Quillivant XR (Methylphenidate): Uses, Dosage, & Side Effects

What Is Quillivant XR?

Quillivant XR is a central nervous system (CNS) stimulant medication used in the treatment of attention-deficit hyperactivity disorder (ADHD). ^{1, 2} This ADHD medication has no generic currently available. Quillivant XR is taken as an oral liquid where it releases medication right when it’s taken and then over the period of a day so that the patient only has to take one dose in the morning to control their ADHD symptoms.^{1, 2}

How Does Quillivant XR Work?

Quillivant XR works to improve ADHD symptoms by changing the amounts of certain natural chemicals in the brain so that there is more available to use to control ADHD symptoms. Quillivant XR is a liquid that is formulated to release the medication at different times. About 20% of the medication is released immediately when it is first ingested, then the remaining 80% works slowly over time and continually releases medication the rest of the day to provide control of ADHD symptoms throughout the day.^{1, 2}

Is Quillivant XR the Same as Ritalin?

Quillivant XR is not the same as Ritalin. The two medications share the same active ingredient, which is methylphenidate, but the difference is in how long they work for and their dosage forms. Both medications come as extended-release formulations, but Ritalin also has an immediate-release formulation. Quillivant XR comes only as a powder that is mixed into a liquid solution by the pharmacist, while Ritalin is manufactured as a tablet and capsule.^{1, 4}

Is Quillivant XR Safe for Kids?

Quillivant XR has been established to be safe and efficacious for kids ages 6 to 17 years old.  Studies have confirmed the usage of Quillivant XR in this population, but the long-term efficacy of methylphenidate, the active ingredient, in pediatric patients has not been established. There is not enough data to support the use of Quillivant XR in those under the age of 6 years old. (^{1, 2}: special populations pediatric use)

What Is Quillivant XR Used to Treat?

Quillivant XR is a medication FDA-approved for the treatment of attention-deficit hyperactivity disorder (ADHD).¹ FDA-approved means that medication has gone through extensive research, and the FDA has recognized that it is safe and effective for its given indication. There are uses for Quillivant XR that are not approved by the FDA, also referred to as off-label use.

An off-label use is when an FDA-approved drug is used for a purpose other than what it is approved for. A prescriber can decide to use a medication off-label if they believe, in their professional judgment, it may offer a benefit to someone. One such example of Quillivant XR used off-label would be its use in depressive disorders resistant to other treatments.³

Side Effects of Quillivant XR

All medications have a potential for side effects. It is not guaranteed that a person will experience side effects associated with Quillivant XR. Side effects associated with Quillivant XR are similar to ones you find with other stimulant medications used for ADHD, like Ritalin, such as loss of appetite, insomnia, and irritability. Most will experience temporary effects that go away with consistent usage of the medication as the body adjusts to it, but sometimes side effects may be prolonged or get worse, which may require medical care.

Common Side Effects of Quillivant XR

Common side effects associated with Quillivant XR are the general symptoms one would see with any methylphenidate product, such as mood change and appetite suppression, and side effects that are specific to Quillivant XR. One could potentially experience specific reactions like skin-picking and tics. Most side effects are typically seen within the first week of taking the medication but should get better with consistent medication usage. If these symptoms impact your ability to go about your daily life or worsen, then contact your doctor.

Common side effects of Quillivant XR include:*²

• Rapid exaggerated changes in mood
• Skin-picking resulting in broken skin or lesions
• Initial insomnia
• Tic movements
• Decreased appetite
• Vomiting
• Motion sickness

*All medications, including Quillivant XR, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Mild Side Effects of Quillivant XR

Mild side effects one might experience would be ones that are typically tolerable. One might experience general side effects like nausea, changes in appetite, and sleep problems. These are side effects that are widely seen in other stimulants used in the treatment of ADHD symptoms. Largely, these side effects are easily managed, going away when the body gets used to the medication or when the dosage is changed to decrease the likelihood of side effects.

Mild side effects of Quillivant XR include:*^{1, 2}

• Nausea
• Decreased appetite
• Decreased weight
• Insomnia
• Indigestion

*All medications, including Quillivant XR, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Quillivant XR

Serious side effects that occur with Quillivant XR involve how it works in the body. If there are too many naturally occurring chemicals built up in the body, then it can cause adverse effects. These side effects could be potentially serious and even life-threatening. Quillivant XR could potentially cause Serotonin Syndrome, changes in eyesight and in a person’s mental state, such as hallucinations or disorientation. A person who experiences these side effects needs to seek immediate care.

Serious side effects of Quillivant XR may include:*^{1, 2}

• Seizure
• Heart-related symptoms such as chest pain, shortness of breath, or fainting
• Eyesight changes or blurred vision
• Serotonin syndrome
• New or worsening mental symptoms or new manic symptoms

*All medications, including Quillivant XR, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Allergic Reactions to Quillivant XR

As with all medications, some may be allergic to Quillivant XR. If a person has an allergy to the medication or any of its ingredients, they should avoid using Quillivant XR. Allergic reactions can be a serious medical event. Some reactions that indicate an allergic reaction would be a change in your ability to breathe and a rash or hives. If you or a person you know experience an allergic reaction, seek appropriate medical care.

