New drug: QuilliChew ER (methylphenidate extended release chewable caplet)

QuilliChew ER is a new long acting formulation of methylphenidate for the treatment of ADHD.   Methylphenidate in its immediate release form is, of course, Ritalin.    Long acting formulations include Concerta and Ritalin LA (both pills), Quillivant XR (liquid), and Aptensio XR (openable capsule).

Advantages:

• It is chewable.  Ritalin  IR tablets are technically ok to give crushed, but taste so awful that most children won't take the medication like this daily.
• It is long acting (about 12 hours).  
• It is not less effective than other stimulants.
• It is stable at a variety of temperatures, unlike Quillivant XR, which must be kept at room temperature.
• The dosage can be varied somewhat more easily than some long acting formulations because the 20 mg pill is scored.

Disadvantages:

• Pill formulation means that titration may still be difficult for patients who are more sensitive to medication.
• Like all methylphenidate formulations, this one is not FDA approved for use in children under the age of 6.
• This is still a stimulant with all of the issues that stimulants bring including appetite suppression, insomnia, anxiety, and other, more uncommon problems.
• Like all new drugs, this one is likely to be expensive while it is still on patent.   While Pfizer has not announced yet whether there will be a patient assistance program for QuilliChew ER, the company has a long history of providing assistance to patients in the past.

Whom will this drug be best for:

Children over the age of 6 and adults who are unable to swallow pills will be the most likely to benefit from this medication.

Children who are having difficulty with titration with other long acting methylphenidate formulations may find this slightly easier to titrate, although Quillivant XR is still the easiest to titrate because it is a liquid.

Adults who want or need to carry their medication around with them and are unable to swallow or are otherwise unable to tolerate other formulations of methylphenidate may find this easier to manage than something liquid like Quillivant XR.

Reference:

QuilliChew ER [package insert]. Monmouth Junction, NJ: Tris Pharma; 2015.