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Letters to the Editor
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Dispensing
Methylphenidate modified release formulations
From Dr D. Coghill, MRCPsych
As a specialist in child psychiatry with a particular interest in the management
of attention-deficit hyperactivity disorder (ADHD), I am contacting The
Journal to bring to your attention an area of potential confusion and to reinforce
the need for branded prescribing in this particular therapy area.
An important drug treatment in ADHD is methylphenidate, more particularly
the modified release presentations that offer control throughout the day and
obviate the need for midday (school-time) dosing. There are a number of extended-release
formulations available, each characterised by a different release profile
and, therefore, clinical effect.
Following the launch of Medikinet XL (10, 20, 30 and 40mg strengths) by Flynn
Pharma earlier this year in the UK, there now exist two differentiated brands,
the second being Equasym XL (available in 10, 20 and 30mg strengths), which
have different release profiles and clinical effect profiles across the day
but certain strength presentations in common.
Around one third of prescriptions
for extended-release methylphenidate are written generically. With these
generic prescriptions the prescriber’s intent for the patient to have a particular
release profile, associated with a particular brand, may not be realised when
the prescription is dispensed.
The choice of product for the patient is important — while both Medikinet
XL and Equasym XL have a duration of action of approximately eight hours,
Medikinet XL is designed to release 50 per cent of the methylphenidate dose
initially and 50 per cent after approximately four hours, whereas Equasym
XL releases 30 per cent of the dose initially and 70 per cent after approximately
four hours. The individual clinical response of any patient cannot be assumed
to be the same for both presentations.
Children with ADHD are an important and vulnerable group for whom drug selection
and use play an important part in their care. Where a child psychiatrist
or paediatrician has elected to use a specific formulation of modified-release
methylphenidate, it is vital that the patient receives the same in the community,
where therapy is continued often under the care of a GP. May I invite pharmacist
colleagues in that sector to play their full part in ensuring this to be
the
case.
It may be timely to remind prescribers and pharmacists of the need for branded
prescribing in respect of modified release presentations of methylphenidate.
Perhaps, through your columns, primary care trusts and community pharmacists
may be made aware as I believe it is in the community where potential for
inadvertent switching may occur.
David Coghill
Senior Lecturer in Child and Adolescent Psychiatry
University of Dundee |
The
Pharmaceutical Journal