Types of Long-Acting Methylphenidate Formulations

Understanding Immediate Release (IR) vs. Extended Release (ER) Components

Many XL (extended-release) medications combine two types of methylphenidate:

• Immediate Release (IR): This part of the medication works quickly, usually within 30-60 minutes of taking it. It provides a fast boost of symptom control but wears off quickly.
• Extended Release (ER): This part of the medication is released slowly over several hours, helping to maintain symptom control throughout the day.

Think of it like a rollercoaster ride:

• The IR component is like the first big push up the hill—you feel the effects quickly.
• The ER component is like a long, steady ride—it keeps you going throughout the day without as many ups and downs.

Different medications have different IR:ER ratios, meaning some give you more of the fast-acting boost (like Medikinet XL), while others focus more on steady, all-day control (like Concerta XL). Understanding this helps in choosing the right medication based on when you need symptom control the most.

How Switching Works

When switching from one formulation to another, consider the following factors:

• Different release profiles affect symptom control throughout the day.
• Dosage conversion may be necessary based on immediate-release and extended-release ratios.
• Side effects may vary, especially if switching to a formulation with a higher immediate-release component.
• A transition period may be needed, during which symptom control should be closely monitored.
• Consult your prescribing specialist before making any medication adjustments.

FINAL ADVICE

• Always consult a specialist before switching formulations.
• Monitor for side effects and adjust dosage accordingly.
• Switching should be done based on symptom control and daily needs.

Actions for Specialists

Step 1: Prior to Considering a Switch in Modified Release Preparation

1. Undertake an urgent review/risk assessment of the patient, weighing the pros and cons of switching.
2. Consider whether a treatment holiday is the best option for the patient.
3. Discuss with the patient the possible differences in symptom management.
4. Consider the timing of target symptoms and use this to guide which capsule formulation may be best.
5. Discuss possible side effects and escalation processes.
6. Ensure family/carers are aware that any changes in symptoms of co-morbidities should be reported to the prescriber.

Step 2: Formulation Comparison

Step 3: Switching Between Preparations

1. Switching formulations can result in changes in symptom control at different times of the day.
2. Example: TYPE 3 medications (e.g., Medikinet XL) target symptoms in the morning more potently, whereas TYPE 1 medications (e.g., Concerta XL) have a stronger clinical effect later in the day (early afternoon).
3. Patients should be reviewed after the switch, and doses adjusted if required.
4. Preferred Switching Strategy:Switching between bioequivalent tablets (TYPE 1) is the recommended first option.During shortages, generic prescriptions for TYPE 1 medications should be issued to allow pharmacies to dispense any available equivalent brand.If no supplies are available, consider switching to a suitable long-acting capsule (TYPE 2 or TYPE 3).
5. Modified Release Capsules MUST be Prescribed by Brand- Different brands have different release profiles, making it essential to prescribe by brand name to ensure consistent symptom control.
6. Guidance for Adjusting to New Medication: Since clinical equivalence is most closely related to the IR component, IR should be used as a reference when switching between long-acting MPH formulations.Use reference tables for guidance on dose conversions.Patients should be monitored closely post-switch to ensure symptom control remains effective.