Liquid and Chew “Ritalin”: Quillivant XR & Quillichew XR

quillivant XR and Quillichew XR as new forms of Ritalin

With the introduction of a  liquid and a chew, people with ADHD gained yet another novel way to benefit from stimulant medication. Since I first wrote about these new options, in 2013 and 2015, corporate juggling has made supply erratic. As a result, many people are unfamiliar with Quillivant XR and Quillichew XR. Now in 2022, the supply seems relatively stable. For now!

Today’s dizzying array of stimulant choices can feel overwhelming. But it also means more people have a better chance of finding a stimulant that works best for their unique neurochemistry and preferences.

Who Might Benefit From Quillivant XR or Quillichew XR?

I find at least four reasons why one of these stimulants might be a welcome option:

  1. Difficulty swallowing: Many people with ADHD (and not just children)  have a “gag reflex.” It makes swallowing pills difficult. Hence, a liquid or chew comes as a useful alternative.
  2. Fear of losing control: When a person is especially fearful of taking a stimulant for the first time, feeling more in control can be helpful.  With Quillivant XR, you control the dose precisely (see illustration below).
  3. Ultra-slow drug metabolism: Some people find they metabolize stimulant medications very slowly. That means even the lowest dose of a pill can be too much.  Again, the dropper allows more customized dosing, with the prescriber’s guidance.
  4. More precise dosing: Sometimes a person’s “sweet spot” lies somewhere between the available dosage strengths of the pills or capsules. A liquid might allow more precise dosing. (This is not a claim made by the company. Talk with your prescriber.)
  5. Easier titration: The basic rule of thumb when beginning to take a stimulant medication is, “Start low, Titrate slow.”  That is, increase slowly until maximum benefit is attained.  This is not always easily accomplished with other medication choices. The risk is starting too high and, with a negative response, deciding that medication isn’t for you.  Obviously, the liquid is easily titrated. Yet, the chew is also scored, so that you can split it (see illustration below).

Both Quillivant products are FDA-approved for children, adolescents, and adults. For more on this topic:

Quillivant XR applicator

 

Quillichew Xr dosing

Delivery System Makes All the Difference

These two medications fall into the methylphenidate (MPH) class of stimulants.  Also in this class: Ritalin, Concerta, Daytrana Aptensio XR, Metadate CD, Methylin, Jornay PM, Adhansia XR, and Cotempla.  In other words, all of these choices contain the exact same active ingredient, methylphenidate.

Why then might one of these choices work well for a given individual while others don’t?   It’s all in the the delivery system. For example, in addition to this liquid and chew, there are pills, an osmotic pump, a patch, and various types of time-release capsules. The delivery system determines how and how fast the medication enters the bloodstream—and the rate in which it exits.

That’s why, even though these products contain the very same medication, they vary in efficacy for individuals.

Problematic History with Quillivant: Resolved?

Initial interest in the Quillivant products subsided amidst product shortages and, later, a recall. Much confusion resulted from Pfizer purchasing the product from NextWave/Tris—and then Tris buying it back—all in the space of about 3 years.  (It’s very hard to follow the trail, though, given all the subsidiaries.)

At any rate, those problems seem to have been resolved.  But drug shortages can happen for any number of reasons.  You can always check supply status at the U.S. Federal Drug Administration’s FDA Drug Shortages.

I asked a Tris company representative for an update and explanations of this medication’s roller-coaster history, including with a 2017 recall:

  • The recall happened when Pfizer owned the company. Tris since purchased the company, NextWave.
  • The recall concerned two lots of the product that “did not meet the specification for dissolution.”  There was no contamination or other severe problem. But the dosing apparently was affected (which can present its own kind of problem). I’m aware of  no recalls since that one.You can read more here: CMO for Pfizer ADHD drug hit with US FDA warning

A Few More Details:

Here is an overview of each “Quilli” choice.

Quillivant XR: Liquid Extended-Release Form of MPH

Quillivant XR is a liquid, extended-release formulation of the stimulant methylphenidate (MPH). It’s 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:

  • Glass bottle (containing the liquid)
  • Oral dosing dispenser, and
  • Bottle adapter.

