What is Contramyl XR?
Contramyl XR is a prescription medication with the active ingredient methylphenidate hydrochloride, a central nervous system (CNS) stimulant. The 'XR' in its name signifies 'extended-release,' meaning the medication is formulated to release its active component over an extended period, typically lasting throughout the day. This allows for a once-daily morning dose, which is convenient for patients with Attention Deficit Hyperactivity Disorder (ADHD).
Unlike some other extended-release methylphenidate products, which use an osmotic-controlled release system (OROS), Contramyl XR utilizes a Multiple-Unit Pellet System (MUPS). This technology involves the medication being composed of numerous smaller pellets that release the active ingredient over time, providing a biphasic release profile—a rapid initial release followed by a slower, sustained one. A study conducted in South Africa confirmed its effectiveness for managing ADHD symptoms in both treatment-naïve patients and those switching from other methylphenidate formulations.
Mechanism of action
Methylphenidate, the active component of Contramyl XR, acts as a norepinephrine-dopamine reuptake inhibitor (NDRI). This mechanism involves several key steps within the brain's neurotransmitter systems:
- Blocking Reuptake: Methylphenidate prevents the presynaptic neuron from reabsorbing the neurotransmitters dopamine (DA) and norepinephrine (NE) from the synaptic cleft.
- Increased Neurotransmitter Levels: By blocking the reuptake, the concentration of dopamine and norepinephrine increases in the extraneuronal space.
- Enhanced Brain Activity: These elevated neurotransmitter levels lead to increased activity in specific brain regions, particularly the prefrontal cortex, which is responsible for executive functions like attention, impulse control, and working memory.
- Symptom Improvement: The enhanced activity in these areas is thought to be the reason for the therapeutic effects in individuals with ADHD, helping to improve attention span, concentration, and reduce impulsivity and hyperactivity.
Indications and uses
Contramyl XR is primarily indicated for the treatment of ADHD in specific age groups. A total treatment program often includes other measures such as psychological, educational, and social support. The therapeutic uses include:
- ADHD in children and adolescents: The medication is approved for use in pediatric patients aged 6 to 17 who meet established diagnostic criteria for ADHD.
- ADHD in adults: It is also indicated for adults aged 18 to 65 with ADHD.
- Dosage considerations: Dosages are individualized based on the patient's needs and response, with treatment often starting at a low dose and gradually increasing.
Dosage and administration
It is crucial to follow the prescribing doctor's instructions for dosage and administration of Contramyl XR. Key guidelines include:
- Once-daily dosing: The tablets should be taken once daily in the morning.
- Swallow whole: The tablet must be swallowed whole with liquid and should not be chewed, divided, or crushed.
- With or without food: Contramyl XR can be taken with or without food.
- Missed dose: If a dose is missed, it's generally best to skip it rather than taking it too late in the day, as it can interfere with sleep due to its long duration of action.
Side effects and risks
As a CNS stimulant and Schedule II controlled substance, Contramyl XR has a high potential for abuse, misuse, and dependence. A boxed warning alerts users to this risk. Common and serious side effects are associated with methylphenidate products.
Common side effects often include:
- Decreased appetite and weight loss
- Insomnia (trouble sleeping)
- Headache
- Nausea and stomach pain
- Dry mouth
- Anxiety and irritability
- Increased heart rate and blood pressure
- Dizziness
Serious side effects and risks can include:
- Cardiovascular issues: Serious heart problems, including sudden death, have been reported in patients with pre-existing cardiac conditions. Blood pressure and heart rate should be monitored.
- Psychiatric problems: The medication can cause new psychotic or manic symptoms, or exacerbate existing conditions like bipolar disorder.
- Growth suppression: Long-term use in children may lead to a temporary slowing of growth rate.
- Priapism: Prolonged and painful erections have been reported in male patients.
- Circulation problems: Peripheral vasculopathy, including Raynaud's phenomenon, can occur.
Comparison: Contramyl XR vs. Concerta
Both Contramyl XR and Concerta are extended-release methylphenidate products used for ADHD, but they differ primarily in their delivery mechanism and overall formulation.
| Feature | Contramyl XR | Concerta |
|---|---|---|
| Active Ingredient | Methylphenidate hydrochloride | Methylphenidate hydrochloride |
| Delivery System | Multiple-Unit Pellet System (MUPS), which releases medication through multiple smaller units | Osmotic-controlled release oral delivery system (OROS), which uses a semipermeable membrane and osmotic pump |
| Formulation | Extended-release tablets | Extended-release tablets |
| Duration of Action | Provides a controlled release over an extended period (8–12 hours) | Also provides a prolonged effect over many hours (e.g., 12 hours) |
| Tablet Properties | Tablets must be swallowed whole and cannot be divided | Tablets are nondeformable and should be swallowed whole; the outer shell may be visible in stool |
| Regional Availability | Marketed in regions like South Africa | Widely marketed globally, including the United States |
Is Contramyl XR right for me?
As with any prescription medication, the decision to use Contramyl XR should be made in close consultation with a qualified healthcare professional. They will conduct a thorough medical assessment, including family and personal history, to determine if the benefits of treatment outweigh the risks. It is not appropriate for all patients, particularly those with certain pre-existing conditions like serious cardiac issues, glaucoma, or a history of drug abuse. Adherence to prescribed dosages and regular monitoring are essential for maximizing therapeutic benefits while minimizing risks. For comprehensive information, regulatory bodies like the South African Health Products Regulatory Authority (SAHPRA), under which Contramyl XR is approved, provide detailed product information.
Conclusion
Contramyl XR is an extended-release form of the CNS stimulant methylphenidate, indicated for the treatment of ADHD in children, adolescents, and adults. Its effectiveness is based on increasing dopamine and norepinephrine levels in the brain, which improves attention and concentration. While effective, it is a Schedule II controlled substance with a high potential for abuse and carries risks of both common and serious side effects. As an alternative to other methylphenidate formulations like Concerta, it provides another option for managing ADHD symptoms, but its use should always be guided by careful medical evaluation and continuous monitoring.
Authoritative resource
For in-depth product information, consult the official patient information leaflet for Contramyl XR approved by the SAHPRA, the regulatory body in South Africa where the medication is marketed. [https://pi-pil-repository.sahpra.org.za/wp-content/uploads/2023/01/dec22-final-PIL-Contramyl-XR.pdf]
