ADHD in adults

Medikinet XL: Symptom control for adult ADHD patients
Patient tolerability of Medikinet XL
Medikinet XL dosing and titration

Paediatric ADHD

Medikinet XL is a pharmacological treatment for the management of adult ADHD.

Medikinet XL is a prolonged-release formulation of methylphenidate hydrochloride which is a first-line pharmacological treatment for ADHD in the UK, indicated for both children and adults with ADHD.

Sean - aged 25

"I started seeing myself as someone who couldn't be relied on."

History of personal difficulties during adolescence
  • Regularly in trouble at school
  • Left education with no qualifications at 16
  • Enjoyed high-risk activities, often got into physical fights and started carrying a knife
  • Cautioned by the police on several occasions
Given a job in a hotel restaurant by a family friend
  • Struggles organising tasks and often misses service times
  • Has difficulty sustaining attention and is easily distracted, often leading to minor injuries whilst at work
  • His carelessness has been commented on and he has had time off work with stress
Sean feels he is at ‘crisis point’... He was referred to Adult Psychiatric services as the GP was concerned about his mental well-being

ART - ADHD Referral Toolkit

Sean's symptoms

  • Inattention
  • Easily distracted
  • Disorganised
  • Poor time management
  • Poor stress tolerance
DSM-5 identifies a number of conditions with symptoms that overlap with those of ADHD.2 Comorbid conditions are common with adult ADHD patients.3

Click on the symptoms below to see Sean's symptom overlap.

Personality Disorders
Major Depression
Generalised Anxiety
Substance Abuse or Dependence
Features shared with ADHD:
Impulsivity
Affective lability
Subjective report of poor concentration, attention and memory
Difficulty with task completion
Fidgetiness
Difficulty concentrating
Difficulties with attention, concentration and memory
Mood swings

Medikinet XL: Symptom control for adult ADHD patients

Percentage of patients demonstrating significant improvement in ADHD symptoms

Responders in the Medikinet XL and placebo group

(Fisher's exact test, P<0.0001)

Mean daily dose = 66 mg ± 20 mg post titration at 8 weeks

Adapted from Retz, W. et al (2012)5

Half of patients treated with Medikinet XL demonstrated a clinically relevant improvement in ADHD symptoms at 8 weeks as measured by WRAADDS*.5

Clinical domains measured by WRAADDS* are:5

  • inattention
  • hyperactivity
  • impulsivity
  • affective lability
  • hot temper
  • stress intolerance
  • disorganisation

*WRAADDS (Wender – Reimherr Adult Attention Deficit Disorder Scale)

~ The a priori definition of a responder was a patient achieving a 30% or greater reduction in WRAADDS score

Mean reduction of the SDS total score at week 8 by treatment group (ITT# population, Wilcoxon U-test, P=0.017).
Adapted from Retz, W. et al (2012)5
Medikinet XL significantly reduced impairment associated with ADHD symptoms at 8 weeks versus placebo.5
Patients reported a significant improvement in daily functioning on the Sheehan Disability Scale (SDS) at week 8 during treatment.5
  • SDS is used for assessment of the degree to which ADHD interferes with function in the domains of daily living: work/ school, social and family life
  • Reduction of SDS score indicates an improvement in functional impairment
Medikinet XL demonstrated clinically significant improvement in ADHD symptoms with maintained benefit in the longer-term.6,7
Adapted from Rösler, M. et al, (2008)6
  • Clinically significant improvement of symptoms during the titration phase6
    • Medikinet XL demonstrated a clinically significant reduction in ADHD symptoms rated with WRAADDS*6
    • Clinical effect increased during the titration phase, reaching significance by the end of week 56
  • Continued benefit of symptom control in the longer term7
    • Symptom control was maintained at 52 weeks7

* WRAADDS (Wender – Reimherr Adult Attention Deficit Disorder Scale)

