Switching Guide from Astaryz to Focalin XR
When switching from Astaryz to Focalin XR (dexmethylphenidate extended-release), a direct milligram-to-milligram conversion is recommended as both medications contain the same active ingredient but with different release mechanisms.
Understanding the Medications
- Astaryz: Contains dexmethylphenidate (d-MPH), the active isomer of methylphenidate
- Focalin XR: Contains dexmethylphenidate extended-release with a bimodal release profile 1
Switching Protocol
Step 1: Assess Current Dosing
- Document the current Astaryz dose the patient is taking
- Confirm the patient's symptom control and any side effects with current therapy
Step 2: Direct Conversion
- Convert to an equivalent dose of Focalin XR using a 1:1 ratio
- For example:
- Astaryz 5 mg → Focalin XR 5 mg
- Astaryz 10 mg → Focalin XR 10 mg
- Astaryz 20 mg → Focalin XR 20 mg
Step 3: Administration Considerations
- Focalin XR should be administered once daily in the morning 1
- Can be taken with or without food
- Capsules can be swallowed whole or opened and sprinkled on applesauce for patients who have difficulty swallowing 1
Step 4: Monitoring After Switch
- Evaluate efficacy throughout the day, as Focalin XR provides coverage for approximately 11-12 hours 1
- Monitor for any changes in side effect profile
- Assess for adequate symptom control, particularly during the afternoon hours
Important Clinical Considerations
Pharmacokinetic Differences
- Focalin XR has a bimodal release profile that mimics two doses of immediate-release dexmethylphenidate given 4 hours apart 2
- This provides an initial rapid release followed by a second delayed release 2
Efficacy Expectations
- Focalin XR has demonstrated significant improvement in ADHD symptoms compared to placebo, with effects starting as early as 30 minutes after administration and lasting up to 11-12 hours 3
- Efficacy has been confirmed across multiple settings by teachers, parents, and clinicians 3
Common Side Effects
- Similar to other stimulant medications: decreased appetite, headache, insomnia
- Side effects are typically mild to moderate in severity 3
Potential Pitfalls to Avoid
Dosing Time Errors: Focalin XR should be administered in the morning to prevent insomnia
Abrupt Switching: While direct conversion is possible, monitoring for changes in efficacy or side effects is essential
Crushing or Chewing: Patients should be instructed not to crush or chew Focalin XR capsules as this would alter the release profile
Overlooking Duration of Action: If the patient previously required afternoon dosing with Astaryz, they may not need this with Focalin XR due to its extended duration of action
Failure to Consider Individual Response: Some patients may require dose adjustments after switching based on individual response and tolerability
By following this structured approach to switching from Astaryz to Focalin XR, clinicians can help ensure continued symptom control while minimizing potential adverse effects during the transition.