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Drug Regimen Individualization for Attention-Deficit/Hyperactivity Disorder: Guidance for Methylphenidate and
Kennerly Sexton Patrick1, Jennifer L Radke1, John R Raymond1
1Department of Drug Discovery & Biomedical Sciences, Medical University of South Carolina, College of Pharmacy, Charleston, South Carolina.
This review compares methylphenidate (MPH) formulations for attention-deficit/hyperactivity disorder (ADHD), detailing immediate-release (IR) percentages and modified-release (MR) product differences. It aids in selecting the best MPH regimen for individual ADHD treatment.
Area of Science:
- Pharmacology and Therapeutics
- Neuroscience
- Clinical Pharmacy
Background:
- The first biphasic modified-release (MR) methylphenidate (MPH) formulation for attention-deficit/hyperactivity disorder (ADHD) was approved in 2000.
- Subsequent MR-MPH products offer once-daily dosing with distinct pharmacokinetic profiles.
- Various dosage forms, including transdermal and orally disintegrating tablets, are available to address administration challenges.
Purpose of the Study:
- To compare available oral MR-MPH products to guide rational selection for individualized ADHD treatment.
- To review advancements in MPH formulations, including chiral switch dexmethylphenidate (dexMPH) and new bioavailability metrics.
- To discuss drug interactions, pharmacogenomic predictors, and emerging MPH formulations.
Main Methods:
- Comparative review of existing methylphenidate (MPH) formulations for attention-deficit/hyperactivity disorder (ADHD).
- Analysis of immediate-release (IR) percentages and modified-release (MR) characteristics across different products.
- Inclusion of data on dexmethylphenidate (dexMPH), bioavailability metrics, drug interactions, and pharmacogenomics.
Main Results:
- The immediate-release (IR) portion of biphasic MPH formulations now ranges from 15% to 50%.
- New FDA bioavailability metrics have led to reclassification of some generic MR-MPH products.
- Alcohol significantly increases MPH bioavailability, potentiating euphoric effects and abuse liability.
Conclusions:
- Rational selection of MPH regimens requires understanding the distinct exposure profiles of various formulations.
- Pharmacogenomic factors and drug interactions, such as with alcohol, are crucial considerations in MPH therapy.
- Novel MPH formulations are under development, promising further advancements in ADHD treatment.
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