Biphentin: The Newest ADD/ADHD Medication in Canada
Despite there being many medications available to treat Attention Deficit Hyperactivity Disorder (ADD or ADHD) in the US, there are relatively few medicines in Canada. We had one new medicine added to our arsenal in Canada around September 2006 - Biphentin. This article will summarize what role Biphentin can play in treating ADD/ADHD.
What is Biphentin?
Biphentin is a new formulation of methylphenidate. Methylphenidate is the same medication that is found in Ritalin. Methylphenidate has been around for over 50 years. Despite many concerns and warnings discussed in the media, it is a safe medicine, when taken as prescribed and monitored by a physician. It also can work very well. Approximately 70-80% of people with ADD/ADHD will have significant improvement when they take this medicine.
In Canada, methylphenidate also comes as: Ritalin, Ritalin SR, and Concerta.
In the US, methylphenidate also comes as: Ritalin, Ritalin LA, Concerta, Metadate CD, Focalin XR.
Biphentin is being marketed in Canada, and is made by Purdue Pharma. It is not being marketed in the US. I was told (in a personal communication - certainly not official!) that Biphentin may eventually be marketed in Europe, but likely not in the US. Why not the US? I was told that it is very competitive in the US to market another form of Methylphenidate.
What are the characteristics of Biphentin?
Biphentin is a long acting form of methylphenidate. It lasts 8-10 hours with once daily dosing.
Biphentin is a capsule - with little beads inside. This allows the medicine to be ’sprinkled’ onto soft foods like: apple sauce, yogurt or ice cream. This can help with children who cannot swallow the pills. In Canada, this is the only medication option for methylphenidate that can be taken by children who cannot swallow pills. (As a side note, Adderall XR - which is an amphetamine, can also be opened and sprinkled.)
Biphentin comes in multiple strengths. This flexibility of dosing may make it easier for your doctor to find the right strength for you.
The strengths are: 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg.
Who is Biphentin approved for?
Health Canada has approved Biphentin for the treatment of ADD/ADHD across the lifespan. Specifically, Biphentin is approved to treat ADD/ADHD in children, adolescents and adults.
What are the side effects of Biphentin?
Biphentin’s side effects are the same as the side effects of the other methylphenidate products. The common side effects include: decreased appetite, insomnia, worsening of tics, approx. 2% risk of slowing growth. There are rare concerns of agitation, mood symptoms, etc. [N.B. This post is for educational purposes only - speak to your Doctor about side effects in detail]
How much does Biphentin cost?
Biphentin will most likely be covered under private insurance plans through your work. If it isn’t, I am happy to report that in general, it is cheaper than the newer forms of ADD/ADHD medication. The price does depend on the strenght of the pill.
The cost of Biphentin for 30 days of treatment is estimated as follows:
- Biphentin 10 mg once daily for 30 days: $29.40
- Biphentin 15 mg once daily for 30 days: $38.40
- Biphentin 20 mg once daily for 30 days: $46.80
- Biphentin 30 mg once daily for 30 days: $60.90
- Biphentin 40 mg once daily for 30 days: $75.00
- Biphentin 50 mg once daily for 30 days: $89.10
- Biphentin 60 mg once daily for 30 days: $103.50
These prices are listed in Canadian dollars. These are estimates, and the prices may vary at your pharmacy.
As a brief comparison of cost - here are estimated costs of some of the other ADD/ADHD medications in Canada:
- Concerta 18 mg once daily for 30 days: $71.70
- Concerta 36 mg once daily for 30 days: $90.90
- Concerta 54 mg once daily for 30 days: $110.40
- Adderall XR 5 mg once daily for 30 days: $96.00
- Adderall XR 30 mg once daily for 30 days: $96.00
- Strattera 10 mg once daily for 30 days: $134.97
- Strattera 60 mg once daily for 30 days: $134.97
- Ritalin SR 20 mg once daily for 30 days: $25.20
- Ritalin 10 mg once daily for 30 days: $18.30
When can Biphentin be used?
Biphentin can be used to treat ADD/ADHD at any age - it is approved for the treatment of kids, teens and adults.
Biphentin can be used as a ‘first line’ treatment - i.e. the first medicine given for someone with ADD/ADHD.
Because Biphentin is a once a day treatment - the patient doesn’t have to worry about taking a pill in the middle of the day. This is particularly helpful for children who can take their pill in the morning, and then not have to go to the office at school to get their noon medicine. This makes it easier for a child at school.
If someone has been on a different form of methylphenidate and had problems, it may be reasonable to try Biphentin to see if this long acting formulation may work better.
If your child has trouble swallowing pills, but your doctor thinks that methylphenidate is the right choice of medication, then Biphentin is the best choice.
Can Biphentin Be Abused?
One of the concerns with any stimulant medicine is the risk that it may be abused. If someone takes too much of the medicine, and tries to take it as a drug - i.e. snort it - then it can produce a ‘high’.
I am happy to report, that similar to the other long acting preparations of stimulant medicines (like Concerta and Adderall XR), Biphentin is not abusable. That means that someone couldn’t use it to get a ‘high’.
It is important for you to also know that Biphentin is not addictive.
