Focalin Side Effects: Emotional And Physical Reactions

Last Updated: December 18, 2019

Authored by Isaak Stotts, LP

Like any other medication for ADHD, there are various side effects of Focalin, some of which should be seriously taken into consideration, needing immediate medical attention. Knowing how to make the difference between dexmethylphenidate side effects and when to address a doctor could save the patient’s life.

Common Side Effects of Focalin

Dexmethylphenidate comes as short-release and an extended-release capsule to be taken by mouth. However, both of these drug formulations share similar side effects.

Common Psychological Side Effects

The most common psychological side effects of dexmethylphenidate are:

  • insomnia (mostly in children)
  • anxiety
  • restlessness
  • dizziness
  • nervousness
  • feeling jittery
  • irritability
  • lethargy
  • dyskinesia
  • tics

These side effects are mild if the drug is taken as prescribed, orally in tablet form, and they are usually well tolerated by patients.

Another psychological side effect is hostility or aggressive behavior usually seen in teenagers and children who are under treatment with dexmethylphenidate. That is why patients under this drug should be monitored to prevent the appearance or worsening of such behavior.

Common Physical Side Effects

The common physical side effects include stomach pain or upset stomach, heartburn, dry mouth, sore throat, loss of appetite, headache, nausea, weight loss, and blurred vision.


Focalin side effects in adults might cause a small increase in the average heart rate and blood pressure.

Such medical conditions include ventricular arrhythmia, recent myocardial infarction, heart failure, or pre-existing hypertension.

Peripheral Vasculopathy

Among the physical Focalin 10 mg side effects, it is included the 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.

Driving Impairment

Focalin impairs driving ability, operating machinery, or performing potentially dangerous tasks by causing dizziness, affecting mental alertness or masking the need of rest or signs of fatigue. This side effect will wear off in time.

dizzy woman driving a car

Severe Side Effects of Focalin

However, not all adverse reactions to dexmethylphenidate are moderate. Some of the side effects may require medical attention.

Severe Psychological Side Effects


One of the Focalin long term side effects could be an addiction. Because this drug is a stimulant, there is the possibility of patients abusing Focalin to get the dexmethylphenidate high. 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. At higher doses, Focalin 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 side effects have been seen when comparing ADHD drugs, such as Focalin vs Vyvanse.

Manic or Psychotic Symptoms

Focalin 10mg, the usual prescribed dose for ADHD, can also cause manic or psychotic symptoms under the form of mania, delusional thinking or hallucinations in teenagers and children.

In such a situation, the physician would advise the discontinuation of the treatment.

Exacerbation of a Psychotic Disorder

In patients with an existing psychotic disorder, Focalin could exacerbate the behavior and symptoms of this illness. An example would be patients with bipolar disorder who might experience manic episodes.

Severe Physical Side Effects

Life-Threatening Cardiovascular Reactions

The life-threatening cardiovascular Focalin side effects in adults include myocardial infarction, stroke, and even sudden death. These side effects 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

Focalin has also 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.


Another of the dexmethylphenidate side effects that require immediate medical attention is priapism. Cases of prolonged, painful elections caused by the treatment with Focalin have been reported in both young and adult patients.

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 Focalin who are not gaining weight or height as expected. In such cases, the treatment should be immediately interrupted.

two children measuring height

Signs Of Allergy Or Intolerance

People who are allergic to methylphenidate or dexmethylphenidate should not take Focalin. Allergies to this drug are possible, and the most common Focalin adverse effects include:

  • Increased heart rate
  • Tightening of lung passageways
  • Decreased blood pressure
  • Dizziness
  • Shortness of breath
  • Swelling of the throat, tongue, and lips, resulting in choking
  • Hives
  • Fever

Black Box Warnings

According to the federal government, Focalin 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.

The drug should not be prescribed or prescribed with extreme caution in people with a history of substance abuse. Continuous monitoring should take place to assess any signs of abuse and dependence during the treatment.

Also, some patients may experience psychological side effects, including Focalin anxiety and depression, and even suicidal thoughts or behavior.

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.


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. Focalin is usually prescribed when lifestyle and behavioral modifications have failed to improve ADHD symptoms.

Geriatric patients are more susceptible to specific side effects such as insomnia, tremor, behavior and mood changes, headache, increased blood pressure, or 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. 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 Focalin can lead to psychological dependence and marked tolerance, associated with frank psychotic episodes, abnormal behavior, and Focalin depression. Careful attention is required during the withdrawal after chronic use of the drug.

Preventing Focalin Side Effects

How long does Focalin stay in system? Focalin 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 side effects might last. But there are also some things that can make these side effects 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 and not three big ones and have dinner at a later time in the evening after the medication side effects have worn off. There is a connection between Focalin and weight loss due to the loss of appetite. Talk to a doctor if too much weight is lost during the treatment.
  3. Try taking the medication early in the day so that it has time to wear off until evening. If the long-acting stimulant has been prescribed, talk to a doctor to prescribe a short-acting one, so that the effects can wear off faster. Try to avoid or limit coffee intake, and turn off the phones, computer, and TV an hour before bedtime.
  4. Try taking the medication with food. If it has to be administered in the morning, try eating something to eat right away.
  5. 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 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: December 18th, 2019

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.


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