Tarnow Articles

Often Overlooked, Focalin Offers Benefits by Jay Tarnow, M.D.

There are a variety of drugs appropriate for treating ADHD. Those that get the most attention are often those that have the strongest marketing program behind them. Because it lacks a strong marketing push, Focalin is often overlooked, but it offers unique benefits and deserves consideration when treating ADHD.

Focalin Dextro Methylphenidate was developed three years ago. It is based on a very old product, methylphenidate. Dextro Methylphenidate is the dextro stereo isomer, in other words the right side, only of methylphenidate. It was approved by the FDA in 2001.

In testing, it is shown that the right "dextro" form of methylphenidate is more pharmacologically active than the left "levo" and seems to be mostly deposited in the brain, and has less peripheral effect.

Focalin comes in two forms. Focalin Regular (which reaches it's maximum blood level in 1.5 hours) has doses of 2.5 mg., 5 mg., and 10 mg. It lasts approximately four to six hours. Focalin XR (extended release) which comes in 5, 10, and 20 mg capsules and lasts 10 to 12 hours. Thus, it can be taken once a day. Since XR comes in capsules it is particularly easy to use for children who have difficulty swallowing pills since the capsules can be opened and the medication sprinkled on applesauce, ice cream, etc. The dosing of Focalin (dextro methylphenidate) is approximately one-half that of methylphenidate.

Research shows that Focalin is as effective as methylphenidate and has a similar potential for side effects. The most typical side effects for the methylphenidate compounds are loss of appetite, interference with sleep, and headaches.

Focalin, however, seems to offer benefits when compared to methylphenidate. My experience with Focalin is that it seems to have fewer body-stimulating effects and, therefore, I have been able to use it in children, adolescents, and adults who are anxious or who get jittery on the typical forms of methylphenidate and mixed amphetamine salts.

I have found that Focalin causes less eating disturbance and insomnia. It has been my experience that many children who have Attention Deficit Disorder and learning differences, also have a great deal of academic anxiety. Therefore, Focalin has a unique place in treating ADHD/ADD.

In an effort document the clinical benefits we have found, The Tarnow Center is presently doing research into Focalin XR in children six to twelve years old.