Dr John Kruse
@drjohnkruse·16.8K subscribers·484 videos
Azstarys for ADHD
Posted
May 10, 2026
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761
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May 10, 2026
761
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Azstarys is two, or maybe one-and-a-half drugs in one. It contains immediate release (IR) methylphenidate (Ritalin) as well as a prodrug, or inactive form of methylphenidate called serdexmethylphenidate (SDX) which needs to be passed into the intestines before it is cleaved to create an active methylphenidate molecule. While SDX itself has very low potential for addiction, and is therefore classified as a schedule 4 substance, when it is recombined with IR methylphenidate in Azstarys it is a schedule 2 substance, and as such is not an attractive option for individuals who have abused stimulants.
Many people who have used Azstarys described it as "smooth" (as do many who have tried another ADHD prodrug, Vyvanse), which is attributed to a very slow tapering of blood levels of methylphenidate, thus avoiding a withdrawal or crash as the drug leaves the body. In fact, the tapering is so gradual with Azstarys because it is actually delivering considerable amounts of methylphenidate throughout the night. From a single morning dose, blood levels of methylphenidate 24 hours later are somewhere between 25% to 40% of the peak blood levels. This would likely cause interference with sleep for many individuals.
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References:
Safety and Tolerability of Serdexmethylphenidate/Dexmethylphenidate Capsules in Children with Attention-Deficit/Hyperactivity Disorder: A 12-Month, Open-Label Safety Study (Childress 2023)
Serdexmethylphenidate/dexmethylphenidate effects on sleep in children with attention-deficit/hyperactivity disorder (2023, Childress, Mattingly)
Evaluating serdexmethylphenidate and dexmethylphenidate capsules as a once-daily treatment option for ADHD (2023)
Dose Proportionality and Steady-State Pharmacokinetics of Serdexmethylphenidate/Dexmethylphenidate, a Novel Prodrug Combination to Treat Attention-Deficit/Hyperactivity Disorder (2022)
Oral, intranasal, and intravenous abuse potential of serdexmethylphenidate, a novel prodrug of d-methylphenidate (2022, Shram)
FDA registration of serdexmethylphenidate (2021)
Full Chapter list:
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Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions.
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