You’ll find the question-and-answer page on this product here: Questions/Quillivant XR.

Quillivant XR

 

This isn’t the first liquid-stimulant formulation. It might, however, be the most sophisticated in its extended-release profile.

Simply put, a profile refers to 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.

Quillivant XR profile

Note that  Quillivant XR appears to avoid 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 compared to the immediate-release formulations.  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.

Quillivant profile

For example, let’s 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 some folks need—an extra boost of the medication at that time. Compared to this, Quillavant XR 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 their body metabolizes the medication.

QuilliChew XR: Chewable, Extended-Release Form of MPH

QuilliChew has its own FDA product insert. It’s difficult to compare the two profiles (Quillivant XR liquid and QuilliChew) because they use different labels. Roughly, they seem very similar.

Quillichew profile

QuilliChew XR comes in a blister pack, as a chew. Two doses (20 mg and 30 mg) are scored to allow half doses. That is not the case with the 40 mg dose.

Quality Relies on Pharmacist, Consumer Following Instructions

Last I spoke with Tris, there had been reports of pharmacists not properly following instructions with the Quillivant XR liquid product.

The product kit, as depicted above, includes an empty glass bottle. The pharmacist should add the powder to that glass bottle, mix with the indicated amount of water, and shake vigorously.  (Consumers should also shake the bottle vigorously before each use.)

Apparently, some pharmacists  ignored instructions and opted to mix the solution in alternate containers, including plastic and amber-colored. Why is this a problem? Because, according to Tris, proper emulsification (the water mixing well with the powder) depends on the liquid hitting that type of glass.

Given this information, it behooves consumers to directly question the pharmacist about the procedure before purchasing Quillivant XR liquid.

Now, onto the other issues.

Does Food Interfere With Either Product? Uncertain

Generally, there are two areas to consider when it comes to stimulant medications potentially reacting with food or vitamins:

  1. Citric Acid
  2. Dietary Fat

Citric acid is in orange juice and some multi-vitamins. You’ll also find it as a preservative in many food products (check the label).

To varying degrees, Citric acid can interfere with some stimulant medication’s effectiveness.  (See one of my most popular blog posts: Can Acidic Foods Affect Stimulant Medications for ADHD?) Some stimulant medications are affected by dietary fat.

Each “Quill” product can be taken with or without food, according to the product inserts.

Let’s examine each Quillivant XR product for these two factors: citric acid and dietary fat.

1. Quillivant XR Liquid: Affected by  Citric Acid or Fat?

I find no evidence on the drug insert for Quillivant XR liquid—that consuming citric acid is a concern. In fact, the inactive ingredients include one type of citric acid (anhydrous citric acid).

What’s anhydrous citric acid? From the definition at Drugs.com:

It is found naturally in citrus fruit such as lemons and limes and is used as a natural preservative.

Anhydrous citric acid has had the water molecules removed and is usually in a dry, powdered formulation.

Meanwhile, consider this item about consuming high-fat meals, also 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.

Full disclosure: I am not a psychopharmacologist. 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. Please ask your pharmacist or prescriber.

2. QuilliChew XR: Affected by  Citric Acid or Fat?

The product insert indicates no warning about citric acid. In fact, citric acid is an inactive ingredient. I’ll list all the inactive ingredients here. Sometimes there are food/chemical sensitivities (e.g. aspartame). If so, this should be checked before taking any new medication:

Inactive Ingredients: aspartame, cherry flavor, citric acid, crospovidone, D&C red #30 (for 30 mg strength), D&C red #7 (for 40 mg strength), guar gum, magnesium stearate, mannitol, microcrystalline cellulose, polyvinyl acetate, polyvinyl alcohol, povidone, silicon dioxide, sodium polystyrene sulfonate, talc, triacetin, xanthan gum.

Regarding the only potential food effect:

High-fat meal had no effect on the time to peak concentration, and increased Cmax and systemic exposure (AUCinf) of methylphenidate by about 20% and 4%, respectively, after a single dose administration of 40 mg QuilliChew ER.

Quillivant Quillichew savings card

Quillivant XR & Quillichew XR Savings Program

Click here to learn about the current Tris Savings program.

If you have questions about the product or the savings program, call 1-844-865-8684.