How does Biphentin compare to Ritalin, Ritalin SR and Concerta?
All of Biphentin, Ritalin, Ritalin SR and Concerta are the same medication - i.e. methylphenidate. The difference is the preparation and how it acts in the body.
Ritalin is a short acting medicine, and is required to be taken two or three times daily for symptom control. The advantage is that it is cheap. It doesn’t work as well as the long acting forms.
Ritalin SR is a long acting preparation of methylphenidate which has been around for a long time. It doesn’t work very well for many people. Sometimes it lasts 6 hours, but often it doesn’t work well at all. The advantage is that it’s cheap.
Concerta is an excellent preparation of methylphenidate. It is a once daily, long acting medicine. It works for up to 12 hours. It is well tolerated and has been a great medicine in the treatment of ADHD for the past 3 years or so in Canada, and longer in the US.
Biphentin is a once daily, long acting medicine. One major advantage over Concerta is that the capsule can be opened and sprinkled in apple sauce, yogurt or ice cream. This will help children with trouble swallowing. It is also approved for the treatment of adult ADHD, which Concerta is not yet (though I hear that this is coming shortly…).
One final difference between Biphentin and Concerta is that Biphentin releases approximately 40% of its medicine in the early part of the day, whereas Concerta only releases 22%. This may mean that Biphentin may work better for ADD/ADHD in the morning, whereas Concerta may last a little longer into the day.
The Bottom Line About Biphentin:
Treatment of ADD/ADHD requires many components - including psychotherapy, behavioral management, academic supports, and medication. This article has been focusing on medication for the purpose of describing a new treatment for ADHD in Canada. For more information on the other treatments of ADD/ADHD: 1) sign up for my ADD/ADHD newsletter at www.TheADHDDoctor.com, and 2) peruse this blog for more articles about ADD/ADHD.
Biphentin is a new great option for the treatment of ADD/ADHD in Canada. It has its unique features, as described above. It is welcomed, as in Canada, we have fewer medicines available than in the US. Biphentin may help in the treatment of your ADD/ADHD (or that of your loved one).
If you are considering the use of Biphentin, ask your doctor. You may want to print this article, and take a copy with you to your next doctor’s appointment.
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Written by Dr. Kenny Handelman - The ADHD Doctor
To find get a FREE special report on ADD/ADHD Medication, visit: Medication Mastery
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November 27th, 2006 at 10:04 am
Thanks for all your newsletters Dr Handelman. My son is 15 and since the first grade we have been trying to find something that works for him. He has had a difficult time finding doctos too with the shortage in the area. we have finally found on about 45 minutes away. Anyway this child has been on Ritalin, Concerta, Statterra, Biphentin and now we are trying Adderal XR. So far all show little improvement. In the primary grades it wasn’t so bad as it was easier to get teachers and aids to work with him one on one and we could help a lot at home. However, now that he’s in highschool it’s like a whole new world. No comunication from school and they think that he will just do the work on his own. Are there other options that might help this boy?
Thanks Sandy
November 27th, 2006 at 10:51 am
Sandy -
It is a good idea to try Adderall XR. Apart from Strattera, all of the medicines you have listed (Ritalin, Concerta and Biphentin) are all the same chemical compound. So, if one doesn’t work at all, the others won’t either. It is wise to switch from one to the other if there is only a partial response, or a duration of response issue.
It is possible that Adderall XR may work. Other than that, we are limited in Canada.
There are some ‘third line’ treatments - i.e. ones that only work after being on the ‘first line’ and ’second line’. Probably the best one there is Wellbutrin. That said, it is not great for ADHD.
Please let us know if Adderall XR makes the difference.
November 27th, 2006 at 5:56 pm
Hi,
The doc should be working hard on getting to an optimal dose. It seems he needs some accomodations at school. Does he have an IEP , there could be a learning disability. Some kids learn better , one on one rather than in a classroom as from his experience . I suggest a tutor or even better a buddy-tutor . Your child needs somebody to help me believe in his innate abilities and make him successful and engage in a few close relationships.
Allan
December 4th, 2006 at 8:00 am
As an ADHD sufferer, I hate the stigma associated with the stimulant drugs used in ADHD treatment. These drugs, used properly, have a very low chance of addiction. That being said, your statement:
“similar to the other long acting preparations of stimulant medicines (like Concerta and Adderall XR), Biphentin is not abusable. That means that someone couldn’t use it to get a ‘high’.
It is important for you to also know that Biphentin is not addictive.”
is blatantly FALSE. Concerta and Adderall XR are most certainly abusable and are potentially addictive, especially when abused.
December 4th, 2006 at 9:53 am
Hi Ralph,
Thank you for your comment.
I agree with you that there shouldn’t be stigma around the stimulant medicine.
I am interested in your knowledge of how Concerta and Adderal are abused.
Can you share?
Thanks,
Kenny Handelman
December 18th, 2006 at 8:35 pm
Hello. Today my 13 year old daughter has been prescribed Biphentin. I have just read there is a 2% chance of slowing growth. Since my daughter is on human growth hormone, would her risk increase or do i just have to wait and see? We have tried Strattera but her difficulty with swallowing pills made us discontinue usage. Thanks for any information you can provide, Jill.