# LOCF (Last Observation Carried Forward)

Methylphenidate is recommended as a first-line treatment for the management of ADHD in adults.8
  • Medikinet XL can be continued in adult patients who have shown clear benefit from treatment with Medikinet XL in childhood and/or adolescence1
Medikinet XL has the widest range of methylphenidate presentations.9
Treatment should be optimised to the individual needs of the patient.1
Tailored control: Medikinet XL 5mg allows fine-tuning of the methylphenidate dose to meet the individual needs of the patient both during titration and ongoing maintenance.1
Consider dose reduction in the event of an intolerable adverse event.
Adapted from Medikinet® XL SmPC, January 20211
Patient tolerability of Medikinet XL is rated as ‘good’ or ‘very good’ in the majority of patients.6
  • A global assessment showed ‘good’ or ‘very good’ tolerability in 79.3% of patients treated with Medikinet XL at 24 weeks6
  • 63% of all adverse events were rated as 'moderate'5
    • Most common side effects were decreased appetite (48%), dry mouth (38%), excessive thirst (32%) and headache (30%)
  • There were no treatment-related serious adverse events5
Healthcare professionals should stress the value of a balanced diet, good nutrition and regular exercise for adults with ADHD.8
  • In adults with ADHD, Medikinet XL should be given in the morning and at lunchtime with or after meals1
  • Taking medication as part of their daily routine can be an important adherence strategy for patients with ADHD8
Adapted from Garcia-Garcia et al. (2009)8

Medikinet XL taken bd with or after meals

Note: capsules not actual size

Medikinet XL Dosing and Titration: Adults new to Medikinet XL
  • Medikinet XL should be given in the morning and at lunchtime with or after meals1
  • Initiation of treatment in adults who are new to Medikinet XL requires careful dose titration1
    • The recommended starting dose of Medikinet XL is 10mg daily, which may be increased if necessary by weekly increments of 10mg1
    • The total daily dose should be given in two divided doses, in the morning and at lunchtime1
    • Each dose may be tailored to achieve optimised symptom control for individual patients
  • The aim of individual titration should be to find the lowest daily dose that achieves satisfactory symptom control1
  • Adult patients may require a daily dose up to 1mg/kg, based on the patient’s body weight1
    • The maximum daily dose for an adult is 80mg1
Dose range includes a 5mg dose which allows fine-tuning of the Medikinet XL dose to meet the individual needs of the patient1
  • Has demonstrated clinically significant improvement in adult ADHD symptoms by the end of week 56, which were maintained in the long term6,7
  • Improved clinical symptoms and functional impairment associated with adult ADHD from both the clinicians’ and the patients’ perspective5
  • Rated as having ‘good’ or ‘very good’ tolerability in the majority of adult patients6
  • Has the widest range of methylphenidate presentations9
  • Dose range includes a 5mg dose which allows fine-tuning of the Medikinet XL dose to meet the individual needs of the patient1
Helping Sean to manage his ADHD
  • Sean was initiated on 5mg Medikinet XL b.d.
    • 10mg daily and was titrated over 6 weeks to an effective dose of 50mg daily
    • 30mg in the morning, 20mg at lunchtime
  • Sean’s symptoms of inattention and disorganisation have improved, and he is able to manage the stresses of work
  • At work, Sean is able to concentrate better, and is managing to keep up with the tight service deadlines of the restaurant
  • Sean has a brighter outlook on life and is a valued member of the kitchen staff
References:
1. SmPC Medikinet® XL 5-60mg January, 2021
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013
3. Rösler, M. & Retz, W. Diagnose, Differentialdiagnose und komorbide Leiden der ADHS. Psychotherapie 2008;13:175–183
4. Searight, H., et al. Adult ADHD: Evaluation and Treatment in Family Medicine. Am Fam Physician, 2000; Nov 1;62(9):2077-2086
5. Retz, W., et al. Multiscale assessment of treatment efficacy in adults with ADHD: A randomized placebo-controlled, multi-centre study with extended-release methylphenidate. World J Biol Psychiatry, 2012;13(1):48–59
6. Rösler, M., et al. A randomised, placebo-controlled, 24 week, study of low-dose extended release methylphenidate in adults with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci., 2008;XX:1–10
7. Philipsen, A., et al. Effects of Group Psychotherapy, Individual Counselling, Methylphenidate, and Placebo in the Treatment of Adult AttentionDeficit/Hyperactivity Disorder: A Randomized Clinical Trial (COMPAS). JAMA Psychiatry, 2015; online: 1–12
8. Garcia-Garcia, P., et al. Methylphenidate Extended-Release Capsules: A New Formulation for Attention-Deficit Hyperactivity Disorder. Frontiers in Drug Design & Discovery, 2009;4:228–246