ABOUT FOQUEST®

HELPING PATIENTS

Frequently Asked Questions

A. For patients already taking methylphenidate, start with FOQUEST® at the next lower strength based on total methylphenidate daily dose. Wait at least 5 days between adjustments, if dose adjustment is warranted. Maximum Daily Dose is 100 mg in adults and 70 mg in children and adolescents 6 to < 18 years.

Please see FOQUEST® product monograph for complete dosing information.

A. As a general rule for titrating ADHD treatment, CADDRA Guidelines recommend to start low and go slow, but continue to increase the dose until:2

  • the desired goals of treatment have been reached or
  • side effects preclude dose increases or
  • the maximum recommended dosage is reached.

Optimal treatment means that ADHD symptoms have decreased and that there is improvement in general functioning.2 To achieve the optimal FOQUEST® dose, you may slowly increase the dose (each increase should be no less than 5 days apart) to the lowest effective dosage since individual patient response varies widely.1 Maximum daily dose is 100 mg in adults, and 70 mg in children and adolescents 6 to <18 years.

Please see the FOQUEST® product monograph for complete dosing information.

A. In children (6-11 years of age), FOQUEST® was shown to have a duration of action of 13 hours, as measured by SKAMP-C scores (key secondary endpoint).1*

In adults, FOQUEST® was shown to have a duration of action of 16 hours, as measured by PERMP Total score vs. placebo (LS Mean PERMP Total Score at 16h: FOQUEST®: 302.8 vs. placebo, 284.9, p<0.05; key secondary endpoint).1†

* Randomized, double-blind, placebo-controlled, parallel-arm, fixed-dose, multicentre trial measuring the efficacy and safety of FOQUEST® once-daily in children aged 6-12 who met the DSM-5 criteria for ADHD. Following a washout period, children (n=156) entered an open-label dose optimization period of up to 6 weeks in which they were given 25 mg once-daily in the morning to start, thereafter titrated once weekly from 25 mg to 35 mg to 45 mg to 55 mg to 70 mg to 85 mg FOQUEST® until an optimal dose was reached. Subjects (n=147) then entered 1-week of randomized double-blind treatment with placebo (n=75) or FOQUEST® capsules (n=73) at the optimized dose. (Note, the maximum recommended daily dose of FOQUEST® is 70 mg in children 6 to <18 years of age.1). At the end of the week, investigators evaluated attention and behaviour of subjects in a laboratory classroom setting using the SKAMP rating scale. The primary efficacy endpoint was the difference between FOQUEST® and placebo in mean SKAMP-C score across the entire laboratory classroom trial.

Key secondary endpoints were onset and duration of clinical effect as measured by SKAMP-C at post-dose time point 1, 2, 4, 6, 8, 10, 12 and 13 hours. The LS mean difference in SKAMP-C scores was statistically significantly lower (demonstrating improvement) with FOQUEST® compared to placebo from 1 hour through to 13 hours.

† Randomized, double-blind, multicentre, placebo-controlled trial involving 285 adult patients (18 to 60 years of age) who met the DSM-5 criteria for ADHD. Following an up to 7 week dose optimization period (FOQUEST® titrated from 25 mg to 100 mg), patients entered a one-week randomized, double-blind treatment with FOQUEST® (n=121; full analysis set) or placebo (n=118; full analysis set). At the end of this week, subjects completed an age-adjusted math test assessment in a laboratory classroom setting using the PERMP test. The primary efficacy endpoint was the difference between FOQUEST® and placebo in mean PERMP Total score across the entire laboratory classroom trial.

A. The PERMP (Permanent Product Measure of Performance) Total score is the sum of the number of math problems attempted plus the number of math problems answered correctly in a 10-minute session with scores ranging from 0-800 with higher scores indicating better performance.1 The PERMP Total score was the primary endpoint in the post-market trial in adults.

A. SKAMP (Swanson, Kotkin, Agler, M-Flynn and Pelham) is a 13-item scale that assesses manifestations of ADHD in a classroom setting. Each item is rated on a 7-point impairment scale: none, slight, mild, moderate, severe, very severe, maximal. A lower score vs. baseline indicates an improvement.1,7 The SKAMP-Combined score was the primary endpoint in the pivotal trial in children.