December 18th, 2006 at 8:47 pm
Hi Jill,
The issue of growth slowing with Biphentin (or any stimulant) in the context of receiving human growth hormone is a situation that I haven’t considered before.
It is best to contact your specialist in charge of the growth issues for this one. It is possible that because growth hormone is being taken, that the risk is less for this, but I have to say that I don’t know, and you will have to check with your specialists.
All the best,
Dr. Kenny Handelman
January 16th, 2007 at 11:16 am
I am hosting the Canadaian Micronutrient Conference on May 4th & 5th, 2007.
There is a significant ADHD component at this event, and I am hoping to have information about the conference posted on your site.
Please contact me if you require more information.
Thank you.
January 22nd, 2007 at 6:48 pm
Why have you not mentioned Dexedrine Spansule? It last throughout the day. It is fairly inexpensive. The drug is dextroamphetamine, so it is different than both methylphenidate and the 4 drug combination in Adderall XR.
February 6th, 2007 at 4:44 pm
My son is 6 he been diagnosed with severe adhd and biphentin works like a miracle, where ritalin was not working anymore. He was taking 40 mg of ritalin a day and still not able to have an attention span of more then 1 minute. We tried concerta - but it didn’t work at all. But with biphentin, he doesn’t have to go to the principal’s office 3 time a day to get his medication. He is more calm and he is learning to read - which we thought was impossible this years. So I think they should cover this médication because the cost is too much but biphentin works.
February 23rd, 2007 at 2:56 pm
Dr. Handelman,I have a 7 year old son who is diagnosed with ADHD and no other disorders. He was on Concerta 18 to 36 mg for two weeks,with no obvious improvement. He is switched to Biphentin 15 mg two weeks ago. I noticed that the first two or three day of taking Biphentin he was doing much better in school, accroding to his teacher’s daily comments. But by the third and especially the fourth day, his work output is back to the level before taking biphentin, far below what the expected work output of students in the same grade. We took him off Biphentin over the weeends, by Monday and Tuesday, he is doing much better again, but not so by Thursday. So is there a change in him to say build a tolerance to the medication? If so, how should we against the dosage. Thanks.
February 23rd, 2007 at 9:43 pm
Hi Robert.
Thanks for sharing your son’s experience with Biphentin. It is worth noting that although Concerta and Biphentin both have the same medicine in them - i.e. methylphenidate, some people responde better to one than the other - in your case - Biphentin works better.
You are bringing up the question of developing tolerance to Biphentin (and this can apply generally to any stimulant). Well, I have to say that I have never heard a story quite like that. It does sound like he may need a higher dose of biphentin at the end of the week than he did at the beginning. This is definately one that you will have to review with the prescribing doctor.
I certainly have seen patients who have developed what seems to be tolerance to stimulants - so that over time, there was a slight dosage increase. That said, I have never seen someone with what sounds like this kind of tolerance within 1 week.
Talk to the doctor about the dose of biphentin. It may be beneficial to take the biphentin 7 days per week - and this may create a more stable dosing regimen, or your doctor may suggest a different dosing strategy altogether.
Please do come back and let us know what happens in the future.
Thanks for sharing,
Dr. Kenny
March 13th, 2007 at 5:10 pm
Just an update. My son is around 55 lbs. He has been on Biphentin 15 mg for the last four weeks. For the first 3 weeks, his teacher’s comments are “excellent, on time” for Mondays, Tuesdays and Wednesdays., “distracted” for Thursdays and “quite distracted” for Fridays. Last week, the fourth week he has been on Biphentin, the comments are consistently “distracted” for early weekdays to “quite distracted” for late weekdays ie Thursday and Friday. He was fine Monday monring last week and after lunch, he became distracted again. We still take him off on meds during weekends; I am aware of the current recommended regiment of daily dose every day.
March 13th, 2007 at 5:25 pm
continued. So the dose of Biphentin is upto 20 mg per day. The doctor also arranged for EEG . She noticed that at times my son starts while he was talking, “phase out?” for a while then restart the conversation. My wife and dont’ notice that detail for maybe we are used to him. Once in a while he does take some time to respond when we call him. Maybe he was too involved in his reading or playing. The doctor mentioned “sometimes a bit of delay in answer”. Son said I had to think or he did not want to answer Dr’s questions. His birth was normal, quick delivery. No major sickeness. He had a fall on his head at 2 years old, no obvious injury or loss on consciousness or vomitting. Otherwise healthy. Normal with hand and eye co-ordination. We will see his GP for a complete physical and also arrange with school for a psychological analysis.
March 17th, 2007 at 4:22 am
more Biphentin experience. My son has bee on Biphentin 15 mg for the last four weeks. He is around 55 lbs. The first three weeks, Mondays to Wednesdays he did very well in school. Sincere thanks for his teacher who writes comments every day on a note book so we the parents can closely track the son’s progress. But on Thursdays and Fridays, he is “distracted to quite distracted. ” We take him off medicine during weekends. The fourth week however, seems the 15 mg dose has no effect on any day of the week, not even in the early part of week. Now, this is the fifth week, he started taking 20 mg. We have not yet seem any dramatic changes so far. His doctor booked EEG to more diagnosis.
