Focalin Side Effects: Emotional And Physical Adverse Reactions

Last Updated: July 20, 2021

Authored by Isaak Stotts, LP

Reviewed by Michael Espelin APRN

Dexmethylphenidate, under the brand name Focalin, belongs to the drug class called stimulants and its main use is for the treatment of Attention Deficit Hyperactivity Disorder or ADHD. As a stimulant, this medication is useful in helping patients to focus and improve their control behaviors. In 2018, around 4 million prescriptions of Dexmethylphenidate were issued in the United States. Like any other drugs for ADHD, there are various side effects of Focalin, some of which should be seriously taken into consideration, needing immediate medical attention. For these reasons, it can be said that knowing how to make the difference between Focalin side effects and when to address a doctor could save the patient’s life.

In this article, information about the side effects of Focalin, warnings and the risk of Focalin overdose when taking this medication, variables that affect the occurrence of Focalin side effects, and tips on how to prevent adverse reactions will be provided.

Common Side Effects of Focalin

Dexmethylphenidate may also come in the form of an extended-release capsule. However, the side effects of the XR form and the regular Focalin are the same.

Moreover, aside from the age of a patient and response to the medication, common Dexmethylphenidate adverse reactions depend on the dose taken, and the treatment being given. In this section, information about common psychological and physical side effects of this medication will be provided.

Common Psychological Side Effects

Dexmethylphenidate, a drug whose main use is to treat ADHD, also comes with various adverse reactions, and these may be psychological. According to a study, the most common psychological side effect of Dexmethylphenidate is insomnia which is more common in children.

Below Are Some Other Common Psychological Side Effects of Focalin and Focalin Xr:

  • Anxiety
  • Restlessness
  • Dizziness
  • Nervousness
  • Feeling jittery
  • Irritability
  • Lethargy
  • Dyskinesia
  • Tics

The listed Focalin plain or Focalin XR side effects above are mild if the drug is taken as prescribed. Additionally, they are usually well tolerated by patients. Another Focalin emotional side effect is hostility or aggressive behavior that is usually seen in teenagers and children who are under treatment with Dexmethylphenidate. Because of this, patients under this drug should be monitored to prevent the appearance or worsening of such behaviors.

Common Physical Side Effects

Physical Focalin plain or Focalin XR side effects can also be seen aside from the psychological ones. According to a study, the most common physical side effect of this medication is loss of appetite (36% prevalence rate) which is related to Focalin weight loss.

Some Other Common Physical Focalin Plain or Focalin Xr Side Effects of This Medication and They Are Arranged According to Their Prevalence:

  • Sleep problems (26%)
  • Mood (21%)
  • Nausea and gastrointestinal pain (11%)
  • Headache (10%)

Other common physical adverse reactions of this medication aside from the ones mentioned above are dry mouth, heartburn, sore throat, and blurred vision, and their prevalence rate is less than 10%. Additionally, Focalin plain or Focalin XR side effects also affect the general health of a patient.

It Gives Way for the Following Conditions to Occur:

  • Hypertension – Focalin side effects in adults might cause a small increase in the average heart rate and blood pressure.  Although this increase is not considered dangerous to the health, caution is indicated in patients whose existing medical conditions might be worsened by these changes. Such medical conditions include ventricular arrhythmia, recent myocardial infarction, heart failure, or pre-existing hypertension.
  • Peripheral Vasculopathy – Among the physical Dexmethylphenidate 10 mg adverse reactions, patients may experience peripheral vasculopathy, with symptoms that are usually mild and intermittent, and which generally improve after the dosage is reduced or the treatment is discontinued. Such symptoms include a color change of the toes and fingers into red, blue, or white.

Even if the adverse reactions being experienced by a patient are common, it is always important to share them with a doctor for further observations. Doing this will help the patient avoid dangerous events to the health and will also allow the patient to get help in managing these adverse reactions.

Severe Side Effects of Focalin

When it comes to any medicine, adverse reactions may be common, unusual, or severe. As being said, not all adverse reactions to Dexmethylphenidate are moderate. Some of the adverse reactions may require medical attention in patients taking this medication.

Severe Side Effects of Focalin.

Severe Psychological Side Effects

The stimulant medication, Dexmethylphenidate, has severe psychological adverse reactions and usually, these are more on the appearance of new psychological problems. Additionally, prolonged use of this drug may cause addiction, manic disorders, and exacerbation of pre-existing psychotic disorders. To understand more, the information in this section will explain.

