Paediatric ADHD

50:50 release profile of Medikinet® XL

When to take Medikinet® XL

How to prescribe Medikinet® and Medikinet® XL

Management of ADHD in adults

This is Harry, he is...

  • Very disorganised in the morning, he finds it difficult to get ready for school, often losing his possessions; his difficulties begin even before school starts
  • Easily distracted, he fidgets constantly and frequently leaves his seat during lessons
  • Commonly disobedient and even confrontational with his teacher who describes him as ‘Bright but naughty’
  • Prone to make careless errors in school work and fails to pay close attention in class
  • Regularly sent out of class before 10am
  • An enthusiastic footballer, but often disruptive leading to him being left out and increasingly excluded by his peers
Which 8 hour extended-release profile would ensure children like Harry get a good start to their day?

Medikinet XL combines the advantages of a fast onset of action with the build-up of an extended-duration plateau phase2

Click the mg amounts below to see the extended release profiles

Methylphenidate given
as a once-daily presentation
  • 30 mg
  • 20 mg
  • 10 mg
  • 0 mg

  • 15mg

  • 9mg
  • Medikinet XL
    Equasym XL
    Immediate Release Component
    Morning


  • 15mg

  • 21mg
  • Medikinet XL
    Equasym XL
    Extended Release Component
    Afternoon

Medikinet® XL is a registered trademark of Medice GmbH
Equasym® XL is a registered trademark of Shire pharmaceuticals
Medikinet® XL and Equasym® XL are NOT Bioequivalent3
  • The 50:50 release profile of Medikinet XL mimics 2 equal doses of immediate-release methylphenidate given 4 hours apart providing balanced morning and afternoon symptom control, which is consistent with the school day2
  • Differences in the pharmacokinetics of different methylphenidate formulations enables flexibility to choose the preparation best suited to a patient’s needs and preferences4

Geometric mean methylphenidate plasma concentration-time profiles after administration of 20mg Medikinet® XL and 20mg Equasym® XL in 13 healthy adult volunteers

Adapted from Schütz, H. et al.3

Which extended-release profile would ensure children like Harry get a good start to their day?

  • The 50:50 release profile of Medikinet XL mimics 2 equal doses of immediate-release methylphenidate given 4 hours apart providing balanced morning and afternoon symptom control, which is consistent with the school day2
Adapted from BNF for Children1
Flexible
As little as possible, as much as necessary
  • Medikinet XL has the widest range of once-daily methylphenidate presentations1
  • Medikinet XL 5mg allows fine-tuning of the methylphenidate dose to meet the individual needs of the patient2
  • Medikinet XL offers the broadest range of once-daily methylphenidate presentations1
  • Medikinet XL 5mg allows fine-tuning of the methylphenidate dose to meet the individual needs of the patient2
* Dose equivalence and conversion: Total daily dose of 15 mg of standard-release formulation is considered equivalent to Concerta XL 18 mg once daily.1
Adaptable
Delivered to suit individual patient needs
  • The capsule may be opened and the capsule contents sprinkled onto a small amount (tablespoon) of apple sauce or other similar soft food1
  • An advantage of Medikinet XL is that it should be taken in the morning with, or after, breakfast easily becoming part of your patient’s normal routine2
Why it’s important to take Medikinet XL with, or after food
  • Medikinet XL combines the advantages of both immediate-release and extended-release formulations of methylphenidate2
  • 50% of the Medikinet XL dose is provided by the immediate-release component and 50% of the dose is provided by the extended release component2
  • When taken after breakfast, the immediate-release portion of Medikinet XL dissolves rapidly and results in an initial peak plasma concentration2
  • After passing through the stomach and into the small intestine, the extended-release portion of the hard capsule releases its methylphenidate resulting in a second rise in plasma concentration approximately 3 hours later2
  • It is important to take Medikinet XL with, or after food, to prevent the extended-release component releasing prematurely2
* Not actual size. Adapted from Medikinet® XL SmPC 2021
As little as possible, as much as necessary Medikinet XL…
  • Combines the advantages of a fast onset of action with the build-up of an extended duration plateau phase2
  • Has the widest range of once-daily methylphenidate presentations2
  • 5mg allows fine-tuning of the methylphenidate dose to meet the individual needs of the patient2
  • May be opened and the capsule contents sprinkled onto a small amount (tablespoon) of apple sauce or other similar soft food2
  • Should be taken with or after food2
Medikinet Tablets…

Direct bioequivalence - Change to Medikinet XL from Medikinet or any immediate release methylphenidate preparation using the same total daily dose.2

How to prescribe Medikinet and Medikinet XL...
  • Different modified-release preparations may not have the same clinical effect. To avoid confusion prescribers should specify the brand to be dispensed1
  • The regimen that achieves satisfactory symptom control with the lowest daily dose should be employed2
  • For children receiving methylphenidate for the first-time2,6
    • Dose titration is necessary
    • Start treatment with immediate release methylphenidate 5mg once or twice daily
    • The daily dose can be increased by 5-10mg at weekly increments to a maximum total daily dose of 60mg
    • Medikinet XL 10mg may be used in place of immediate release methylphenidate 5mg twice daily from the beginning of treatment

References:

1. BNF for Children; https://bnfc.nice.org.uk/medicinal-forms/methylphenidate-hydrochloride.html (Accessed October 2021)
2. Medikinet® XL SmPC January 2021
3. Schütz, H. et al., International Journal of Clinical Pharmacology and Therapeutics, 2009; 47 (12): 761-769
4. Banachewski, T. et al., European Journal of Child and Adolescent Psychiatry 2006; 15 (8): 476-495
5. Döpfner, M. et al., Journal of Child and Adolescent Psychopharmacology 2011; 21 (5): 1-10
6. Medikinet® Tablets SmPC January 2021