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Thursday, January 28, 2016

New Drug: Adzenys XR-ODT (amphetamine extended release, orally dissolving tablet)

The FDA recently announced the approval of a new drug for ADHD, Adzenys XR ODT.  This drug, produced by Neos Pharmaceuticals, 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 Dyanavel XR and Adderall XR, it is a long acting, however it is an orally disintegrating tablet, meaning that it can be taken without the need to swallow a pill.

Disadvantages
Cost.  Like Dyanavel XR, Adzenys XR ODT is likely to be pricey as the orally disintegrating tablet technology is still under patent, and the company is also paying royalties to Shire, LLC.  It will likely not be covered by insurance when it is first released, which the company projects will be around the second quarter of 2016.  Neos Pharmaceuticals does not currently offer any kind of discount or coupon program for this product, nor any other product.
Nothing new.  This drug does not really offer anything new in terms of avoiding potential risks.  It has been designed to be bioequivalent to Adderall XR. It is still causes issues with appetite, sleep, anxiety, emotionality, and other symptoms commonly associated with stimulants in some patients.
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.
Not as easy to titrate as a liquid.  The orally dissolving technology does not allow the dose of this medicine to be easily divided.

Advantages
Does not need to be swallowed whole.   This drug is likely to find a place with younger patients who cannot swallow pills.
Different.  As with other stimulants, this one has a unique release profile which may suit some patients better than others.
Taste.  Compared to crushed amphetamine salts (Adderall), this pill is designed in a way to mask the bitter taste of amphetamine.

Should you use Adzenys XR-ODT?
The ideal candidate for Adzenys XR-ODT falls into one of two categories:
1)  Unable to swallow pills.  Depending on your insurance coverage, Adzenys may be as expensive, or less expensive than Quillivant or Dyanavel.  Focalin XR, which can be opened and sprinkled may still be a major competitor, as it is available as a generic.  Focalin XR can probably be titrated more easily because in a pinch, the capsule can be opened and the dose split.  It is not clear that the ODT technology will or will not allow Adzenys to be split but the pill is not scored.  Adzenys, however, does not require the user to sprinkle the pill’s contents on applesauce or other food or water, which is slightly more convenient.
2)  Intolerant of other stimulants.  This medication offers another option for patients who are not able to take other stimulants due to side effects.  It is not, however, specially designed to prevent side effects and so is not preferable over  other forms of amphetamine salts.  It is simply another alternative.

Reference:
"Neos Therapeutics Announces FDA Approval of Adzenys XR-ODT™ (Amphetamine Extended-Release Orally Disintegrating Tablet) for the Treatment of ADHD in Patients 6 Years and Older." Neos Therapeutics. Neos Therapeutics, Inc., 27 Jan. 2016. Web. 28 Jan. 2016.




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