Generic Name

Trokendi XR

Mechanism

• Dopamine (DA) & Norepinephrine (NE) reuptake inhibition
• Blocks DAT and NET in the prefrontal cortex and basal ganglia, prolonging synaptic concentrations.
• Synaptic modulation
• Enhances signal‑to‑noise ratio in attention circuits, improving executive function and impulse control.

Pharmacokinetics

• Absorption: 1–4 h for peak effect.
• Bioavailability: ~57 % oral.
• Distribution: Linear; protein binding ~10 %.
• Metabolism: Primarily via hydrolysis to ritalinic acid; minimal CYP involvement.
• Half‑life: 2–4 h (steady‐state).
• Elimination: Renally excreted (~90 %) as metabolites; unchanged drug <10 %.

Indications

• ADHD in children ≥6 y, adolescents, adults
• ADHD‑IBD formulations (e.g., TBP‑049, Trokendi XR) selected based on patient’s age, clinical response, and safety profile.

Dosing

• Initial dosing: 0.5–0.8 mg/kg/day (max 8 mg/d).
• Titration: Increase 8 mg increments every 1–2 weeks to a target of 16–24 mg/d (often 48 mg max).
• Typical adult dose: 12–48 mg once daily.
• Administration: Oral, preferably with water, can be taken with or without food.
• Missed dose: Skip; do not double dose next day.

Monitoring

• Baseline: Blood pressure, heart rate, BMI, growth metrics, ECG (if indicated).
• Ongoing:
• Blood pressure & heart rate weekly for 4 wks, then monthly.
• Weight and height every 6 wks in children, annually in adults.
• Psychiatric assessment for mood changes, suicidal ideation.
• Review dose effectiveness/improvements during titration visits.

Clinical Pearls

• Extended‑release via microsphere matrix: Gives a “dual‑peak” profile—baseline release plus delayed release—helping symmetry in symptom control and less mid‑day “crash.”
• Patient education: Emphasize strict once‑daily dosing and avoid splitting tablets; the formulation is not intended for sudden dose increases.
• Abuse potential: Because the matrix is designed to resist crushing, it is less susceptible to snorting or insufflation than immediate‑release methylphenidate.
• Growth monitoring: Document height/weight at each pediatric visit; consider holding dose or switching to non‑stimulant if significant growth retardation is observed.
• Drug interactions: Avoid use concurrent with MAO‑I or sympathomimetic agents; if unavoidable, cardiovascular monitoring becomes essential.
• Taper strategy: When discontinuing, halve the dose for 1–2 weeks before complete cessation to mitigate rebound ADHD symptoms or withdrawal.

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