Methylphenidate ER suspension

QUILLIVANT XR

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What it isExtended-release dopamine- and norepinephrine-reuptake inhibitor suspension; ADHD.

Why this oneThe liquid permits measured dose adjustment for patients unable to swallow solids and is 20% IR / 80% ER; Duration of action 8-12 h (Carlat Table 1).

What limits itPatients must shake before use; appetite loss, insomnia, growth effects, and blood-pressure elevation can limit use. Schedule II misuse risk remains.

FDA-approved for

ADHD (2012)

FDA label

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BOXED WARNING High potential for abuse and misuse; can lead to substance use disorder including addiction, and misuse/abuse of CNS stimulants can result in overdose and death.

FDA dosing	Population	Start	Target	Max
ADHD	≥6 yr (incl. adults)	20 mg QD (AM)	titrate to effect	60 mg/day

Titration Increase weekly (10–20 mg increments)

Renal Undefined

Hepatic Undefined

Instructions

Vigorously shake bottle ≥10 seconds before each dose
Once daily in the morning, with or without food
Advise patients to avoid alcohol
Do not substitute mg-per-mg for other methylphenidate products (discontinue prior product and re-titrate)

Contraindications

Concurrent treatment with an MAOI, or use of an MAOI within the preceding 14 days, because of the risk of hypertensive crisis.

Cautions

Avoid in serious cardiac disease (sudden death risk)
Increased blood pressure and heart rate — monitor
Psychiatric reactions: may exacerbate psychosis or induce mania; screen before starting
Priapism
Peripheral vasculopathy, including Raynaud's phenomenon
Long-term growth suppression in pediatric patients — monitor height/weight
Acute angle closure glaucoma; increased intraocular pressure
May cause or worsen motor/verbal tics and Tourette's

Adverse reactions

appetite decreased
insomnia
nausea
vomiting
dyspepsia
abdominal pain
weight decreased
anxiety
dizziness
irritability
affect lability
tachycardia
blood pressure increased

Pregnancy Limited human data insufficient to inform risk; animal studies showed spina bifida in rabbits at 40× MRHD. CNS stimulants may decrease placental perfusion. Pregnancy registry available.

Lactation Methylphenidate present in human milk (infant dose 0.16–0.7% of maternal); monitor infant for agitation, insomnia, anorexia, reduced weight gain.

⚠ BOXED WARNING