New Drugs: Dyanavel XR (amphetamine extended release oral suspension)

The FDA recently announced the approval of a new drug for ADHD, Dyanavel XR.  This drug, produced by Tris Pharmaceuticals (also makers of Quillivant XR) is a stimulant.  The active ingredient, amphetamine, has been on the market for a long time as a medication for ADHD, narcolepsy, and obesity.    The main difference is the formulation.  Similar to Quillivant XR, Dyanavel XR is a long acting oral suspension.

Disadvantages
Cost.  Like Quillivant, Dyanavel is likely to be on the more expensive side as the long acting oral suspension technology is still under patent.  Tris Pharma does not currently offer any kind of discount or coupon program, though this may change as the drug hits the market.
Nothing new.  This drug does not really offer anything new in terms of avoiding potential risks.   It is still likely to cause issues with appetite, sleep, anxiety, and other symptoms commonly associated with stimulants in some patients, though the risk may be lower since the dose can be more easily adjusted to an effective level since it is a liquid and not pills.  Unlike some other long acting stimulants, it still has a high potential for abuse.
Drug levels likely to take a long time to stabilize.  Clinical studies have not actually addressed this issue, but we often see that long acting drugs often manifest side effects later in the game--6 to 8 weeks later.  We would not expect things to be different with this drug.

Advantages
Not a pill.  This drug is likely to find a place with younger patients who cannot swallow pills.
Easy to titrate dose.  As many patients know, finding the right dose of a long acting pill can be difficult as the dose often jumps by more than 10mg at a time.  With a liquid, fine tuning the correct dose should be a lot easier.
Different.  As with other stimulants, this one has a unique release profile which may suit some patients better than others.

Should you use Dyanavel?
The ideal candidate for Dyanavel falls into one of two categories:
1)  New to medications, but unable to swallow pills.  Depending on your insurance coverage, Dyanavel may be as expensive, or less expensive than Quillivant.  Focalin XR, which can be opened and sprinkled may still be a major competitor, as it is available as a generic.  However, Focalin XR cannot be titrated as easily.
2)  Experiencing side effects with other stimulants.  Finding the right stimulant can be a guessing game.  However, Dyanavel does offer the advantage of being more easily titrated than non-liquid medications.

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