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RELEXXII (methylphenidate ER) now available, and here are mascots for all methylphenidate products



RELEXXII

❖  Methylphenidate stimulant

❖  DA > NE reuptake inhibitor

❖  Bioequivalent to Concerta

❖  DEA Schedule II


Pronunciation: re LEX ee

Mnemonic phrase: “(It’s a) Relic, see?”


The bottom line:  If you prescribe generic Concerta, it will cost about $45 monthly, unless you prescribe 45 mg or 63 mg pills which are only available as the off-brand of Concerta called Relexxii, which costs around $650. 


Relexxii is the latest brand of methylphenidate, to be available in 2024. The spelling concludes with -XXII, which is Roman numeral 22, although it is dosed in increments of 9 mg. Duration of action is 12 hours


Relexxii is essentially an off-brand of Concerta, which also has a 12-hour duration of action and is dosed in increments of 9 mg. The color scheme for available Relexxii tabs aligns with that of Concerta tabs. Relexxii tabs are shaped like tablets, while Concerta tabs are shaped like capsules. Both brands have a dimple on the pill through which the medication diffuses by osmosis, leaving an empty shell— ghost pill—which passes in the feces.


Concerta methylphenidate

Concerta release mechanism ghost pills, shells pass in feces

Concerta has been available generically since 2016. In early 2023, Janssen stopped making authorized generics of Concerta. At least two generic forms of Concerta from other manufacturers were downgraded from bioequivalent status with the FDA. Relexxii was determined to be bioequivalent to Concerta.


As far as I can determine, the two I’s in Relexxii do not signify anything—other than needing to use two pills vs one depending on the total dose of Relexxii vs Concerta when exceeding 36 mg, as shown in the table below. The other psychotropic ending in two’s I’s—Abilify Asimtufii—does so for good reason, as it is a LAI form of aripiprazole injected every two months. 


As for the two XX’s, Relexxii is an extended release form of methylphenidate.  Relexii = “Ritalin XX-tended".  


Also applicable to Concerta, Relexxi tabs are nondeformable, i.e., rigid and do not change shape in the GI tract. Either brand should ordinarily be avoided in patients with severe gastrointestinal narrowing (e.g., esophageal motility disorders, small bowel inflammatory disease, "short gut" syndrome due to adhesions or decreased transit time, past history of peritonitis, cystic fibrosis, chronic intestinal pseudo-obstruction, or

Meckel's diverticulum). 


Dosing: Administer once daily in the morning with or without food. For age 6–17, start 18 mg, may increase by 18 mg at weekly intervals, max of 54 mg (age 6–17) or 72 mg (18+).  For age 18+, start 18 mg or 36 mg, may increase by 18 mg at weekly intervals. If switching from Ritalin or Concerta, refer to the tables below.


The pill sizes not available generically are bolded and underlined:

Conversion table for Concerta and Relexxii

Conversion table for Ritalin and Relexxii (methylphenidate)

Conversion table for methylphenidate products including Ritalin, Metadate, Methylin, Focalin, Concerta, Adhansia, Aptensio, Azstarys, Cotempla, Daytrana, Jornay PM, Quillichew, Quillivant, Relexxii

Cytochrome p450 interactions methylphenidate / ritalin

Mascots for the other methylphenidate products


Focalin


Adhansia XR

Aptensio XR

Azstarys Serdexmethylphenidate

Cotempla XR-ODT

Daytrana patch

Jornay PM when do you take it?

QuilliChew ER is it chewable?

Quillivant XR -- Is it equivalent?



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