Choosing a Ritalin equivalent in Spain
January 24, 2024 3:34 AM Subscribe
I'm moving to Spain, and still grappling to find the right solution for my Ritalin intake.
I've been taking a daily capsule of Ritalin LA 30mg for about 15 years now. (When I first started, I took 20mg, and quickly increased the dosage to 30mg when I felt like it wasn't enough. I've been on the same exact type and dosage for over a decade.) In my first months here I also got the chance to try Ritalin SR 20mg for 30 days. It comes in pill form, not capsule, and that was just fine as well. But then I started looking for something that would be readily available from a local pharmacy, and apparently it's a whole parallel universe over here. Nothing is sold under the brand name Ritalin. Instead, there's a host of other names: Equasym, Medicerban, Atenza, Medikinet, Methysym, Rubifen. The latter is apparently the trade name for what I know as the plain old Ritalin that comes in chalky, breakable, circular pill form. Equasym seemed to be the local equivalent of Ritalin LA. I tried it in a 20mg dose for one month, and constantly felt like it wasn't potent enough. When my 30 days ran out, I tried an increased dosage of 30mg. I'm taking it daily now, but unfortunately, I find it to be just as weak as the 20mg version. I find it hard to concentrate, occasionally doze off, and even find myself standing in front of the fridge craving food, even after eating, which I recognize as unmedicated behaviors. So I don't know if I should increase my Equasym dosage again, or switch to one of the other variants. If anyone knows of a resource where I could find out more information about the differences between all of these, please let me know.
I've been taking a daily capsule of Ritalin LA 30mg for about 15 years now. (When I first started, I took 20mg, and quickly increased the dosage to 30mg when I felt like it wasn't enough. I've been on the same exact type and dosage for over a decade.) In my first months here I also got the chance to try Ritalin SR 20mg for 30 days. It comes in pill form, not capsule, and that was just fine as well. But then I started looking for something that would be readily available from a local pharmacy, and apparently it's a whole parallel universe over here. Nothing is sold under the brand name Ritalin. Instead, there's a host of other names: Equasym, Medicerban, Atenza, Medikinet, Methysym, Rubifen. The latter is apparently the trade name for what I know as the plain old Ritalin that comes in chalky, breakable, circular pill form. Equasym seemed to be the local equivalent of Ritalin LA. I tried it in a 20mg dose for one month, and constantly felt like it wasn't potent enough. When my 30 days ran out, I tried an increased dosage of 30mg. I'm taking it daily now, but unfortunately, I find it to be just as weak as the 20mg version. I find it hard to concentrate, occasionally doze off, and even find myself standing in front of the fridge craving food, even after eating, which I recognize as unmedicated behaviors. So I don't know if I should increase my Equasym dosage again, or switch to one of the other variants. If anyone knows of a resource where I could find out more information about the differences between all of these, please let me know.
Best answer: OK first, a disclaimer: you should consult a local doctor on this, try to speak to someone qualified who understands prescribing and drug availability in Spain. I am not a medical professional, not a doctor, not any kind of expert, I am just someone who works in drug distribution, and knows of a few places to look up information on drugs. What I have written here is not medical advice - I am just pointing at some websites. Please consult a professional!
Also, I don't know anything about Spanish healthcare specifically, I am in the UK, so everything I say here may well not apply. But UK drugs are still largely aligned with EU regulations for practical reasons, so I would expect that you could find some useful English language information on many of the drugs available in Spain in the British National Formulary section on methylphenidate: https://bnf.nice.org.uk/drugs/methylphenidate-hydrochloride/
Methylphenidate is the generic name for the active ingredient in Ritalin, and it is a complicated drug, with many different formulations available. Each different version has a different release profile, so you can't just jump from one to another and expect the same effect, as you've found.
It sounds like you were happy with the effects of Ritalin LA at a dosage of 30mg/day. Ritalin LA is a modified-release formulation of methylphenidate. According to the FDA Ritalin LA consists of 50% immediate release methylphenidate and 50% delayed release:
"Each bead-filled Ritalin LA capsule contains half the dose as immediate-release beads and half as enteric-coated, delayed-release beads, thus providing an immediate release of methylphenidate and a second delayed release of methylphenidate." (https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021284s010lbl.pdf)
In the UK the product Medikinet XL has the same immediate/delayed release proportionality (50/50):
"For Medikinet® XL
Consists of an immediate-release component (50% of the dose) and a modified-release component (50% of the dose)." (https://bnf.nice.org.uk/drugs/methylphenidate-hydrochloride/#prescribing-and-dispensing-information)
There does not appear to be an immediate release version of Equasym so I assume that you are referring to Equasym XL. Equasym XL does not have the same release profile as Ritalin LA, it is 30/70. On Equasym XL you are not getting the same initial immediate release dose that you would get from Ritalin LA or Medikinet XL. Based on what you have written, you had been taking significantly less total methylphenidate than previously, and even when you increased the dose to match the overall amount of active ingredient you were stabilised on, you were still reducing the initial immediate dosage by a large amount.