April 12th, 2007 at 4:20 pm
Hi I have something I would like to ask you but first I have a son 4year’s old the doc wants me to put him on Biphentin and here’s the thing if you put a child on medication can they learn to deal with the problems later in life or are we just looking for an easy out? when they get in to there teens and realize that they can make there own choices and don’t want to be on this stuff all there life can they learn then how to control them self? or are we just populating the jail so we can have an easer time when there small? are we cheating them out of a fare life later on? I am rather sure that at some point my son will want to stop taking pills and live normal or what happens if he can not afford them? will there always be someone there to pay for them? no I don’t think so! so in the long turm are we really helping them? or actually hurting them? this is what I need to know before I start him on this stuff thank you for your help
April 12th, 2007 at 4:21 pm
Hi I have something I would like to ask you but first I have a son 4year’s old the doc wants me to put him on Biphentin and here’s the thing if you put a child on medication can they learn to deal with the problems later in life or are we just looking for an easy out? when they get in to there teens and realize that they can make there own choices and don’t want to be on this stuff all there life can they learn then how to control them self? or are we just populating the jail so we can have an easer time when there small?
April 13th, 2007 at 7:00 pm
Hi Stephanie,
You are asking a very very important question.
I will give you some of my thoughts, but I hope that you will take these questions and ask your son’s doctor.
ADHD is a real medical condition - as real as asthma or diabetes. The medicine can play a very important role for most people, but it is not a final answer in and of itself. In addition to medicine, one needs to get parenting support, behavioral treatment, academic help, etc.
In other words, the medicine can support the child to function better, and then the other treatments improve the functioning and teach the child the skills he or she needs to grow and mature.
When it comes to medication in a child with ADD or ADHD who is under 6 years old, there is new research that shows that this can be done safely. You can read a review of that research here: http://addadhdblog.com/adhd-medication-for-3-4-and-5-year-olds/
When it comes to the Biphentin - it is a product of methylphenidate. Methylphenidate was the medicine studied in younger children, so Biphentin may be a reasonable choice if medicine is needed.
To learn more about ADD or ADHD, and helping your child succeed with it, take a look at: http://www.secretstoadhdsuccess.com
All the best,
Dr. Kenny Handelman
May 15th, 2007 at 11:12 pm
My Son started on 15 mG of Biphentin a week ago and after five days has was increased to 20 mG. The teachers comment’s have been very positive for the first couple of days. I have noticed however that he seems very agitated or angry in the evenings. Some of the innitial issues were working on resolving seem to be worsenning rather than improving. Is this an effect of withdrawl at the end of the day possibly? Should we be concerned about his behavior when he first arrives home from school… Anger…agitation?
Regards,
Robert
May 21st, 2007 at 5:30 pm
Robert,
Thanks for your question about your son taking Biphentin.
You didn’t tell us how old he is, or how much he ways, but these are low-ish doses of biphentin.
There is a side effect of stimulants - which is called ‘rebound’.
This was much more common in the short acting stimulants - like Ritalin.
What this refers to is that a small percentage of people actually seem worse when the medicine is leaving their system at the end of the day, than if they hadn’t taken any medicine at all.
It was much more common with short acting medicines given two -three times per day.
That said, a sensitive child could experience that with a ’shorter long acting’. Biphentin lasts about 8 + hours. This is a shorter long acting methylphenidate.
Whereas Concerta is the same medicine, and last 10-12 hours.
If this issue with Biphentin lasts, ask your doctor if this could be ‘rebound’, and see if Concerta may help with it.
It is also possible that he doesn’t react well to methylphenidate (the medicine in biphentin), buy this seems less likely if you are getting good feedback from the teacher. If this is the case, though, consider one of the other medicines - like Adderall XR, Dexedrine, or the non stimulant Strattera.
All the best,
Dr. Kenny
May 25th, 2007 at 10:57 pm
Wow- i read other parents comments and i see my son. He is 9years old and about 55lbs- hs doctor just started him on biphentin and id really do see changes, but like other parents i find my son is quick to anger and to get “annoyed” when the meds ware off. He is currently on 20mg and we have bben advise to increase to 30mg but he stopped sleeping and complained of a headaches. We reduced him back down to the 20mg untill we can get to see his doctor. It is good to see my son excell in school and admazed at himself just how well he can do in school.
Neena
May 29th, 2007 at 3:57 pm
I am 53 years old with ADD. I tried Dexadren a few years ago but didn’t like the feeling both physical and the intensness mentally. I smoke pot in the evenings and enjoy the occaisional glass of wine. My questions are 1) Would I feel any different on Biphentin 2) Are my other two vices contra-indications to this drug’s use?
Thanks
May 29th, 2007 at 10:02 pm
Hi Lorne,
I will give you some thoughts - but please be aware - these are for educational purposes only - you need to speak to your doctor about your treatment.