Addiction to Dexmethylphenidate

One of Dexmethylphenidate’s long-term adverse reactions could be an addiction. Usually, physicians avoid prescribing this drug to patients with a history of alcoholism or drug dependence. Patients under this treatment might become dependent, needing increased doses to achieve the desired result, or might experience symptoms of withdrawal when the medication is stopped, and this is dangerous to their health.

At higher doses, Dexmethylphenidate adverse effects include euphoria, increased focus, self-confidence, sociability, energy, weight loss, staying awake for longer hours, but also paranoia, delusions, hallucinations, aggression, irritability, and even severe cardiac conditions. The same adverse reactions have been seen when comparing ADHD drugs, such as Focalin vs Vyvanse/.

Manic or Psychotic Symptoms

Dexmethyphenidate 10 mg, the usual prescribed dose for ADHD, can also cause manic or psychotic symptoms in the form of mania, delusional thinking, or hallucinations in teenagers and children. These Focalin emotional side effects can take place even in patients without a history of mania or psychotic illness. In such a situation, the physician would advise the discontinuation of the treatment.

Additionally, According to the FDA, Dexmethylphenidate Is Reported to Cause the Appearance of New Psychotic Disorders Such As: 

  • New or worse behavior and thought problems
  • New or worse bipolar illness
  • New or worse aggressive behavior or hostility
  • New psychotic symptoms in teens and children (such as hearing voices, believing things that are not true, are suspicious)
  • New manic symptoms

Call a doctor if any of the mental health problems listed above is being experienced by a patient. Also, if new or worsening mental symptoms or problems are seen while taking Dexmethylphenidate, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious, immediate care must be given.

Exacerbation of a Psychotic Disorder

According to the FDA, clinical experience suggests that in pediatric patients with pre-existing psychotic disorder, Dexmethylphenidate could exacerbate the behavior and symptoms of the disorder. An example would be patients with bipolar disorder who might experience manic episodes. For this reason, it is important to be careful in the use of any stimulant drugs like Dexmethylphenidate in patients with comorbid bipolar disorder in order to avoid the exacerbating of the illness.

Lastly, screening such as getting a family history of suicide and depression should also be made.

Severe Physical Side Effects

Dexmethylphenidate also comes with severe physical adverse reactions and according to a study, the most prevalent severe physical side effects of Focalin are muscle pain and stiffness. Additionally, prolonged use of Dexmethylphenidate may cause various physical health problems. To understand more about these, the information in this section will explain.

Life-Threatening Cardiovascular Reactions

According to a study, the life-threatening cardiovascular Focalin side effects in adults include myocardial infarction, stroke, and even sudden death. These adverse reactions have been seen in patients with structural cardiac abnormalities at standard doses of Dexmethylphenidate. The drug should not be administered in patients with severe heart rhythm and structural cardiac abnormalities, coronary artery disease, or cardiomyopathy. Patients who experience unexplained syncope, chest pain, trouble breathing, or arrhythmias should immediately contact their physician.

Serotonin Syndrome

Serotonin syndrome is a condition where a patient is having too much serotonin in the body and this condition is usually caused by drugs. With regards to Dexmethylphenidate, this medicine has been linked with serotonin syndrome. Medical attention should be sought immediately when symptoms such as hallucinations, shivering, agitation, sweating, fever, twitching, muscle stiffness, fast heart rate, vomiting, loss of coordination, diarrhea, or nausea occur.

Serotonin Syndrome.

Priapism

Another of the Dexmethylphenidate adverse reactions that require immediate medical attention is priapism, a prolonged erection of the penis with pain that is not caused by sexual stimulation.  Moreover, priapism is caused by the treatment with Dexmethylphenidate and it has been reported in both young and adult patients who are taking this drug. These adverse reactions took place after some time on the drug, usually after an increase of the dose, but may also take place in a period of withdrawal from the drug.

Suppression Of Growth

The Focalin side effects in children also include weight loss, as well as a long-term suppression of growth. Сhildren who underwent treatment every day for one year presented a 2-cm growth delay and 2.7-kg weight delay over three years, with no growth rebound during this period. Medical attention is needed for children treated with Dexmethylphenidate who are not gaining weight or height as expected. In such cases, the treatment should be immediately interrupted.

