Azstarys: ADHD Medication Side Effects & Warnings

Generic drug: serdexmethylphenidate and dexmethylphenidate

Brand name: Azstarys

What is Azstarys (serdexmethylphenidate and dexmethylphenidate), and how does it work?

Azstarys (serdexmethylphenidate and dexmethylphenidate) is a central nervous system stimulant prescription medicine used 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 6 years of age and older with ADHD.

It is not known if Azstarys is safe and effective in children younger than 6 years of age.

What are the side effects of Azstarys?

WARNING

ABUSE AND DEPENDENCE

CNS stimulants, including Azstarys, other methylphenidate-containing products, and amphetamines, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing, and monitor for signs of abuse and dependence while on therapy.

Azstarys may cause serious side effects, including:

Painful and prolonged erections (priapism). Priapism has happened in males who take products that contain methylphenidate. If you or your child develop priapism, get medical help right away.
Circulation problems in fingers and toes (peripheral vasculopathy, including Raynaud's phenomenon). Signs and symptoms may include:
- fingers or toes may feel numb, cool, or painful
- fingers or toes may change color from pale, to blue, to red

Tell your healthcare provider if you or your child have numbness, pain, skin color change, or sensitivity to temperature in the fingers or toes.

Call your healthcare provider right away if you or your child have any signs of unexplained wounds appearing on fingers or toes during treatment with Azstarys.

Slowing of growth (height and weight) in children. Children should have their height and weight checked often during treatment Azstarys. Azstarys treatment may be stopped if your child is not growing or gaining weight.

The most common side effects of Azstarys include:

decreased appetite
nausea
indigestion
trouble sleeping
vomiting
stomach pain
weight loss
dizziness
mood swings
increased blood pressure
anxiety
irritability
increased heart rate

These are not all the possible side effects of Azstarys.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the dosage for Azstarys?

Pretreatment Screening

Prior to initiating treatment with Azstarys, assess for the presence of
cardiac disease (i.e., perform a careful history, family history of sudden death
or ventricular arrhythmia, and physical exam).

Assess the risk of abuse prior to prescribing, and monitor for signs of abuse
and dependence while on therapy. Maintain careful prescription records, educate
patients about abuse, monitor for signs of abuse and overdose, and periodically
re-evaluate the need for Azstarys use.

Recommended Dosage

Pediatric Patients 6 To 12 Years Of Age

The recommended starting dosage of Azstarys is 39.2 mg serdexmethylphenidate/ 7.8 mg dexmethylphenidate once daily in the morning.
The dosage may be increased after one week to a dosage of 52.3 mg serdexmethylphenidate/10.4 mg dexmethylphenidate per day, or decreased after one week to a dosage of 26.1 mg serdexmethylphenidate/5.2 mg dexmethylphenidate per day, depending on response and tolerability.
Maximum recommended dosage is 52.3 mg serdexmethylphendiate/10.4 mg dexmethyphenidate once daily.

Adults And Pediatric Patients 13 To 17 Years Of Age

The recommended starting dosage of Azstarys is 39.2 mg serdexmethylphenidate/7.8 mg dexmethylphenidate once daily in the morning.
Increase the dosage after one week to a dosage of 52.3 mg serdexmethylphenidate/10.4 mg dexmethylphenidate per day.
Maximum recommended dosage is 52.3 mg serdexmethylphenidate/10.4 mg dexmethylphenidate once daily.

Pharmacological treatment of ADHD may be needed for extended periods. Periodically reevaluate the long-term use of
Azstarys, and adjust dosage as needed.

Administration Information

Administer Azstarys orally once daily in the morning with or without food.

Azstarys capsules may be taken whole, or opened and the entire contents
sprinkled into 50 mL of water or over 2 tablespoons of applesauce. Consume all
the drug/food mixture immediately or within 10 minutes of mixing; do not store
for future use.

Switching From Other Methylphenidate Products

If switching from other methylphenidate products, discontinue that treatment, and titrate with
Azstarys using the titration schedule described above.

Do not substitute Azstarys for other methylphenidate products on a
milligram-per-milligram basis because these products have different
pharmacokinetic profiles from Azstarys and may have different methylphenidate
base composition.

Dose Reduction And Discontinuation

If paradoxical aggravation of symptoms or other adverse reactions occur; the dosage should be reduced, or, if necessary, the drug should be discontinued.
Azstarys should be periodically discontinued to assess the pediatric patient’s condition. If improvement is not observed after appropriate dosage adjustment over a one-month period, the drug should be discontinued.

What drugs interact with Azstarys?