1) There are two main types of stimulant medicines. There is methylphenidate (which includes Ritalin, Ritalin SR, Biphentin, Concerta, Metadate CD, Focalin, daytrana, methylin) and there are amphetamines (which include Dexedrine, Dexedrine spansules, Adderall XR and ADderall). When it comes to trying medication, you try one in one of the groups, and if it doesn’t work, you should try one from the other group. In your case, you tried dexedrine and it didn’t work well for you. So, if you want to use a stimulant - you should try one of the methylphenidate medicines - biphentin and concerta are the best options in Canada - because they are long acting. In the US, there are more long acting choices.
Or, you could try the non-stimulant, Strattera. (you can read about it on this blog - just search for Strattera).
2) Using some alcohol and cannabis while on ADHD medication is not a contraindication. You need to be careful. You may get more drunk or more high when on these medicines than you would without. Also, mention it to your doctor so he/she can monitor you appropriately (heart rate, blood pressure, etc.)
I hope that helps.
Dr. Kenny
June 7th, 2007 at 1:50 pm
Hi Dr. H
My 8 years old son was diagnosed Sept 2006 with ADHD and is on 5 mg of Ritalin twice a day. The past week his behavior has changed and is being very talkative and disruptive in class. Could he need an increase in the dosage of meds? Is there a daily pill available here in Toronto that lasts longer than 4 hours but only gives 5 or 10 mg with each dose?
Thanks
Love your blogs.
June 7th, 2007 at 10:43 pm
Hi Heather,
Thanks for your comment.
If your son is on ritalin and it isn’t working well - it could be side effects, or it could be that the dose is too low. Best to talk to the doctor about that one.
When it comes to a longer acting formulation of the medication - the article above about Biphentin should be helpful.
Biphentin lasts about 8-10 hours. The dosages of biphentin range, and do have a fair bit of flexibility - to allow minor titration.
You can see the dosages above.
There is another long acting methylphenidate - which is Concerta. Concerta lasts about 12 hours, but it has fewer dosage options, and so it may be harder to titrate.
I hope this helps.
Dr. Kenny
June 8th, 2007 at 9:11 am
Thanks
He tried Concerta first but developed tics with it.
July 19th, 2007 at 9:56 am
Hi Dr. Handelman,
We have just switched my daughters meds from Adderall xr 15 mg to Biphentin 30mg. She is going to be 8 years old in September. She has been on it for 4 days. The first 3 days it was wonderful, her impulsivity has diminished and she was more focused. However on the fourth day it hardly showed that she was on it, she was very hyper. She attended a friends B-Day party could that have been why it didn’t work, because due to her excitement her addrenaline canceled her meds in her body??? Our should we consider augmenting her dose of Biphentin???
Sincerly yours
Nataly
July 21st, 2007 at 8:06 pm
Hi Nataly,
Thanks for your comment about your daughter’s experience with Biphentin.
This is definitely a question for your doctor.
It also may make a difference how she does over a lot more days on the dose.
That’s about all I can say…
I hope biphentin works out!
Dr. Kenny
August 16th, 2007 at 3:38 pm
Dr. Handelman: I wanted to thank you for taking the time to reply to so many people who are struggling through issues with ADHD. I have a couple of questions myself that I was hoping you could answer. But, I figured you’d appreciate a bit of background to the questions so let me start there.
was diagnosed with absence seizures and ADHD. He started taking Depakote for the seizures and it has worked very well in controlling the seizures. The neurologist also prescribed 5 mg of Focalin to help with his ADHD. Oh my goodness, what an unbelievable difference the Focalin made! Without Focalin, he could not complete a simple 2-task list without four or five reminders. But right from the very first day on Focalin, he was able to complete lists of 6 or 7 tasks independently without reminding. The improvement in the quality of his life was incredible.
One year ago, when my family was living in the US for work, my son (now
We have now returned to Canada (our permanent home) to discover that Focalin is not available. Our doctors didn’t want to start him on a stimulant because they said they had had much success with Straterra. So, we started him on Straterra, increasing from 10 to 18 to 25 mg per day. Unfortunately, we did not see the kinds of benefits that others had. At each of the dose levels, he was only a tiny bit more focused than with nothing. At 25 mg, he was so tired and would fall asleep two or three times a day, so we asked the doctors to consider taking him back to 18mg and to explore other options along the lines of Focalin (which we knew worked so well for him). The doctors agreed and recommended trying methylphenidate (in addition to the 18mg of Straterra). He started a generic methylphenidate at 2.5 mg and increased to 5 mg, but to our great disappointment, we have not seen any desirable effects from it. Instead, he became verbally aggressive (saying things like “slap” and “punch” and “hit”) which was completely unlike what he was like without the methylphenidate. We decided to take him off the methylphenidate until we can see our doctor. He continues on the Straterra at 18mg, and only has two 30-min periods of sleepiness during the day.
My questions are:
1. Based on your experience, what would you recommend we try? I have searched the internet for countless hours trying to find a Focalin-like dexmethylphenidate formulation (d-MPD) available in Canada, but with no success. I did however find peer-reviewed articles that provide evidence of its efficacy over the methylphenidate that is available in Canada, consistent with our son’s experience. School is about to start back and we do not have a plan for helping him get back to where he was when he was on Focalin. In one of the articles I read, d-MPD was judged to be equally effective as as Ritalin at half the dose. Does that mean the 5mg of methylphenidate we had tried with him was too low, and that it should have been twice the level of Focalin? We are so scared to try something higher than 5mg of Ritalin because of the aggressive behaviors seen at 2.5 and 5mg. Should we ask about Biphentin because of it’s long-lasting effects?
