Tarnow Articles

Psychopharmacology: Focalin By Jay D. Tarnow, M.D.

There have not been any new products for the specific treatment of ADHD since Strattera came on the market almost 2 years ago. However, in 2001 the FDA approved a new formulation of an old compound-methylphenidate (Ritalin). Novartis made a very important step forward in developing just the right side (dextro) of methylphenidate, dexmethylphenidate or better known as Focalin. I'm not sure why Novartis didn't make a bigger deal about this new compound, but I have found that it has some unique attributes. Obviously chemical compounds in nature are three-dimensional. Some of the molecules bend to the right (dextro) and some to the left (levo). Novartis found that the dextro form of methylpenidate is more pharmacologically active of the two stereoisomers.

Focalin^TM: A Refined Form of Ritalin^®

It seems that the dextro form gets deposited mostly in the brain

In the fasted individual the maximum blood level is reached in 1.5 hours. Focalin comes in 2.5mg, 5mg, and 10mg. Tablets. Focalin is twice the strength of the mixed typical methylphidate. The conversion is exhibited in figure 3.

The research shows Focalin to be just as effective as methylphenidate and has a similar side effect profile. The most typical side effects for all the methylphenidate compounds are loss of appetite, interference in sleep, and headaches. (Other formulations of the typical mixture of methylpheidate are the longest acting Concerta, then the 8hour Metadate CD, and Ritalin LA. Focalin has a length of effect of about 6 hours, whereas the typical methylphenidate (Ritalin) has a 4hour effect.) The word on the street is that Novartis is working on a long acting Focalin.

My experience with Focalin is that it seems to have less body stimulating effects. I have been able to use it in children, adolescents, and adults who are anxious and get jittery on the typical forms of methylphenidate We also have found that it seems to cause less eating disturbance and insomnia. I haven't done a double blind placebo study yet, so we can't say this is a scientific fact, but rather my and Dr. Stokan's clinical experience. We have been particularly interested in ADHD patients who also have anxiety particularly in the academic setting. Further information can be found on our web site tarnowcenter.com/ academic anxiety. Another new find is the liquid form of methylphenidate called Methylin Liquid. This is helpful for those children who are unable to swallow pills. I usually first try the MetadateCD, RitalinLA, or AdderallXR because the capsule can be opened and beads inside can be sprinkled on food. However some children are even squeamish about this. In my office we have had success with teaching the children relaxation techniques and progressively increasing the size of a placebo capsule. I have even used tiny candies like Nerds. I have also heard that a patch is being developed which will deliver methylphenidate through the skin.

Please note that I do not consult with Novartis nor have worked for them. The opinions expressed in this article are mine.