A. The ADHD-5-RS (ADHD-5-Rating Scale) is an 18-item scale for the assessment of children that incorporates the symptoms of ADHD established in the DSM-5. Items are scored on a 4-point scale from a 0 = not present to 3 = severe, giving a maximum total score of 54. A lower score vs. baseline indicates ADHD symptom improvement.1,3 The ADHD-5-RS score was the primary endpoint in the pivotal trials in adolescents and adults.

A. FOQUEST® has been studied in 1031 ADHD patients across four FOQUEST® clinical trials, including 582 adults, 293 adolescents (12-17 years) and 156 children (6-12 years).

A. Yes, FOQUEST® is currently covered on the:

  • Ontario Drug Benefit Formulary (General Benefit with therapeutic notes)8
  • RAMQ* List of Medications (Exception Medication; Code SN280)9
    • For the treatment of persons with attention deficit disorder, with or without hyperactivity. For full coverage details, click here.
  • Saskatchewan Formulary (Exception Drug Status)10
  • Manitoba Drug Benefits Formulary (Part 1, no formulary criteria)11
  • Non-Insured Health Benefits (NIHB) Drug Benefits List (open benefit with therapeutic notes)12
* Official Mark of the Régie de l’assurance maladie du Québec.

A. While both FOQUEST® and BIPHENTIN® are methylphenidate-based medications indicated for the treatment of ADHD in adults and children (6 years of age and older), there are some differences between the two drugs.

MLR® Technology

Both BIPHENTIN® and FOQUEST® are uniquely engineered with multi-layer release (MLR®) bead technology1, 5, 13*†

However, the amount of methylphenidate HCl contained within the immediate-release layer and the controlled-release layer differs between the two drugs1,4,6*†

BIPHENTIN® Gelatin Capsules

  • 40% of the total dose is contained in an IR layer
  • 60% is in a delayed CR layer

Adapted from Reiz JL, et al.13 * Comparative clinical significance is unknown. † Clinical significance is unknown.

FOQUEST® Capsules

  • 20% of the total dose is contained in an IR layer
  • 80% (the remainder of the total dose) is in the delayed CR layers.1*

Length of time on the market

FOQUEST® is a newer* drug, available in Canada since 2017. BIPHENTIN® has been available in Canada since 2006.

BIPHENTIN® (methylphenidate hydrochloride controlled release capsules) is indicated for treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in children (6-11 years of age), adolescents (12-18 years of age), and adults (>18 years of age).

BIPHENTIN® is indicated as an integral part of a total treatment program for ADHD that may include other measures (i.e., psychological, educational, and/or social) for patients with this syndrome. Effectiveness for more than 4 weeks has not been systematically evaluated in placebo-controlled trials. Physicians electing to use Biphentin® for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.

Click here to consult the product monograph for important information about:

  • contraindications in patients with anxiety, tension, agitation, thyrotoxicosis, advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, glaucoma, motor tics, or with a family history or diagnosis of Tourette’s syndrome; concomitant use of an MAO inhibitor and within a minimum of 14 days following discontinuation of an MAO inhibitor.
  • the most serious warnings and precautions regarding drug dependence/tolerance, the potential for abuse, and the need for cautious prescribing, particularly in those with a history of drug dependence or alcoholism because such patients may increase dose on their own initiative, the need for careful supervision during drug withdrawal, and possible need for long-term follow-up.
  • other relevant warnings and precautions regarding: non-interchangeability with other controlled release methylphenidate preparations; misuse of CNS stimulants; the theoretical risk of sudden/cardiac death; risk of sudden cardiac death in: patients with pre-existing structural cardiac abnormalities or other serious heart problems, patients who are involved in strenuous exercise or activities, patients who are using other stimulants or medications for ADHD, or patients who have a family history of sudden cardiac death; cardiovascular effects, pre-existing cardiovascular and cerebral vascular conditions, hypertension; long-term suppression of growth, endogenous or exogenous depression, normal fatigue states, pre-existing psychosis, bipolar disorder, emergence of new psychotic or manic symptoms, aggression, suicidal behaviour and ideation, serotonin syndrome, neurologic effects, ophthalmologic effects, priapism, peripheral vasculopathy including Raynaud’s phenomenon, pregnancy and lactation, an element of agitation, driving and heavy machinery, drug interactions, monitoring and laboratory tests during prolonged therapy.
  • conditions of clinical use, adverse reactions, drug interactions, and dosing instructions.
* clinical significance unknown.