MEDICATION GUIDE

What is the most important information I should know about DYANAVEL XR?

­­­­DYANAVEL XR can cause serious side effects, including:

• Abuse and dependence. DYANAVEL XR, other amphetamine containing medicines, and methylphenidate have a high chance for abuse and can cause physical and psychological dependence. Your healthcare provider should check you or your child for signs of abuse and dependence before, and during, treatment with DYANAVEL XR.
  • Tell your healthcare provider if you or your child have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
  • Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction.
• Heart-related problems, including:
  • sudden death, stroke and heart attack in adults
  • sudden death in children and adolescents who have heart problems or heart defects
  • increased blood pressure and heart rate

  Your healthcare provider should check you or your child carefully for heart problems before starting treatment with DYANAVEL XR. Tell your healthcare provider if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems.

  Your healthcare provider should check you or your child’s blood pressure and heart rate regularly during treatment with DYANAVEL XR.

  Call your healthcare provider or go to the nearest hospital emergency room right away if you oryour child has any signs of heart problems such as chest pain, shortness of breath, or fainting during treatment with DYANAVEL XR.

• Mental (psychiatric) problems, including:
  • new or worse behavior and thought problems
  • new or worse bipolar illness
  • new psychotic symptoms (such as hearing voices, or seeing or believing things that are not real) or new manic symptoms

Tell your healthcare provider about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.

Call your healthcare provider right away if you or your child have any new or worsening mental symptoms or problems during treatment with DYANAVEL XR, especially hearing voices, seeing or believing things that are not real, or new manic symptoms.

What is DYANAVEL XR?

DYANAVEL XR is a central nervous system (CNS) stimulant prescription medicine used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in people 6 years of age and older. DYANAVEL XR may help increase attention and decrease impulsiveness and hyperactivity in people with ADHD.

It is not known if DYANAVEL XR is safe and effective in children under 6 years of age.

DYANAVEL XR is a federally controlled substance (CII) because it contains amphetamine that can be a target for people who abuse prescription medicines or street drugs. Keep DYANAVEL XR in a safe place to protect it from theft. Never give your DYANAVEL XR to anyone else, because it may cause death or harm them. Selling or giving away DYANAVEL XR may harm others and is against the law.

Do not take DYANAVEL XR if you or your child are:

• allergic to amphetamine products or any of the ingredients in DYANAVEL XR. See the end of this Medication Guide for a complete list of ingredients in DYANAVEL XR.
• taking, or have taken within the past 14 days a medicine called a monoamine oxidase inhibitor (MAOI), including the antibiotic linezolid and the intravenous medicine methylene blue. Ask your healthcare provider or pharmacist if you are not sure if you or your child take any of these medicines.

Before taking DYANAVEL XR tell your healthcare provider about all medical conditions, including if you or your child:

• have heart problems, heart defects, or high blood pressure
• have mental problems including psychosis, mania, bipolar illness, or depression
• have circulation problems in fingers and toes
• have kidney problems
• are pregnant or plan to become pregnant. It is not known if DYANAVEL XR will harm your unborn baby. Tell your healthcare provider if you become pregnant during treatment with DYANAVEL XR.
  • There is a pregnancy registry for females who are exposed to DYANAVEL XR during pregnancy. The purpose of the registry is to collect information about the health of females exposed to DYANAVEL XR and their baby. If you or your child becomes pregnant during treatment with DYANAVEL XR, talk to your healthcare provider about registering with the National Pregnancy Registry or Psychostimulants at 1-866-961-2388.
• are breastfeeding or plan to breastfeed. DYANAVEL XR passes into breast milk. You should not breastfeed while you are taking DYANAVEL XR.
• Tell your healthcare provider about all of the medicines that you or your child takes, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

DYANAVEL XR and some medicines may interact with each other and cause serious side effects. Sometimes the doses of other medicines will need to be adjusted while taking DYANAVEL XR.

