ADHANSIA XR
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ADHANSIA XR (ADHANSIA XR).
Adhansia XR is a central nervous system (CNS) stimulant. The mechanism of action in attention deficit hyperactivity disorder (ADHD) is not fully known, but it is thought to involve blockade of norepinephrine and dopamine reuptake into presynaptic neurons, increasing their levels in the synaptic cleft. This enhances attention and reduces impulsivity.
| Metabolism | Primarily metabolized by carboxylesterase 1 (CES1) to the inactive metabolite dexmethylphenidate. Minor pathways include microsomal carboxylesterase and oxidative metabolism. |
| Excretion | Primarily renal (78% as unchanged drug), with 10% biliary/fecal elimination. |
| Half-life | Mean terminal elimination half-life is 7.5 hours (range 5-10 hours) following oral administration, allowing twice-daily dosing. |
| Protein binding | 97% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | 3.5 L/kg, indicating extensive tissue distribution. |
| Bioavailability | Oral bioavailability is approximately 60% (range 53-67%) due to first-pass metabolism. |
| Onset of Action | Oral: Clinical effect (symptom relief) typically begins within 1-2 hours. |
| Duration of Action | Duration of clinical effect is approximately 12 hours after immediate-release formulation; Adhansia XR provides extended release covering 12 hours. |
Methylphenidate hydrochloride extended-release: Oral, 18-72 mg once daily in the morning.
| Dosage form | CAPSULE, EXTENDED RELEASE |
| Renal impairment | No specific dose adjustment recommendations; use with caution in patients with severe renal impairment (eGFR <30 mL/min/1.73 m²) as limited data. |
| Liver impairment | Child-Pugh Class A: No dose adjustment. Child-Pugh Class B or C: Avoid use due to increased exposure. |
| Pediatric use | Age 6-12 years: Starting dose 18 mg once daily, titrate weekly by 18 mg increments; maximum 54 mg/day. Age 13-17 years: Starting dose 18 mg once daily, titrate weekly by 18 mg increments; maximum 72 mg/day. Weight-based: Not routinely used; follow age-based dosing. |
| Geriatric use | Starting dose 18 mg once daily; adjust cautiously due to increased sensitivity and higher risk of adverse effects; monitor for hypertension, tachycardia, and weight loss. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ADHANSIA XR (ADHANSIA XR).
| Breastfeeding | Oxcarbazepine and its metabolite MHD are excreted into breast milk. M/P ratio for MHD is approximately 0.5. Relative infant dose is estimated 2-6% of maternal weight-adjusted dose. Monitor infant for drowsiness, poor feeding, and weight gain. Breastfeeding generally considered compatible with caution. |
| Teratogenic Risk | First trimester: Increased risk of major congenital malformations, including neural tube defects and cardiovascular anomalies. Second and third trimesters: Risk of fetal growth restriction, premature birth, and transient neonatal hyperbilirubinemia. Antiepileptic Drugs (AEDs) including oxcarbazepine are associated with teratogenicity; use only if benefit outweighs risk. |
■ FDA Black Box Warning
WARNING: ABUSE AND DEPENDENCE. CNS stimulants, including Adhansia XR, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing, and monitor for signs of abuse and dependence while on therapy.
| Serious Effects |
["Known hypersensitivity to methylphenidate or any component of Adhansia XR","Concurrent treatment with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs","Glaucoma","Tics or family history of Tourette's syndrome","Severe hypertension or symptomatic cardiovascular disease"]
| Precautions | ["Serious cardiovascular events: Sudden death, stroke, and myocardial infarction have been reported in patients with structural cardiac abnormalities or other serious heart problems.","Blood pressure and heart rate increase: Monitor patients for tachycardia and hypertension.","Psychiatric adverse events: May precipitates psychosis, mania, or aggression. Use with caution in patients with bipolar disorder or psychosis.","Long-term suppression of growth: Monitor height and weight in pediatric patients.","Priapism: Urgent medical attention required.","Peripheral vasculopathy: Including Raynaud's phenomenon."] |
| Food/Dietary |
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| Fetal Monitoring | Monitor maternal serum concentrations of oxcarbazepine and MHD periodically due to pregnancy-induced clearance changes. Perform fetal ultrasound for structural anomalies. Monitor fetal growth and well-being. Newborn should be observed for withdrawal symptoms, coagulopathy (vitamin K prophylaxis recommended), and hyperbilirubinemia. |
| Fertility Effects | No specific data on fertility impairment in humans. In animal studies, no adverse effects on fertility were observed. However, AEDs may affect hormonal contraception efficacy due to enzyme induction; consider non-hormonal methods. |
| Avoid high-fat meals as they may delay the absorption and onset of action. Grapefruit and grapefruit juice may increase methylphenidate levels; avoid concurrent use. Caffeine or other stimulants may exacerbate CNS side effects like jitteriness and insomnia. |
| Clinical Pearls | Adhansia XR (methylphenidate hydrochloride extended-release) should be swallowed whole, not crushed or chewed, to maintain extended-release properties. Monitor for changes in blood pressure and heart rate, especially in patients with pre-existing cardiovascular conditions. Avoid use in patients with severe anxiety, tension, agitation, or glaucoma. Consider drug holidays to assess for persistent symptoms and decrease tolerance. Monitor for signs of psychosis or mania, particularly in patients with bipolar disorder. |
| Patient Advice | Take exactly as prescribed, usually once daily in the morning. · Swallow capsule whole; do not crush, chew, or break. · Avoid taking with or after a high-fat meal as it may delay absorption. · Do not take in the evening to prevent insomnia. · Store at room temperature away from moisture and heat. · Report any chest pain, shortness of breath, fainting, or signs of serotonin syndrome. · Avoid alcohol while taking this medication. · Do not share medication with others as it may cause serious side effects or addiction. |