A Caveat About Fruit-Flavored

I want to emphasize one feature of these medications: flavor. Quillivant XR liquid comes in banana flavor. QuilliChew XR uses cherry flavoring.

To my mind, stimulant medications tasting similar to fruit or candy require extra diligence.  It might be wise to explain to a child taking the medication that neither form of Quillivant XR is candy. Of course, as with all medications, also keep it safely out of a child’s reach.

Please keep in mind: Many first-hand experiences with this medication date to the original post, in 2014. Some issues have been resolved, as I explained in the post.

Please note that I have never accept  support of any type from the pharmaceutical industry. My advocacy is entirely self-funded. This ongoing report is a public service.

—Gina Pera

289 thoughts on “Liquid and Chew “Ritalin”: Quillivant XR & Quillichew XR”

  1. Yes doctor told me to.start it on sat Sunday and the week to see how he does and 1 teaspoon of 5ml since he is new to meds I’m just going do what doc say plus they going call me on thur to see how he doing on it but I’m just going eather give it with hes milk are juice and feed him with it I dont want him to get any side effects from it

  2. I wont be telling him its inside juice and doc want me to start it in sat 1 day but after that I will not be doing weekend only on school days since that problem he havning in school thank you for responding and I’m sorry be bother

    1. Hi Anna,

      You’re not a bother. I understand your concerns.

      Have you thought about this? That the doctor might want you to try the first dose on a Saturday so you can be with him and see how he reacts?

      Do you really want to give him the medication and then send him off to school?

      g

  3. My question is has anyone try the ritalin 5mg on there 5 year old child the liquid one its only once a day for school what to np if anyone child had side effects from it

    1. Perhaps other parents will respond.

      As an expert in this topic, I can tell you…..everyone is different. No two brains are alike. Our brain and body chemistries are unique. While we can expect a range of fairly predictable results, when starting at a low dose, we cannot know what type of side effects might follow — or what dose — will be best for that individual.

      I encourage you to write down the date, the medication and the dose, and note his responses.

      This data will come in handy as you continue to look for a good “fit.”

      Perhaps it will be easy, and 5 mg will sufficiently help him. Or, he might need a higher dose.

      g

  4. No he only has ADHD nothing else and learning disability and the Ritalin they gave him is 5mg liquid one its only for school I’m not doing it for my home I would deal with the way he is its Mainly for school classes not focus hes all over the place just wanted to no if this medsion is on for him and I’m going put it inside hes juice in morning I’m starting tomorrow just 1 day that is all

    1. Hi Anna,

      Then it’s well worth trying.

      Keep in mind. There are two classes of stimulants: methylphenidate (ritalin, quillivant, etc.) and amphetamines (vyvanse, adderall, etc.). Some people respond better to one class over another. It boils down to individual genetics and neurochemistry.

      It’s really best to have the medication be effective throughout the day. ADHD medications aren’t for getting good grades. They are for improving brain function in many ways, including socially.

      He might not have “LD” at all — but difficulties with learning, writing, hearing, etc, from ADHD itself. He is only 5, so he has lots of development to go.

      But I’m a firm believer in treating ADHD symptoms early. There are developmental milestones that depend on strong brain functioning in the “circuitry” affected by ADHD.

      Anna, it sounds as if your fears could sabotage his treatment. Try to approach this in a less fearful way, because children tend pick up on parents’ fears.

      The more you learn about how the medication works, the less fearful you will be.

      Maybe the product you have it Methylin? I think that’s the only liquid form of Ritalin (Methylphenidate). That an Quillivant.

      Are you going to tell him that you’re putting the medication in his juice?