2) Can we do anything to access Focalin in Canada for our son? We know it works, we know the dose, and we can’t get it. It’s so frustrating.
August 17th, 2007 at 1:27 am
Hi Fred,
Thank you for your long comment.
I will share a couple of thoughts with you - and I hope they help.
I will be sharing a special report on ADHD Medication, as well as a ‘home study course’ soon, so watch the blog (or my newsletter) to get info on that.
Issues - for those who aren’t aware - focalin is an isomer of methylphenidate - i.e. ritalin. An isomer basically means that it has the same components, but is oriented differently in space. Like a right hand and a left hand all have 4 fingers and a thumb - but they are oriented differently in space.
Here are my comments to your email - and please review them with your doctor:
1) if you son was saying things impulsively -this could have been ‘vocal tics’. Worth asking the doctor about.
2) Some people are very sensitive to isomers - and do better with one than another. For others it matters little. It seems that your son is sensitive. But don’t make a final decision yet…
3) We have no focalin in Canada - and I am not aware of it coming soon. If it does - I will be sure to let you know on this blog. (sign up in the top right corner to get updates).
4) In the absense of focalin in Canada, and having had a bad reaction to regular ritalin - is it worth trying biphentin - or concerta? I would say yes - and I would say biphentin. Sometimes more sensitive children do better with a longer duration medicine than they do with the short acting. Why biphentin over concerta? Because you can dose it very low, and there are more choices to slightly adjust the dose. Of course - take my suggestion with a grain of salt - and ask your son’s doctor.
5) What if focalin is the only option that works?
Two things to consider -
a) work with your doctor to get the medicine from the US with a special exception. There are two major hurdles here: i) the company which makes it has to be willing to send it (either for free or for a cost) and ii) Health Canada has to allow it to come in. Although it sounds hard, the mechanism is in place for a reason and it is used for many medical conditions.
b) Take a trip to the US every 3 months and get a doctor to write a prescription for Focalin for your son. There are many logistics here- and one consideration is that you likely won’t get insurance coverage for your son’s medicine.
I believe that you are in Saskatchewan. See if you can get in to see Dr. Declan Quinn - who is smart, experienced, and does a lot of research in ADHD. He is at the university hospital in Saskatoon.
Let us know what happens.
All the best,
Dr. Kenny
September 7th, 2007 at 10:50 am
A quick update. With the fear of school starting up again and no prospects of getting in to see a doctor who works with ADHD, we decided to increase the methylphenidate from 5 to 10 mg, and continue the 18 mg of Stratera. Luckily, it seems to be working. We have been using this combination of treatments for about 3 weeks now, and things are going well. The aggressiveness in our son’s speech that we saw at 5 mg has not returned, and his ability to sustain attention is nearly as good as it was on 5 mg of Focalin. His mornings and evenings are even better than when we were using Focalin. Thanks for being there Dr. Kenny. Although your advice didn’t directly lead us down this path, it gave us the support we needed to not give up in dispair.
October 13th, 2007 at 9:22 am
I was glad to find this website. Very helpful. My son was diagnosed with ADHD last spring. He is very fidgety and looses his focus very easily. He was still mainting average grades, some B’s and C’ s and even an occasional A. He came home from school in tears one day because he could not get his work done. Through his assesment we were informed that he is very bright and that is why he has managed at school so far. We talked about trying some medication to help him and he wanted to be able to focus better at school. So we started the Biphentin He seems so much happier at school and we have noticed an increase in attention at home. We have not told the teacher that we have started this yet. HE has been on the mediction for only 11 days. We wanted to see if the teacher noticed any improvements in the class room. We will disuss with here in one more week. My only concen at this time is he seems to have trouble sleeping. He will be 10 in another month and he has always slept on average 9- 10 hours per night. Now if we can ger 8-9 we are lucky. His appetite has decrease a little but he is a good size child bif for his age. Most people thinks is approx. 12 years old. He is very active in competeive hockey and is on the ice 4- 5 times per week. He should be tired at the end of the day. If we continue with this medication will things get better with his sleep patterns? We have continued on the weekends with medication. Is this a good idea or should we give his system a break on weekends. Would this help him sleep on weekends? He is taking 30 mg a day. His weight approx. 105 lbs.
Looking forward to getting some advise.
Thanks , Sylvia
October 24th, 2007 at 4:24 pm
I have a question, my son is 6 and has been on Biphentin for approx 1 year. He has responded really well. In JK he was suspended for bad behaviour, and in SK after starting on Ritalin, his behaviour improved and now in first grade, after starting Biphentin, he has been invited to “respect lunches” for well behaved children. My question is that I am startin gto nitice old habit re-emerging, after how long of being on the same dose is it OK to increase, I would prefer to have him maintain the same dose (15mg) for as long as possible, but again, I see old habits returning, any advice you could give would be helpful.
