Many patients are currently facing difficulties in procuring their prescribed ADHD medication due to ongoing shortages. In such cases, switching to an alternative formulation may be necessary to maintain symptom control. This guide explains how switching works, the differences between medications and how to ensure a smooth transition.
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Overview
Long-acting methylphenidate formulations provide extended symptom control for ADHD, reducing the need for multiple daily doses. These formulations differ in their release profiles, duration of action, and effect on symptom control throughout the day. This guide details different long-acting methylphenidate options, their dose equivalence, pharmacokinetics, and switching guidance.
Mechanism of action
How Methylphenidate Works
Methylphenidate is a central nervous system (CNS) stimulant that works primarily by increasing the levels of dopamine and noradrenaline in the brain. These neurotransmitters play a crucial role in attention, impulse control and executive function.
Mechanism of Action:
- Blocks Reuptake: Methylphenidate inhibits the reuptake of dopamine and noradrenaline by blocking their transporters (DAT and NET) at the synapse. This leads to increased concentrations of these neurotransmitters in the prefrontal cortex, which is responsible for attention and impulse control.
- Enhances Neurotransmission: By increasing the availability of dopamine and noradrenaline, methylphenidate helps improve focus, attention span and executive function, reducing symptoms of ADHD.
- Immediate vs. Extended Release: Short-acting formulations provide rapid symptom relief, while long-acting formulations (e.g., Concerta XL, Equasym XL, Medikinet XL) use controlled-release mechanisms to sustain effects throughout the day.
How it helps
Effects of Methylphenidate:
- Improves attention and focus
- Reduces impulsivity and hyperactivity
- Enhances executive functioning and task completion
The Types
Types of Long-Acting Methylphenidate Formulations
Type 1: Concerta XL, Xaggitin XL, Matoride XL, Delmosart XL, Affenid XL, Xenidate XL Type 2: Equasym XL Type 3: Medikinet XL, Metyrol XL, Meflynate XL |
Understanding Immediate Release (IR) vs. Extended Release (ER) Components
Many XL (extended-release) medications combine two types of methylphenidate:
- Immediate Release (IR): This part of the medication works quickly, usually within 30-60 minutes of taking it. It provides a fast boost of symptom control but wears off quickly.
- Extended Release (ER): This part of the medication is released slowly over several hours, helping to maintain symptom control throughout the day.
Think of it like a rollercoaster ride:
- The IR component is like the first big push up the hill—you feel the effects quickly.
- The ER component is like a long, steady ride—it keeps you going throughout the day without as many ups and downs.
Different medications have different IR:ER ratios, meaning some give you more of the fast-acting boost (like Medikinet XL), while others focus more on steady, all-day control (like Concerta XL). Understanding this helps in choosing the right medication based on when you need symptom control the most.
Frequently Asked Questions
How to switch?
When switching from one formulation to another, consider the following factors:
- Different release profiles affect symptom control throughout the day.
- Dosage conversion may be necessary based on immediate-release and extended-release ratios.
- Side effects may vary, especially if switching to a formulation with a higher immediate-release component.
- A transition period may be needed, during which symptom control should be closely monitored.
- Consult your prescribing specialist before making any medication adjustments.
Press the link
Links to switching
Switching medication
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Dr. Raffi
Dr Asad Raffi is the Founder of Sanctum Healthcare, Medical Director and Lead Consultant Psychiatrist on the Specialist GMC register. As Medical Director Dr Raffi had over 20 years experience as a psychiatrist and brings a plethora of experience from the NHS and private sector.