      I encourage you to think this through and be thoughtful about it, not fearful. It might take more than one day to judge how helpful the medication can be.

      good luck,
      g

  5. Am 52 and have been medically treated for ADHD for 10 years. My brains favorite drug was Intuniv -however, my blood pressure runs on the low side and the side effect was a bit scary. We tried a couple of stimulants both IR and LR and the crash was no good. Have been on Vyvanse for five years and it just works. Sometimes, when I forget to take it I quickly remember why I take it to begin with due to jitters ,anxiety, and scattered OR hyper focus. Vyvanse calms me. Oddly enough it too lowers my BP but not to double digits of 80/50 like Intuniv. The food interaction is a real thing. What I’ve learned: 1) consume a quality protein shortly after taking it 2) avoid coffee completely BUT if you’re going to anyway-wait a full hour after dosing. 3) avoid vitamin C in am. We need this vitamin obviously but take it with your evening meal when you’re med is wearing off anyway. This includes vitamin c skin serums. Use at night. Most work poorly under makeup anyway. 4) If you’re a female between 35-55 you’re either peri-menopausal or post-menopausal and may be using bio-identical creams or pharmaceutical creams like DHEA , Pregnenolone, Testosterone , E1,E2, (if you’re doctor is prescribing E3-fire them and seek council elsewhere), or Progesterone. These are all well and good if you’re being tested and monitored BUT the first 3 may require a lower dose of your medication. 5) CARBS: oh my -not much talk of them but my experience ( take with grain of salt!) is that simple carbs will make your gut acidic and keep it that way ALL day. If you’re a regular sweet fiend, you may find trouble getting ANY of the ADHD meds to work whether you’re 6 or 60. Plus, after 40, haven’t we noticed how uncomfortable it becomes digesting Thanksgiving dinner? Kids don’t experience the acidity like adults do but let them eat waffles with syrup and their meds won’t work at all or as well. This I know from helping my youngest manage her condition. 6). If you avoid simple carbs and sodas and avoid eating after 6pm you won’t need an antacid which also interferes with your meds.

    1. Hi SR,

      Thanks for your comments.

      That’s an important point for women with ADHD who are likely in perimenopause or beyond: Hormones matter!

      Even for younger women with ADHD, some find that the stimulant doesn’t work as well certain times of the month. Some experts recommend a bit larger dose of medication at such times.

      And, absolutely, processed carbs can have an acidifying effect.

      I love your “taking charge” of all these issues. It’s so important!

      Thanks,
      Gina

  6. My daughter is 9 and has taken Quillavent for 3 years. She does have less appetite. We make sure to watch meals and I provide a protein rich breakfast and I give her DINNER (Full meal with meat, veggetables and starch) when she gets home from school (or when she gets hungry ~4pm). I also keep protein shakes and nutrient rich snacks for her. Our deal is… you have to eat or drink a shake for Breakfast and lunch…… if you eat dinner you can have any snacks you want. (She loves jerky, veggies and popcorn so she has good natural habits)

    Sleep was an issue from infancy!!! (seriously!!!) We give her 10 mg of melatonin 30 mins before bed time. It takes her a LONG time to fall asleep. The first week of quillavent resulted in 3 nights of NO SLEEP. But it balanced out.

    I do give her days off…. if she is not at school and sleeps in, I will give her a day off. (It is rough for me, but I have to balance the impact on appetite and sleep. SHE HAS TO EAT and SLEEP.) She developed food phobia last school year resulting in weight loss . We took her off the quillavent for 2 months. Her school work, behavior, personal grooming were just horrid!!! She has a 139 IQ and knew that she was “gross” and “messy” and “bad”…. it was a sad time for her despite her high energy. When we got the weight up and put her back on her meds… we had a stomach ache for about a week, but she almost instantly felt better about herself as her schoolwork, personal grooming, and behavior returned to normal.

    I do worry that 3 years is a long time to be on a med. So, I give her the time off to see if there is a difference. I watch food, sleep, weight, moods…. I keep a journal. It is SOOOO worth it!!!

    1. Hi Kelly,

      Kudos to you. It sounds like you are a very diligent and observant parent!

      I do see some red flags here, and I’ll share some info that might be helpful.

      Are you sure that she doesn’t have some anxiety (quite common in folks with ADHD) and that the stimulant isn’t exacerbating that anxiety? Maybe even pushing her into an eating disorder? I’ve seen too many young girls, in particular, develop eating disorders from poor prescribing.

      She shouldn’t have to tolerate those side effects. Moreover, I’m not sure that consuming that many protein drinks is healthy.

      It is very important for the prescribing physician to treat the FULL RANGE of symptoms. That can include depression/anxiety (“serotonin” issues).