Clinically Important Interactions With Azstarys

Table 1 presents clinically important drug interactions with Azstarys.

Table 1: Clinically Important Drug Interactions with
Azstarys

Monoamine Oxidase Inhibitors (MAOIs)

Clinical Impact:
Concomitant use of MAOIs and CNS stimulants,
including Azstarys, can cause hypertensive crisis. Potential
outcomes include death, stroke, myocardial infarction, aortic
dissection, ophthalmological complications, eclampsia, pulmonary
edema, and renal failure.

Intervention:
Do not administer Azstarys concomitantly with MAOIs or within 14
days after discontinuing MAOI treatment.

Examples:
Selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, methylene blue

Antihypertensive Drugs

Clinical Impact
Azstarys may decrease the effectiveness of drugs used to treat
hypertension.

Intervention
Monitor blood pressure and adjust the dosage of the antihypertensive drug, as needed.

Examples
Potassium-sparing and thiazide diuretics, calcium channel blockers, angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, centrally acting alpha-2 receptor agonists.

Halogenated Anesthetics

Clinical Impact
Concomitant use of halogenated anesthetics and Azstarys may increase the risk of sudden blood pressure and heart rate increase during surgery.

Intervention
Avoid use of Azstarys in patients being treated with anesthetics on the day of surgery.

Examples
Halothane, isoflurane, enflurane, desflurane, sevoflurane.

Risperidone

Clinical Impact
Combined use of methylphenidate with risperidone when there is a change, whether an increase or decrease, in dosage of either or both medications, may increase the risk of extrapyramidal symptoms (EPS).

Intervention
Monitor for signs of EPS.

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Does Azstarys cause addiction or withdrawal symptoms?

Drug Abuse And Dependence

Controlled Substance

Azstarys contains dexmethylphenidate hydrochloride, a Schedule II controlled substance, and serdexmethylphenidate. (Controlled substance schedule of serdexmethylphenidate to be determined after review by the Drug Enforcement Administration.)

Abuse

CNS stimulants including Azstarys, other methylphenidate-containing products, and amphetamines have a high potential for abuse. Abuse is the intentional non-therapeutic use of a drug, even once, to achieve a desired psychological or physiological effect.
Drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use (e.g., continuing drug use despite harmful consequences, giving a higher priority to drug use than other activities and obligations), and possible tolerance or physical dependence. Both abuse and misuse may lead to addiction, and some individuals may develop addiction even when taking
Azstarys as prescribed.
Signs and symptoms of CNS stimulant abuse include increased heart rate,
respiratory rate, blood pressure, and/or sweating, dilated pupils,
hyperactivity, restlessness, insomnia, decreased appetite, loss of
coordination, tremors, flushed skin, vomiting, and/or abdominal pain.
Anxiety, psychosis, hostility, aggression, suicidal or homicidal
ideation have also been observed. Individuals who abuse CNS stimulants may
chew, snort, inject, or use other unapproved routes of administration which
can result in overdose and death.
To reduce the abuse of Azstarys, assess the risk of abuse prior to prescribing. After prescribing, keep careful prescription records, educate patients and their families about abuse and on proper storage and disposal of CNS stimulants, monitor for signs of abuse while on therapy, and re-evaluate the need for
Azstarys use.

Dependence

Physical Dependence

Azstarys may produce physical dependence from continued therapy. Physical dependence is a state of adaptation manifested by a withdrawal syndrome produced by abrupt cessation, rapid dose reduction, or administration of an antagonist.
Withdrawal symptoms after abrupt cessation following prolonged high-dosage administration of CNS stimulants include dysphoric mood; depression; fatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; and psychomotor retardation or agitation.

Tolerance

Azstarys may produce tolerance from continued therapy. Tolerance is a state of adaptation in which exposure to a drug results in a reduction of the drug's desired and/or undesired effects over time.

QUESTION

The abbreviated term ADHD denotes the condition commonly known as:
See Answer

Is Azstarys safe to use while pregnant or breastfeeding?

CNS stimulants, such as Azstarys, can cause vasoconstriction and thereby decrease placental perfusion.
No fetal and/or neonatal adverse reactions have been reported with the use of therapeutic doses of methylphenidate during pregnancy; however, premature delivery and low birth weight infants have been reported in amphetamine-dependent mothers.
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications, including
Azstarys, during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Psychostimulants at 1-866-961-2388.
There are no available data on the presence of serdexmethylphenidate in human milk, effects on the breastfed infant, or effects on milk production. Dexmethylphenidate is the d-threo enantiomer of racemic methylphenidate.