December 7th, 2007 at 12:01 am
Hi,
My son just turned 7 in November and was just recently diagnosed (July) with ADHD. We always knew that something just wasn’t right with him. Is in grade two and has had problems at school since JK. Has been suspended about 2-3 times in his short school history. We’ve had the police at our house after a 911 call, not once but twice. Constant arguing with his younger brother and just plain oppositional behaviour at home is enough to drive our family over the edge. We first tried the diet change and did notice a difference in his “activity” let’s just say. Once we decided that the diet was not going to be enough, we re-introduced the wheat and dairy. Just had parent/teacher interview with my sons teacher today and she advised that they have noticed a difference in his hyperactivity (higher) than when he was on a more restricted diet. So obviously it was helping to some extent but not enough for the concentration and being able to complete a task, he has a very hard time staying on task. He just started his first dose of Biphentin 10mg yesterday, he is 7 yrs old and weighs 61lbs height 52″, so he’s big for his age. The doctor advised that it would take at least two weeks to notice any positive effects, which I believe is true. Do some people really see positive effects soooner than this? I will wait the two weeks and then evaluate his behaviour then. My doctor advised that I will need to call him in two weeks to advise how the dosage seems to be working. I am very anxious and hopeful that this is going to help him/us…..Medicating my child was the last thing that I ever wanted to do believe me…..but at this point I feel it is the only option, to help him and to hopefully restore some harmony in our family. We have our ADHD son and also a 3yr year old boy and a 15 month old girl. So life is busy at the best of times!!
January 28th, 2008 at 4:50 pm
Hello:
Interesting posts by all. Our personal experience is our 6+ year old, Gr. 1 son was put on a trial of Biphentin 10 mg, 5 days ago. Having ADD and a combination of other difficulties, the first day on the meds we noticed a change in his behaviors. His older brother and sister and Sunday school teacher all made comments as to how surprised they were at his calm, focused behavior. What I have noticed is an increase in appetite (He could use a little weight anyway) and thirst; over the 5 days an increase in hyper activity and back to his “normal” bahaviours towards the evening; staying up later at night 10:00 as opposed to 8:30 -9:00, yet he is well rested in the mornings. I, like another contributor, have not told my son’s teacher, but am waiting to hear if she too is pleased with his improvement in concentration. I hope that our success will continue and that we won’t have to try various dosages and types of meds like others have.
March 13th, 2008 at 12:09 am
I do not think that you should report that biphentin is like adderall and can not be abused to produce a high. Adderall was taken off the Canadian market for a significant period because many people were inducing heart attacks, by attempting to get high from the medication. As well as when I began to research these newer medications for ADHD, I noticed that one of the websites that pops up frequently in the search engine is hightimes article on how a farmer got high on adderall. All stimilant medications are potential addictive and dangerous. And need to be carefully watched as well as there should be much clearer indications on this website as well as the containers themselve for adverse affects with other susbstances.
March 28th, 2008 at 10:47 pm
Dr. Handelman, our son (6 years old) has had some success on short acting Ritalin (10 mg twice day), but he has had difficulties with the peak/valley effects. It also affects his appetite to the point that he doesn’t eat anything between breakfast and dinner time. We tried switching to biphentin (20 mg once a day), and he experienced fewer side effects, but his ADHD symptoms were not well controlled, even when we increased the dose to 25 mg per day. What would you suggest? What is the maximum daily dose of biphentin for a 6 year old (of about 45 pounds)? Can we increase the dose of biphentin, or should we switch to an entirely different drug, like Strattera?
March 29th, 2008 at 11:08 am
Hi,
Biphentin can go as high as 60 mg per day.
Review with your doctor if these doses are OK for your son.
If the ritalin/methylphenidate is working out - with side effects related to the preparation - it may be better to adjust the medicine and preparation before ‘jumping ship’ -i.e. change doses of the biphentin, or even try concerta (also methylphenidate).
All the best,
Dr. Kenny
p.s. to get a free special report on medication for ADHD, visit: http://www.medicationmastery.com
March 29th, 2008 at 1:26 pm
Thank you very much for your quick response! So if the maximum dose for a 6 year old could be 60 mg/day, why does the product monograph for biphentin say that the maximum dose is 1mg/kg/day. If our son weighs 20 kg, wouldn’t this mean that his maximum dose would be 20 mg per day? Do I need to go back to grade 4 math class?
March 29th, 2008 at 9:01 pm
Hi Lisa,
You are right - the product monograph does say a daily max of 60 mg or 1 mg/kg per day and your math is correct.
However, under a doctor’s monitoring, you could go to a higher dose - as long as side effects don’t prevent you from going higher.
All the best,
Dr. Kenny
April 30th, 2008 at 2:03 pm
Hi there
My Son is 7 years old and started on Biphentin 15 mg a year ago…..after a few months he needed to switch to the 20 mg. Now we just switched him to 30mg. He is only 49 pounds so we cannot keep increasing his does. He is on a 10 day trail for the higher does but it does not seem to be helping…he is still distracted and chewing on his clothes and needs many reminders to pay attention at school. His teacher did say he has been a little better then last week but no where close to how she has seen him in the past pay attention. So I am to try this dose for him for the 10 days which is up tomorrow and if I do not think that is working we will switch him to 37mg Concerta. His teacher finds that his meds seem to wear off around 1:00 pm, making the rest of the day hard for him to get through. It almost seems to me like his body is matabolizing these too fast or he does really well then becomes immune to them…is this possible?