Allergic reactions to Quillivant XR may include:⁵

• Difficulty breathing
• Wheezing and coughing
• Fast heart rate
• Itching
• Abnormally low blood pressure
• Hives
• Swelling of lips, face, or throat

If you experience any of these symptoms, seek immediate medical care. This can be a life-threatening event which may require medical intervention. An allergic reaction to Quillivant XR means that you can no longer take this medication. You and your doctor will have to discuss other forms of treatment, which can include things like coping strategies, cognitive behavioral therapy, or a different medication.

Quillivant XR Warnings & Precautions

There are warnings and precautions associated with Quillivant XR. These are warnings that a patient should discuss with their doctor, especially if they have prior conditions that may be affected by Quillivant XR. Medical attention may be necessary to address these side effects should a person experience them. It should be noted that these are warnings, and it is not guaranteed that a person will experience these problems should they take Quillivant XR.

Precautions for taking Quillivant XR address:^{1, 2}

• Taking Quillivant XR during pregnancy or breastfeeding: It is unknown if Quillivant XR will harm an unborn baby. Quillivant XR can pass into breast milk while breastfeeding.
• Potential for abuse and dependence: Quillivant XR has a high potential for abuse and dependence.
• Serious cardiovascular reactions: Stroke, heart attack, and other serious cardiac problems have occurred in patients who take Quillivant XR. This medication should be avoided in patients with known structural heart abnormalities, arrhythmias, coronary artery disease, and other serious cardiac problems.
• Blood pressure and heart rate increases: CNS stimulants like Quillivant XR can cause an increase in blood pressure and heart rate. Patients should be monitored for high blood pressure and fast heart rates.
• Peripheral vasculopathy: Vascular problems can occur, including Raynaud’s Phenomenon. Signs and symptoms generally improve after reducing the dose or discontinuing the drug.
• Psychiatric reactions: Psychosis and mania symptoms may occur. Pre-existing psychosis may worsen, and manic episodes in patients with Bipolar Disorder may be triggered.
• Priapism: Prolonged and painful erections that sometimes require surgical interventions have been reported in both children and adults.
• Long-term suppression of growth: Weight loss and slowing of growth rate in children has been associated with the use of CNS stimulants. Weight and height should be monitored in pediatric populations.

Interactions With Quillivant XR

All medications have possible harmful effects when taken with other medications, substances, and herbs. Quillivant XR has a couple of interactions that should be noted. Quillivant XR’s interactions that are notable have to do with some mental health medications and blood pressure medications.

A combination of these medications with Quillivant XR may result in a high blood pressure crisis or increased side effects. If you are starting Quillivant XR, discuss with your doctor and pharmacist about the substances you take to make sure no serious reactions will occur. Medical professionals are trained to assess the risks and benefits of your therapies, so you should be honest with them in your discussions.

7 substances you should avoid while taking Quillivant XR include:^{1, 2, 6}

• MAO Inhibitors (MAOIs): Administering Quillivant XR at the same time as an MAOI, or within 14 days after discontinuing MAOI treatment, may result in a high blood pressure crisis. This can be a life-threatening event.
• Antihypertensive drugs: Quillivant XR may decrease the effectiveness of medications used to treat high blood pressure. Those on these medications should monitor their blood pressure.
• Risperidone: A combination of Quillivant XR and risperidone may increase the risk of risperidone side effects, specifically extrapyramidal symptoms (EPS).
• Cold or allergy medicines containing decongestants: Some decongestant medications, such as products containing pseudoephedrine, can increase blood pressure. Together, both medications may cause an unwanted increase in blood pressure.
• Selective serotonin reuptake inhibitors (SSRIs): A combination of SSRIs and Quillivant XR may increase the risk of a serious reaction called serotonin syndrome.
• Other stimulants: Quillivant XR works on the central nervous system and can result in high blood pressure and fast heart rates. When in combination with another drug that works similarly, it can result in dangerously high blood pressure.
• Alcohol: Alcohol may worsen side effects caused by Quillivant XR.

Quillivant XR Dosages for FDA-Approved Treatment

Dosages can vary for each individual on Quillivant XR depending on their personal factors. The dosage that a person needs for treatment depends on several factors such as what current medications a patient takes, a patient’s conditions, and their individual response to the medication can affect what dosage is needed for treatment.

Quillivant XR is approved for use in people age 6 and older. The recommended starting dose is  20 mg once per day. It is not recommended to take more than 60 mg per day.^{1, 2}

Quillivant XR Forms & Strengths

Quillivant XR is supplied to a pharmacy as a bottle of powder. Before the medication is given to the patient, it is mixed by the pharmacist with the correct amount of liquid to make an oral suspension. All strengths of Quillivant XR come as an extended-release formulation.^{1, 2} This form acts fairly quickly, with patients seeing it start working around 45 minutes after the dose is taken.⁷ The most appropriate strength for a person will depend on individual factors and how one responds to the therapy at a certain strength.

