Foquest versus Biphentin: Choosing the Right Long-Acting Methylphenidate in ADHD

Navigating the world of  attention deficit hyperactivity disorder medications can be a bit like finding your way through a maze—especially when options seem similar but have subtle differences that can impact your day significantly. Today, we’re diving into a side-by-side comparison of Foquest® and Biphentin®—two stimulant contenders in the battle against ADHD symptoms, both powered by methylphenidate, yet they march to the beat of different drums with their release mechanisms.    Vyvanse and Adderall Xr are also medications for ADHD and have a long-acting formulation but they fall under the amphetamine category and will be discussed in another article. T

The Company Developing Drugs Used to Treat ADHD Elvium Life Sciences medical department stated that there are no Head to Head clinical trials comparing the two products so establishing a “winner” is not feasible.

To be fair, given the vast individuality of ADHD symptoms among adults with adhd patients a head to head comparison trial of long-acting medication to figure out which “work better” may be futile and it would be better to look at the delivery mechanism of each stimulant medication and extract an educated clinical guess as to which product may be more suited for each hyperactive or impulsive patient based on findings and discussions.

Breaking Down the Release Mechanisms

Imagine if your medication was a slow-drip coffee maker.

Foquest® would have 20% of its coffee drip immediately, giving you that quick morning jolt, while the remaining 80% released slowly and would keep a steady flow throughout the day.

Biphentin®, on the flip side, serves up a stronger first cup with 40% immediate release, followed by a 60% slower drip.

These differences aren’t just about preference; they determine how your day unfolds with ADHD.

This medication ”magic” works through the sophisticated manufacturing of capsules/beads with multi-layer technology. The outside of the beads releases some of the medication immediately. The inside layers of the beads have coatings that need a specific pH to break them down. As you get closer to the center of the beads, the coatings require a higher pH to break down. This helps avoid the need for multiple doses per day and allows the remaining of the medication to be released slowly in the digestive system and available medication throughout the day.

Pros and Cons

FOQUEST® (Approved by Health Canada for the treatment of ADHD in 2017 to Purdue Pharma and again in 2020 to Elvium Life Sciences)

Pros:

1. Endurance Runner: Thanks to its 80% slow-release mechanism, Foquest® is like the long-distance runner of ADHD treatments, maintaining symptom control from breakfast to dinner—a big win for those with a marathon of a day ahead.
2. Smooth Sailing: A predominant slow release might mean fewer ups and downs in medication levels, potentially easing side effects and providing a smoother ride throughout the day.

Cons of Extended Release (XR) ADHD Medications

1. Slow “Off the Start”: Foquest®’s quick release is smaller, so it might not kick in as swiftly as you’d like. Early birds might find it a bit slow to wake up with them.
2. Tweak and Repeat: Finding the perfect dose with a predominantly slow-release formula can be more of an art, possibly requiring more doctor visits to get it just right and more frustrations.

There are different strengths for Foquest® and no Generic Versions (at least In Canada).

Each capsules last approximately 16 hours and they come in 25, 35, 45, 55, 70, 85, and 100 mg dosage.

• FOQUEST should be taken once-daily, with or without food, as soon as possible in the morning
as the effects of FOQUEST can last late into the evening and may affect sleep.
• FOQUEST capsules should be swallowed whole with a full glass of water and must never be
crushed or chewed.
• For patients who cannot swallow pills, the entire contents of the capsule can be opened and
sprinkled onto applesauce or yogurt or ice cream. Do not sprinkle in liquids.

Foquest® PRICE

These cost are approximate and provided by MisterPharmacist® pharmacy in Toronto.

Pro Tip: Give your pharmacy 24-48 hours to source the product as the product is on the “pricey” spectrum and may need to order it.

Pros and Cons

BIPHENTIN®  (Approved by Health Canada in 2006 to Purdue Pharma and again in 2020 to Elvium Life Sciences)

BIPHENTIN® (methylphenidate hydrochloride controlled-release delivery system capsules) is indicated for the treatment
of Attention-Deficit Hyperactivity Disorder (ADHD) in:
• Treatment for Children 6 years – 11 years of age
• Adolescents aged 12-18 years for ager
• Adults diagnosed with adhd  (>18 years of age)

Pros:

1. Quick Start: This product packs a punch early on with its 40% immediate release, helping you hit the ground running. Ideal for those who need to be on their A-game from the moment they step out of bed.
2. Flexible Friend: With a noticeable effect from the get-go, adjusting for daily demands or symptom spikes can be more straightforward, providing a bit more control over your treatment plan.

Cons:

1. A Bit Bumpy: The higher initial release can lead to more pronounced peaks and troughs in how the medication feels throughout the day—potentially a rollercoaster you didn’t sign up for.
2. Side Effect Shuffle: More medication early on might mean a higher chance of side effects like jitters or anxiety as the medication kicks in—a bit like too much caffeine in that morning coffee.

Biphentin® comes in 10,15,20,30,40,50,60,80mg capsules. Information in the product information sheet from the manufacturer states that “BIPHENTIN was administered as a single, optimized, morning dose. Improvements, relative to placebo, were noted within 1 hour on BIPHENTIN and persisted into the early evening” which could be inferred as lasting less than the effect of Foquest®.

BIPHENTIN® Price

Making the Choice

Which medication is the MVP for you depends on your daily playbook. Foquest® might win for those needing steady, all-day coverage without a mid-day med time. Meanwhile, Biphentin® could be the go-to for folks who need strong support from the start and the ability to adjust through the day. Some patients may feel the need to increase the dose and add a regular methylphenidate tablet (Ritalin short-acting 5 or 10mg for example) to round off their late afternoon.

The possible side effects to expect are listed here and which one you will get and which you can tolerate will depend on each person. These include Loss of appetite,  BP and HR increaser, Constipation/Diarrhea, Dry mouth, GI upset, Nausea/vomiting, Anxiety, Dizziness, Dysphoria/irritability, Headache,  Initial insomnia, Rebound effect, Tics, Decrease in weight, Sexual dysfunction (uncommon) and Skin reactions.

Teamwork with Your Healthcare Provider

Choosing between Foquest® and Biphentin® as ADHD medications isn’t a solo sport. It involves teamwork with your healthcare provider(s), considering your history, how you’ve fared on other meds, and your daily life’s demands. Regular check-ins can help tweak your game plan for the best defense against ADHD symptoms.

The decision to stay with either medication to treat adhd , the timing of side effects or beneficial effects, the timing of potential “crashes” and which strength seems the “best” will need to be tested out – this means spending enough time at each dosage/strength (ex: 14-30 days) before deciding to tweak the prescription. This remains true if the side effects are tolerable. Otherwise any extreme side effect should be of course addressed immediately. Options would include to not take the planned subsequent dose and either stopping the medication altogether or discussing a smaller dose alternative (if the lower dose is available of course).

Final Thoughts 

Both Foquest® and Biphentin® bring unique strengths to the field in managing ADHD in adults and children and adolescents. . By understanding their differences and discussing options with your doctor, you can tailor your treatment to best suit your needs, smoothing out the bumps on your road to managing ADHD effectively.

Concerta is also a long acting Methylphenidate formulation use to treat a person with ADHD.  It will be addressed further in another blog.