Especially tell your healthcare provider if you or your child take

• MAOIs
• selective serotonin reuptake inhibitors (SSRIs)
• serotonin norepinephrine reuptake inhibitors (SNRIs)
• medicines used to treat migraine headaches called triptans
• tricyclic antidepressants 
• tramadol
• lithium
• buspirone
• tryptophan
• St. John's Wort

Your healthcare provider will decide whether DYANAVEL XR can be taken with other medicines. Do not start any new medicine while taking DYANAVEL XR without talking to your healthcare provider first.

How should I take DYANAVEL XR?

• See the detailed “Instructions for Use” for information on how to give a dose of DYANAVEL XR extended-release oral suspension. 

• Take DYANAVEL XR exactly as prescribed by your healthcare provider.
• Your healthcare provider may change the dose if needed. 
• Take DYANAVEL XR 1 time each day in the morning.
• DYANAVEL XR can be taken with or without food.
• DYANAVEL XR extended-release tablets may be chewed or swallowed whole.
• DYANAVEL XR extended-release 5 mg tablets are scored and can be divided into equal parts at the score line.
• Your healthcare provider may sometimes stop DYANAVEL XR treatment for a while to check ADHD symptoms.

If you or your child takes too much DYANAVEL XR, call your healthcare provider or poison control center, or go to the nearest hospital emergency room right away. In case of poisoning call your poison control center at 1-800-222-1222.

• You should avoid drinking alcohol during treatment with DYANAVEL XR.

What are possible side effects of DYANAVEL XR?

DYANAVEL XR can cause serious side effects, including:

• See “What is the most important information I should know about DYANAVEL XR?”
  
• Slowing of growth (height and weight) in children. Children should have their height and weight checked often during treatment with DYANAVEL XR . Your healthcare provider may stop the treatment with DYANAVEL XR if you or your child is not growing or gaining height or weight as expected.
• Circulation problems in fingers and toes (peripheral vasculopathy, including Raynaud’s phenomenon). Signs and symptoms may include:

  o   fingers or toes may feel numb, cool, painful
  o   fingers or toes may change color from pale, to blue, to red

  Tell your healthcare provider if you or your child have numbness, pain, skin color change, or sensitivity to temperature in your fingers or toes.

  Call your healthcare provider right away if you or your child have any signs of unexplained wounds appearing on fingers or toes while taking DYANAVEL XR.

•  Serotonin syndrome.  potentially life-threatening problem called serotonin syndrome may happen when DYANAVEL XR is taken with certain other medicines. See, “Before taking DYANAVEL XR, tell your healthcare provider about all medical conditions, including if you or your child.”  Stop taking DYANAVEL XR and call your healthcare provider or go to the nearest hospital emergency room right away if you or your child develops any of the following signs and symptoms of serotonin syndrome:

• agitation
• fast heartbeat
• flushing
• seizures
• coma 
• sweating
• loss of coordination
• confusion
• dizziness
• tremors, stiff muscles, or muscle twitching
• seeing or hearing things that are not real (hallucination)
• changes in blood pressure
• high body temperature (hyperthermia)
• nausea, vomiting, diarrhea

• The most common side effects of amphetamine products include:

• Store DYANAVEL XR at room temperature between 68°F to 77°F (20°C to 25°C).
• Store DYANAVEL XR in a safe place, like a locked cabinet.
  
• Dispose of remaining, unused, or expired DYANAVEL XR by a medicine take-back program at authorized collection sites such as retail pharmacies, hospital or clinic pharmacies, and law enforcement locations.  If no take-back program or authorized collector is available, mix DYANAVEL XR with an undesirable, nontoxic substance such as dirt, cat litter, or used coffee grounds to make it less appealing to children and pets.  Place the mixture in a container such as a sealed plastic bag and throw away DYANAVEL XR in the household trash.

Keep DYANAVEL XR and all medicines out of the reach of children.

General information about the safe and effective use of DYANAVEL XR

Medicines are sometimes prescribed for purposes other than those listed in the Medication Guide. Do not use DYANAVEL XR for a condition for which it has not been prescribed. Do not give DYANAVEL XR to other people, even if they have the same symptoms. It may harm them and it is against the law. You can ask your healthcare provider or pharmacist for information about DYANAVEL XR that was written for health professionals.