Focalin weight loss

Dexmethylphenidate affects the metabolism and nutrition of a patient. Moreover, prolonged Dexmethylphenidate therapy can result in weight loss. This is related to one of the side effects of Focalin which is loss of appetite. Weight loss is dependent on the dose of Dexmethylphenidate. In one study, as the dose of the Dexmethylphenidate increases, an increase in clinical Focalin weight loss is also seen.

Dexmethylphenidate Warnings And the Risks Of Overdose

According to the federal government, Dexmethylphenidate is required to carry a black-box warning. There is the possibility of habit-forming and chronic abuse can result in psychological dependence and a marked tolerance. These can be associated with abnormal behavior, depression from abusive use, withdrawal, and frank psychotic episodes.

Continuous monitoring should take place to assess any signs of abuse and dependence during the treatment. The withdrawal from prolonged Dexmethylphenidate treatment may resurface symptoms of the underlying condition that may need follow-up. Additionally, sudden death and cardiac abnormalities can also happen in the case of the abuse or misuse of this medication.

Focalin Overdose

When a patient intentionally abuses or misuses the medication, this may actually lead to an overdose. However, an overdose may also be unintentional such as when an elderly patient is unaware that he or she has already taken the medicine.

Moreover, Focalin Overdose Symptoms Include the Following:

  • Vomiting
  • Shaking of the body
  • Muscle twitching and pain
  • Seizures
  • Unconsciousness
  • Irregular heartbeat
  • Widening of pupils
Focalin Overdose.

When Focalin overdose symptoms occur, it is important to call a doctor and seek emergency care. There are also ways on how to avoid Focalin overdose such as following the doctor’s instructions, being mindful of the dose being taken, and taking note of the other drugs and substances that may interact with the drug.

Variables That Affect Side Effects Emergence

The incidence of Focalin side effects depends on many factors, such as body weight, metabolism, tolerance, and personal sensitivity. But other variables should be taken into consideration. In this section, information about the list of variables that affect the emergence of the adverse reactions of Dexmethylphenidate will be provided.

Age

Geriatric patients might be more prone to experiencing Focalin side effects. The drug should be used with caution due to an increased incidence of cardiac disease. Dexmethylphenidate is usually prescribed when lifestyle and behavioral modifications have failed to improve ADHD symptoms.

Geriatric Patients Are More Susceptible to Specific Adverse Reactions Such as: 

  • insomnia
  • tremor
  • behavior and mood changes
  • headache
  • increased blood pressure
  • gastroesophageal reflux

Certain eating disorders

Patients with eating disorders, such as bulimia nervosa or anorexia nervosa, may present metabolic abnormalities and physiologic complications that can augment the side effects of Focalin XR or its plain form. The drug is known for causing weight loss and appetite suppression, so the incidence of abuse in such patients is increased.

Individual tolerance

Chronic use of Dexmethylphenidate can lead to psychological dependence and marked tolerance, associated with frank psychotic episodes, abnormal behavior, and Dexmethylphenidate depression. Careful attention is required during the withdrawal after chronic use of the drug.

Preventing Focalin Side Effects

To prevent the occurrence of the side effects of Focalin XR or its plain form, it is important to know the information about how long Dexmethylphenidate stays in the system. Dexmethylphenidate has a half-life varying from 2.2 hours to 7 hours, depending on the drug’s release time. This will aid in understanding how long the adverse reactions might last. But there are also some things that can make these be reduced or even prevented.

  1. Take the medication with a meal and keep drinking lots of water to prevent dehydration. In the case of dizziness, talk to a doctor to have a blood pressure check and readjust the dosage.
  2. Try eating several smaller meals, not three big ones and have dinner at a later time in the evening after the medication’s side effects have worn off. There is a connection between Dexmethylphenidate and weight loss due to the loss of appetite. Talk to a doctor if too much weight is lost during the treatment.
  3. Drink plenty of water to avoid having a dry mouth. Lozenges might also help in keeping the mouth moist.

However, all these tips will not be useful in case of drug abuse and addiction. Get in touch with medical professionals to get referred to the best addiction treatment options in the state. In some cases, rehabilitation in one of the substance dependence centers will be necessary.

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Published on: June 12th, 2019

Updated on: July 20th, 2021

About Author

Isaak Stotts, LP

Isaak Stotts is an in-house medical writer in AddictionResource. Isaak learned addiction psychology at Aspen University and got a Master's Degree in Arts in Psychology and Addiction Counseling. After graduation, he became a substance abuse counselor, providing individual, group, and family counseling for those who strive to achieve and maintain sobriety and recovery goals.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.