Based on what the FDA and the BNF say, assuming the product is the same in Spain, I would suggest that a 30mg daily dose of Medikinet XL may have a more similar effect to 30mg Ritalin LA.
Again, I AM NOT A DOCTOR, you should really consult a doctor on this one, methylphenidate is a controlled drug for good reasons. Best of luck, I hope you get this sorted.
posted by tomsk at 7:17 AM on January 24, 2024 [4 favorites]
Also, I don't know anything about Spanish healthcare specifically, I am in the UK, so everything I say here may well not apply. But UK drugs are still largely aligned with EU regulations for practical reasons, so I would expect that you could find some useful English language information on many of the drugs available in Spain in the British National Formulary section on methylphenidate: https://bnf.nice.org.uk/drugs/methylphenidate-hydrochloride/
Methylphenidate is the generic name for the active ingredient in Ritalin, and it is a complicated drug, with many different formulations available. Each different version has a different release profile, so you can't just jump from one to another and expect the same effect, as you've found.
It sounds like you were happy with the effects of Ritalin LA at a dosage of 30mg/day. Ritalin LA is a modified-release formulation of methylphenidate. According to the FDA Ritalin LA consists of 50% immediate release methylphenidate and 50% delayed release:
"Each bead-filled Ritalin LA capsule contains half the dose as immediate-release beads and half as enteric-coated, delayed-release beads, thus providing an immediate release of methylphenidate and a second delayed release of methylphenidate." (https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021284s010lbl.pdf)
In the UK the product Medikinet XL has the same immediate/delayed release proportionality (50/50):
"For Medikinet® XL
Consists of an immediate-release component (50% of the dose) and a modified-release component (50% of the dose)." (https://bnf.nice.org.uk/drugs/methylphenidate-hydrochloride/#prescribing-and-dispensing-information)
There does not appear to be an immediate release version of Equasym so I assume that you are referring to Equasym XL. Equasym XL does not have the same release profile as Ritalin LA, it is 30/70. On Equasym XL you are not getting the same initial immediate release dose that you would get from Ritalin LA or Medikinet XL. Based on what you have written, you had been taking significantly less total methylphenidate than previously, and even when you increased the dose to match the overall amount of active ingredient you were stabilised on, you were still reducing the initial immediate dosage by a large amount.
Based on what the FDA and the BNF say, assuming the product is the same in Spain, I would suggest that a 30mg daily dose of Medikinet XL may have a more similar effect to 30mg Ritalin LA.
Again, I AM NOT A DOCTOR, you should really consult a doctor on this one, methylphenidate is a controlled drug for good reasons. Best of luck, I hope you get this sorted.
posted by tomsk at 7:17 AM on January 24, 2024 [4 favorites]
Response by poster: Thanks tomsk! This is very helpful information.
The Equasym I'm taking is named just that, no XL or other letters following the trade name. But it does come in capsules which I assume are filled with beads.
I'll ask my local doctor about possibly switching to Medikinet XL. Thank you!
posted by Silky Slim at 7:30 AM on January 24, 2024 [1 favorite]
The Equasym I'm taking is named just that, no XL or other letters following the trade name. But it does come in capsules which I assume are filled with beads.
I'll ask my local doctor about possibly switching to Medikinet XL. Thank you!
posted by Silky Slim at 7:30 AM on January 24, 2024 [1 favorite]
Response by poster: Just out of curiosity, do you know what the modified bead ratio is for Ritalin SR? I wonder if it is also 50/50, just like Ritalin LA.
posted by Silky Slim at 7:32 AM on January 24, 2024
posted by Silky Slim at 7:32 AM on January 24, 2024
Further to my comment above, I found this explanation from a reputable source which does a pretty good job of explaining the issue. Essentially there are two key issues: 1) the approved range of bioequivalence for generics is fairly wide plus 2) supposedly 'inactive' ingredients can make a difference to the formulation.
posted by guessthis at 8:08 AM on January 24, 2024
posted by guessthis at 8:08 AM on January 24, 2024
I can't seem to find any info on Ritalin SR's release profile in the places I'm familiar with, sorry, and it looks to have been discontinued (?) so might be hard to track down accurate info on it. SR usually means 'Sustained Release' in pharma marketing terms, so it could have been an entirely delayed release formulation with no immediate release component, but that's pure speculation on my part.
guessthis makes a good point also - there is a lot of variation between supposedly identical generic drugs of this type due to other ingredients and different manufacturing processes etc. A presentation with the same basic proportion of immediate/modified release is more likely to be similar to your previous medication, though.
posted by tomsk at 9:20 AM on January 24, 2024 [1 favorite]
guessthis makes a good point also - there is a lot of variation between supposedly identical generic drugs of this type due to other ingredients and different manufacturing processes etc. A presentation with the same basic proportion of immediate/modified release is more likely to be similar to your previous medication, though.
posted by tomsk at 9:20 AM on January 24, 2024 [1 favorite]
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Rather than increasing the Equasym dose I would try different variants until you find one that works better for you. I know this is anecdotal, but I hope someone else can find and link the science that explains why methylphenidate variants can behave so differently at the same dose.
posted by guessthis at 7:06 AM on January 24, 2024 [1 favorite]