“The good news is, there has never been a better time to have ADHD,” I said last night to a client consulting with me about her new diagnosis of ADHD.
Sure, I sought to boost her optimism about making the life changes she desired but found daunting. But it’s the truth. Never have we enjoyed such a huge number of ADHD-related published studies, evidence-based strategies, support sources, and medications.
Case in point: I mentioned to her a new medication: Quillivant XR. It is based on the oldest, most well-studied medical treatment for ADHD: the stimulant called methlyphenidate, or MPH. (Other MPH medications include Ritalin, Concerta, and the Daytrana patch.)
UPDATE: Quillivant’s manufacturer, Pfizer, reports a shortage, starting 1/28/2018 and continuing until today, 3/12/2018. The company offers no date for when it expects the shortage to end. More information at the FDA Site reporting medication shortages.
Liquid, Extended-Release Form of Ritalin
With the recent introduction of Quillivant XR, we now have a liquid, extended-release formulation designed to last 12 hours (as always, your mileage may vary, given your unique neurochemistry).
Basically, it comes as a powder that your pharmacist will mix for you into a liquid. You will receive:
- 1 bottle (containing the liquid)
- 1 oral dosing dispenser, and
- 1 bottle adapter.
You’ll find the question-and-answer page on this product here.
Easier to Swallow Than Pills; Enables Precise Dosing
One obvious appeal for a liquid stimulant option is for children who have a hard time swallowing pills or capsules.
But a liquid also enables more precise and individualized dosing – for children, teens, or adults. After all, sometimes a person’s ideal dose lies somewhere between the available dosage strengths of the pills or capsules.
This isn’t the first liquid-stimulant formulation. If it, however, the most sophisticated in its extended-release profile.
What’s this profile? Simply put, it is the pattern the medication follows from the time it’s taken to the time it wears off. Below is the profile for Quillivant XR, compared to an immediate-release (IR) methylphenidate oral solution.
Note that the Quillivant avoids the “roller coaster” ups and downs that are so common with the IR products.
Also worth noting: Other extended-release methylphenidate options, such as Concerta, also show more sustained and smooth profiles. So do some amphetamine-class stimulants such as Vyvanse.
A Preferred Profile for Some, Not for Others
At the same time, this profile might not work best for you or your loved one.
For example, look again at the profile for the immediate-release (IR) methylphenidate oral solution. See that “spike” between 5 and 10 hours (on average)? That might be exactly what’s needed for some folks—an extra boost of the medication. Compared to this, Quillavant starts a steady decline at about 5 hours.
Each person will have a profile preference, either due to cognitive demands during the day or simply the way his or her body metabolizes the medication.
Does Food Interfere? Maybe
Citric acid (Vitamin C) has been known to interfere with stimulant effectiveness.
Citric acid is in orange juice and some multi-vitamins. It is also used as a preservative in many food products (check the label). I find no evidence that consuming citric acid is a concern while taking Quillivant. Yet, it seems likely. I will update this post if I find new information.
Meanwhile, consider this item about consuming high-fat meals, found on the drug insert:
In a study in adult volunteers to investigate the effects of a high-fat meal on the bioavailability of QUILLIVANT XR at a dose of 60mg, the presence of food reduced the time to peak concentration by approximately 1 hour (fed: 4 hours vs. fasted: 5 hours). Overall, a high-fat meal increased the average Cmax of QUILLIVANT XR by about 28% and the AUC by about 19%. These changes are not considered clinically significant.
I am not a psychopharmacologist. But I interpret this to mean that fasting prolongs the time it takes to achieve peak concentration by one hour. Consuming a high-fat meal reduces the time it takes to achieve peak concentration.
You can read more details about Quillivant XR here.
UPDATE: I have made many attempts to call the customer service line associated with this card. It has not been a pleasant experience.
Given the “phone tree choices,” consumers can only choose to “activate” their card or be sent to recorded FAQs. I could not get through to a human, to find out why some readers are experiencing problems with their cards. Such as with this reader comment:
But our local CVS is only saying the copay card is $20 off the total cost, not just $20 for the Rx as the card states. They ran it both with and without our insurance to compare costs. Without insurance it would have been $150 out of pocket or $130 with the savings card. With our insurance (Blue Cross/Blue Shield) it is $121 out of pocket or $101 with the card.
I am frustrated because I cannot get a live person on any of the telephone numbers listed with the card literature, nor the # listed in this blog thread.
I finally “tricked” the phone-tree system by selecting “pharmacy representative” instead of consumer. As I predicted, I got right through to a human.
First, that human told me that what I had experienced with the phone-tree system did not happen—that consumers can get through to a person instead of being sent only to recordings. Then he proceeded to tell me what did happen. In other words, he tried to “gaslight” me. 🙂
Finally, I asked to speak to a supervisor. There was none available. He offered to have someone call me. But I’ve been around the track and back. That won’t happen.
Here, though, is where we have a good use of Twitter. Companies that won’t answer calls or deal with the public privately will respond to public shaming on Twitter. Let’s try that!
In the comments, you’ll find plenty of first-hand experiences with this medication, along with some questions. Feel free to join in.
Please note that I accept no funding from pharmaceutical manufacturers. My advocacy is entirely self-funded. This piece is a public service.