Azstarys for ADHD
Video References
What makes it stand out from other stimulants?
-In clinical trials, it was shown to have little to no impact on appetite after the first month of treatment, which is a major improvement over many other stimulants.
- Combines an immediate-release dose of d-methylphenidate with the slower released dose of the prodrug serdexmethylphenidate. It has been shown to last longer than many other brands that also work with methylphenidate as a core ingredient, including Focalin XR and Concerta. This helps avoid the need for afternoon dosing of short acting stimulants, or what we sometimes refer to as "booster" doses.
- Capsule contents can be sprinkled over applesauce or dissolved in water for patients unable to swallow the capsules.
How is Azstarys Dosed?
It is available in 3 doses, and these differ depending on age and sensitivity to medications. It is recommended to start at the middle dose and titrate up/down as needed based on response. However, your provider may recommend starting at a lower or higher dose for various reasons. Consult with your provider at Philadelphia Integrative Psychiatry to discuss your individualized dosing plan!
-Ages 6–12: 26.1 mg/5.2 mg, 39.2 mg/7.8 mg, or 52.3 mg/10.4 mg
-Ages 13 and older: 39.2 mg/7.8 mg or 52.3 mg/10.4 mg
Which symptoms of ADHD does Azstarys treat?
All of them, including attention, hyperactivity, and impulsivity.
Dosing Tips:
-Capsules can either be taken whole or they can be opened and the contents sprinkled onto applesauce or dissolved in water
-When sprinkled over applesauce or taken in water, the entire solution should be consumed immediately
-A dose of a single capsule should not be divided
-Avoid dosing after the morning because of the risk of insomnia
-Side effects are generally dose-related
-May be possible to dose only during the school week for some ADHD patients
-May be able to give drug holidays over the summer in order to reassess therapeutic utility and effects on growth/weight and to allow catch-up from any growth suppression as well as to assess any other side effects and the need to reinstitute stimulant treatment for the next school term
***However, most studies show that parental height is what determines a patient’s final height, and that most children/adolescents taking stimulants reach their expected height, just more slowly than children/adolescents not exposed to stimulants
-Can be taken with or without food
How does this medication work in the brain?
It works, as do all stimulants, by limiting the reuptake of norepinephrine and dopamine in the prefrontal cortex, which allows this region of the brain to work more effectively. This region of the brain is responsible for impulse control, focus, and decision making (executive function tasks).
Here is more information on side effects to watch for when taking stimulants:
**If there is a history of cardiac problems such as sudden cardiac death or arrhythmias in the immediate family (parents, siblings), please obtain an EKG prior to starting stimulants. Stimulants are thought to be safe on the heart but, like drinking high amounts of caffeine, stimulants can be problematic for people who have a family history of severe cardiac issues.
**Do not take stimulants if you are pregnant.
Stimulants are the most commonly prescribed treatment for ADHD & impulse control disorders. The reason for this is that they are SO effective and they tend to be reasonably well tolerated. That said, they have side effects to watch for. Here are the important 5 side effects we ask parents and patients to watch for, followed by other issues to consider in general:
-Appetite suppression (with weight loss eventually) *this med has demonstrated less impact of appetite suppression as compared to other stimulant medications
-Irritability (either when on the med or, more likely, when it wears off...less likely with Azstarys because of its longer mechanism of action)
-Anxiety while on the medication (just as caffeine makes some people more anxious) *in practice, we frequently see these meds decrease anxiety in most, however
-Insomnia *in practice, these meds can improve insomnia once ADHD symptoms are more controlled during the day
-Tics -- motor and/or verbal tics, which tend to be more of an issue in boys under the age of 10
The other issues for all stimulants are:
-Gi upset
-Headache
-Dry mouth
-High heart rate and palpitations
For further information, please visit the company’s website here. There is an informational video that is very helpful.
AZSTARYS is a central nervous system (CNS) stimulant prescription medicine FDA approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in people 6 years of age and older. AZSTARYS may help increase attention and decrease impulsiveness and hyperactivity in people with ADHD.
