dimesylate.
When comparing the potency between Focalin vs. Vyvanse, it can be said that it is relatively similar, and both can interact with other drugs used to treat mental disorders. The difference between Focalin vs Vyvanse comes in when looking at their side-effects. Those using Vyvanse may also experience a range of additional adverse effects, including weight loss, sweating, and an unpleasant taste in the person’s mouth. The side effects with the use of Vyvanse making it the most discontinued drug among the stimulants group.
Focalin Vs Concerta
The primary difference between Focalin versus Concerta is the active ingredients used in these medications for the treatment of ADHD. The main ingredient in Concerta is Methylphenidate. These are extended-release tablets that can provide effective relief of ADHD-related symptoms over a longer period compared to some of the other drugs that can be used to treat the condition. This is one of the main advantages that the drug has in the comparison of Focalin versus Concerta.
Concerta does not cause a sore throat or jitteriness as side effects like Dexmethylphenidate. This drug does, however, cause vision problems, weight loss, and vomiting in some people. For this reason, many people may choose Dexmethylphenidate when making the decision between Focalin versus Concerta.
Reasons To Look For Focalin Alternatives
There are various reasons as to why patients with Attention-Deficit/Hyperactivity Disorder (ADHD) may seek out alternatives to their treatment option. Logically, the most important reason for seeking out an alternative medication would probably be the presence of medical contraindication to the use of Dexmethylphenidate
- MAOI use;
- Family history or diagnosis of tic disorders;
- Severe hypertension;
- Congestive Heart Failure;
- Thyroid pathologies.
The emergence of intolerable side effects during treatment and the cost of brand-name medication may also be some of the other reasons why patients may seek alternatives for the medication they are currently taking for their ADHD.
Reaching For Focalin Alternatives
The use of Dexmethylphenidate and other similar drugs is common among children, adolescents, and even adults with ADHD. While these medications are effective at reducing symptoms of this disorder, they are also considered somewhat dangerous due to potential side effects. Individuals who reach for Dexmethylphenidate first often look for alternatives.
Individuals who are experiencing side effects while taking the drug are advised to consider alternatives. A discussion about alternatives with a physician can also help a person obtain information and better understand which drug may be a more appropriate option for them.
Note that in the case of drug dependence, switching to another drug may not be an option. Associated Dexmethylphenidate withdrawal symptoms may be quite harsh. Consider enrolling in a rehabilitation facility. Sometimes professional treatment assistance of trained medical professionals is the best option.
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- Archer, M., Steinvoort, C., Frydrych, V., & Oderda, G. (2016, May). Drug Class Review: Central Nervous System Stimulants used in the Treatment of Attention Deficit Disorder. University of Utah College of Pharmacy. https://medicaid.utah.gov/pharmacy/ptcommittee/files/Criteria%20Review%20Documents/2016/2016.05%20Central%20Nervous%20System%20Stimulants%20Drug%20Class%20Review.pdf
- Brunton, L. L., Hilal-Dandan, R., & Knollmann, B. C. (2018). Goodman & Gilman’s The Pharmacological Basis of Therapeutics (13th ed.). McGraw-Hill
- Liu, F., Minami, H., & Silva, R. R. (2006). Dexmethylphenidate hydrochloride in the treatment of attention deficit hyperactivity disorder. Neuropsychiatric disease and treatment, 2(4), 467–473. https://doi.org/10.2147/nedt.2006.2.4.467
- Moen, M.D., Keam, S.J. Dexmethylphenidate Extended Release. CNS Drugs 23, 1057–1083 (2009). https://doi.org/10.2165/11201140-000000000-00000
- Novartis Pharmaceuticals Corporation. (2021, April). Full Prescribing Information for FOCALIN. https://www.novartis.us/sites/www.novartis.us/files/focalinXR.pdf