Quillivant XR is available in the following forms and strengths:^{1, 2}

• Bottle of 300 mg powder (to prepare 60 mL oral suspension)
• Bottle of 600 mg powder (to prepare 120 mL oral suspension)
• Bottle of 750 mg powder (to prepare 150 mL oral suspension)
• Bottle of 900 mg powder (to prepare 180 mL oral suspension)

How Should I Take Quillivant XR?

Quillivant XR should be taken exactly as prescribed by one’s doctor. Quillivant XR is taken once per day in the morning and should be used with the oral dosing dispenser provided with the product so that an accurate dosage can be taken each and every time by the patient. This medication may be taken with or without food.^{1, 2}

How Long Does it Take to Adjust to Quillivant?

Those on Quillivant XR should see that the medication works fast, typically working within 45 minutes of taking the first dose. The side effects a person may experience with the medication vary from person to person, but these temporary effects should get better after the body adjusts to the medication. This typically takes a week, but sometimes this medication might not be right for some people.. Side effects can persist, which may require help from their doctor.

What Happens If I Miss a Dose of Quillivant XR?

If you miss a dose, take the next dose as soon as you remember. But if it is close to the time you take your next dose, then only take one dose. Do not double up or take extra doses, as this can lead to serious side effects, sometimes requiring medical intervention. Do not stop taking Quillivant XR abruptly or without medical supervision because this may cause you to experience withdrawal symptoms associated with stimulant usage.

Can You Become Addicted to Quillivant XR?

There is a potential to become addicted to Quillivant XR. This medication is classified as a Schedule II medication by the government, which means that there is a high potential for abuse and dependence. To combat potential abuse situations, doctors and pharmacists follow a strict protocol set by the government to avoid having too much of Quillivant XR and similar medications out in the market where it can be misused. Doctors will often check in with a patient who has started taking Quillivant XR.

Another method in place to prevent misuse of medications would be the expiration date on Quillivant XR prescriptions as well as the amount of refills allowed on the medications. This medication is highly regulated, so the prescription is only good for 6 months from the day it’s written. No refills are allowed for that same prescription number, so a person would have to get a new prescription if they wish to fill it again.

If a person becomes dependent or abuses Quillivant XR, then they may need to go through a medical detox or have a supervised medication discontinuation. This is when a person is medically supervised as they stop using a misused substance. Detox provides medical support and care as the body adjusts to the absence of this substance.

Can You Overdose on Quillivant XR?

It is possible to overdose on Quillivant XR. This medication has a high potential for abuse and dependence, so those who are thinking of getting on this Quillivant XR should be honest with their doctor if they have current or past histories of addiction or abuse of a substance. Some symptoms of an overdose include digestive symptoms, anxiety, tremors, confusion, and blood pressure changes.^{1, 2} This is not an exhaustive list, so those who think they may have overdosed should seek medical care.

What Should You Do If You Take Too Much Quillivant XR?

If you have taken too much Quillivant XR, seek immediate medical care by going to the emergency room or calling 911. If you are not showing any symptoms, you may consult with a certified poison control center (1-800-222-1222), where they will ask you questions and determine if you should seek further medical care.

Questions to Ask Your Healthcare Provider About Quillivant XR

You may have questions about Quillivant XR, and speaking to your doctor or psychiatrist about them is an important part of your treatment. Talk to them about your expectations for Quillivant XR, what side effects to expect, and how this medication works as part of your overall treatment plan. If meeting with a doctor in person is not feasible, online psychiatry services may be a good option, especially if you need to change prescribers.

Questions to ask your care team about Quillivant XR include:

• How long will it take for me to adjust to taking Quillivant XR?
• Am I at risk for more serious symptoms if I am already taking medication treatments for other mental health disorders?
• What is the best dosage to ensure fewer side effects?
• When should I reach out to you if I am experiencing sexual side effects?
• Is there anything I should tell my therapist about this new medication?
• How often should I see you for checkups while taking Quillivant XR?
• What should I do if I am unsure if Quillivant XR is the right medication for me?
• What side effects should I be most concerned about with Quillivant XR?
• How long does it take for me to see benefits from this medication?
• Are there discounts or coupons for Quillivant to help me save on my prescription?

In My Experience

In my experience, this medication works well to control ADHD symptoms, lasting around 12 hours. The most common complaint I’ve seen from the medication is that it may cause insomnia and change a person’s appetite or make them moody. These side effects typically go away after a week or two of consistent medication usage.

ADHD has many pharmaceutical and non-pharmaceutical options to help manage the symptoms, so if one therapy does not work for a person, there are others they could try. I advise anyone struggling with their ADHD symptoms to reach out to their doctor even if they are medicated, as there may be solutions that can improve a person’s therapy.