Please advise if you think Concerta would be a better choice
May 17th, 2008 at 12:53 am
my son just turned six in early may, and has been put on biphentin 20 ml dose daily. what does this medication make a person body feel like after it kicks in and starts to work? i dont want him to feel “high” or limp all day. this is the last thing i ever wanted to do but our family was like wild animals at the zoo every day with the upset from him, his yelling hating his sister who is 2 years older then him, wanting his way or everyone would pay for him not getting it. is this something he will need to be on for ever?
thanks
May 23rd, 2008 at 11:41 am
All medications for treating ADHD,( the non existent disorder,) all have traces of cocaine! All it does is dull the children’s mentality and then over time it does damage to the other parts of their brain. How can you say that it is effective and safe?
May 24th, 2008 at 11:48 am
Bonnie,
I am sorry that you are so misinformed.
ADD/ADHD is very real. Spend some time reading on this blog and see people’s comments - people are sharing how significantly their lives have changed since realizing that they have ADD or their child does.
These medications do not have ‘traces of cocaine’ in them. You are quite misinformed.
I wish you well.
Dr. Kenny
June 3rd, 2008 at 11:28 pm
My son is 30 mg and since he has been on it he doesnt eat a much, not even junkfood. But also since he has been on it he has had three really bad colds. I just wanted to know if any one elce has noticed that there kids were sick more. He has lost 25 pounds and seems to have to clear his throut alot.
June 4th, 2008 at 1:13 am
Hi,
I’m not aware that there is research to say that people get more colds.
When you say that he has been clearing his throat a lot - I just wanted to let you know that that could be a ‘vocal tic’. It is worth checking that out with your doctor.
All the best,
Dr. Kenny
June 5th, 2008 at 8:48 pm
Hello
You have indicated that Concerta only releases 22% of its medicine (e.g., 22% of 32 mg). What is the effective release rate of Biphentin?
I currently take either 60 mg/day of methylphenidate (3×20 mg) or 90 mg of Concerta. What would be my daily dosage with Biphentin (60 mg)?
June 7th, 2008 at 6:10 am
Dr Handelman you are great for anwsering all these people questions and helping them with your problems.DOnt know how you do it.I wanna share something honest with you.Share maybe a new insight on Ritalin SR,or Ritalin period for that matter.This is gonna interest you.
In the past taking Ritalin the first time when I was 18.So far so good intell I was introduced to snorting from a friend.About a year past and snorting beer was introduced to the Ritalin Achohol picture.Then I stopped doing that bit and move to snorting cocaine and beer for a year.Stoped that as well.
To make along story short .I turned my life around.Then decided to got back where I started and try taking my Ritalin PROPERLY.Im 22 and Im trying to figure out why is my body somehow have this ciggerette smoking and achohol intense urge everytime I pop my 20mg SR?And boy do I mean ciggrette and Alchohol craving.Is it somehow my body has devloped a memory(possibly from drinkin with it and smoking from this in the past) for this senseation of cigs and beer.I think its a way to come down from the side-effects?Not to mention this crazy EXPLOSION of Sexual Desire.SUPER SERIOUS.Its like everytime I take one its like I got pop another,another cigrette,Masturbate cigrette,beer cigrette or the stray cocaine feelings(mild feelings of temptation) Madness.I would love the to understand why is this happaning.
So I just dont take any type of Stimulant because of those urges.But orginaly it did help just cant make it back to those orginal feelings. Dont know why I am saying this but I trust you or maybe just dont trust my personal doctor. But I think this story is behind some people that come in your office and ask for Stimulants.Should I try the drug everyones raving about, Biphentin?If you could help I would be MORE than thankful.I hope this enlighted you.Your good man.Keep it up!
Chase
August 16th, 2008 at 3:38 pm
I’d just like to comment on Chase’s story above. I’m not a mental health professional but I do live with a mood disorder. Taking a stimulant would do the same thing to me if I were not diagnosed, and treated for it. It may even do it while I am on my medication. I am unfortunately diagnosed with Adult ADD inattentive type as well as my mood disorder, my son has ADHD and takes biphentin. My psychiatrist has refused me stimulants over and over again for fear of creating an instability in me that would take forever to correct as I have been stable for a long time now. I also cannot take Strattera as it is based on an antidepressant type medication. It is frustrating to live with this illness and not be able to be treated for it. My greatest fear when my son started taking biphentin was that he had been misdiagnosed as ADHD and that he really had a mood disorder and that it would send him into a flying mania. Fortunately that did not happen and he is so much happier now on the biphentin than he was before. He is 10 years old, and it was him that came to me, and asked to see his psychiatrist, and it was him who told his psychiatrist he was ADHD and wanted to try medication. Our children aren’t stupid, they know when something isn’t right.