      Most people with ADHD seem to need a second medication, with the stimulant. That might be a low dose of Strattera (which can also help with sleep) or an antidepressant.

      A low dose of stimulant at night could also help her brain get “organized” to sleep.

      10 mg of melatonin is a very high dosage. It is a powerful hormone and not simply a “sleep aid.” I know that it’s commonly recommended by other parents, but really, melatonin is not the answer for everyone, and it should be given only with great care to a child, and almost never at that high dosage.

      Good luck!
      g

  7. Our 8 yr old 50 lb. son has been on Quillivant 3 mg for the past 15 months, and it’s helped enormously (ADHD with some ODD). But recently he’s been acting up the last hour of the school day, and every ‘specials’ teacher is complaining (those are the end of day specialty teachers like art, music). I told our psychiatrist yesterday but he didn’t seem concerned nor did he say anything about dosage.

    I’m unclear if a slightly higher dosage (like 3.5 mg) would help last the full school day? I will discuss again with our doctor but just wanted to understand if more Quillivant necessarily means it will last a little longer.

    He does very well overall on the medicine but isn’t eating much during the day, and his size is already small – so we are certainly worried about his growth and weight, and wouldn’t want to give him any more medicine if that would mean less eating. Welcome your thoughts!

    1. Hi Emily,

      First, I’m glad your boy is doing well with this treatment.

      It could be that the Rx is wearing off at that last hour. Or, I wonder, if he’s not eating much, if he’s “running out of steam” (as in nourishment).

      If he truly has OCD, it could be that the stimulant, over time, is exacerbating anxiety. This can make the return to baseline, when the Rx wears off, more rocky.

      From what I know, it’s unlikely that a higher dosage would last longer. More likely, it would push him out of his “window” of effective dosage, creating more side effects and not even lasting longer.

      Did he eat well before beginning medication? If so, it might be that the anxiety boosted by the stimulant is interfering with his appetite.

      Then again, I know plenty of young children without ADHD who are much more interested in the world around them than what’s on their plates. 😉 For those kids, and those with ADHD, I think it’s really smart not to allow the child much sugar at all. It can have a way of spoiling the “taste” for anything else.

      good luck!
      g

  8. My 15 year son has tourettes and ADHD and aspergers with oppositional defiant. He was taking the quillachew and liked it but insurance wasn’t going to cover it. It still cost too much with the savings card. But the insurance will cover the Quillivant XR and apply the savings card. After the first two doses of Quillivant XR his head and neck tics are back pretty severe. Should I stop it or keep trying it? Could it just be a coincidence and he maybe getting some tics back? He had the neck tic in Dec.

    1. Hi Michele,

      How frustrating for you both.

      I don’t really know what to tell you. Has anything else changed?

      Is he getting enough sleep? Eating well?

      Maybe try a lower dose?

      Gina

  9. My son has been taking quillivant xr liquid form at first this medication was a life saver expecially in school i mean always doing well while taking it he is 7 years old the dosage isnt the issue here at all hes on the lowest dose. Well the side affects were he would refuse to eat would result in vomiting he would take to himself or maybe he had seen something that wasnt actually there…he was in the shower and he had gotten my razor and cut his thumb i asked why he did that he said his brain told him to and he had a urge to do it. He has never done things like this before ever his eyes always look glazed over and wide awake hes been on 1mg…and sometimes he is great normally at school hes wonderful guessing at home he gets bored not as much stimulation not sure but its very odd behavior so ive taken him off. We tried a non stimulant and he was always sleepy and we gave it at bedtime. Not so sure medication is for us i am afraid to even try anything else expecially after the razor incident

    1. Hi Bri,

      How disturbing for you. And yet he was doing so well in school.

      In a tiny minority of children, a stimulant can cause hallucinations. But I don’t know why.

      That is a puzzle. But our human brains are like snowflakes; no two alike.

      Perhaps he has a co-existing condition. Or maybe a difficult birth. I’ve recently learned that schizophrenia is more common than most of us realize, especially in the milder forms.

      I wish you all the best in helping him.

      g

  10. Pingback: ADHD Medications Guide, Part II - ADHD Roller Coaster with Gina Pera

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