How Does Azstarys Work?

Azstarys works by increasing the levels of two brain chemicals — dopamine and norepinephrine — that play a key role in attention, focus, and impulse control.

What makes Azstarys unique is its two-part design: one ingredient works right away, while the other is a "prodrug" that your body slowly activates throughout the day. This combination is designed to give you both a quick start and long-lasting ADHD symptom control from a single morning capsule.

Let's break down exactly what's happening in your body when you take Azstarys.

What It Does in Your Body

Azstarys contains two active ingredients:

1. Dexmethylphenidate (d-MPH) — This is the immediate-release component. It starts working quickly after you take the capsule.
2. Serdexmethylphenidate (SDX) — This is the prodrug. On its own, it's inactive. Your body's enzymes gradually convert it into dexmethylphenidate over the course of the day.

Think of It Like a Two-Stage Rocket

Imagine a two-stage rocket. The first stage (the immediate-release dexmethylphenidate) fires right away and gets you off the ground — helping you focus within about an hour of taking the capsule. The second stage (serdexmethylphenidate) is the booster that kicks in gradually, keeping you in orbit throughout the afternoon and into the evening.

This is different from older extended-release ADHD medications that use physical barriers (like special coatings or capsule layers) to slow drug release. Azstarys uses chemistry — the prodrug design — to control how long the medication works.

How Dopamine and Norepinephrine Fit In

In people with ADHD, the brain doesn't regulate dopamine and norepinephrine as efficiently as it should. These neurotransmitters are essential for:

• Dopamine — Motivation, reward, focus, and the ability to sustain attention on tasks
• Norepinephrine — Alertness, concentration, and the ability to filter out distractions

Dexmethylphenidate (the active form of both ingredients in Azstarys) works by blocking the reuptake of dopamine and norepinephrine. In plain terms, it prevents your brain from recycling these chemicals too quickly, so they stick around longer and do their job more effectively.

Think of it like a drain stopper. Normally, dopamine and norepinephrine flow into the space between nerve cells and then get quickly sucked back up (reuptake). Azstarys puts a partial block on that drain, allowing more of these chemicals to stay active and improve focus, attention, and impulse control.

How Long Does It Take to Work?

Azstarys typically starts working within 30 minutes to 1 hour after taking it. The immediate-release dexmethylphenidate component provides the initial effect, so most patients notice improved focus relatively quickly in the morning.

However, it may take several days to a few weeks of consistent use for you and your doctor to determine the right dose and see the full benefit of treatment. Your doctor may start you on the lowest dose (26.1 mg/5.2 mg) and increase gradually.

How Long Does It Last?

One of the main advantages of Azstarys is its extended duration of action. In clinical studies, Azstarys demonstrated symptom control lasting up to 13 hours from a single morning dose.

Here's a rough timeline of what to expect:

• Within 1 hour: The immediate-release dexmethylphenidate kicks in
• Hours 2-4: Peak focus as both the immediate-release and converted prodrug overlap
• Hours 5-10: The prodrug continues converting, maintaining steady medication levels
• Hours 10-13: Effects gradually taper off

This long duration means most patients can take Azstarys once in the morning and have coverage through the school or work day and into the evening — without needing a booster dose.

What Makes Azstarys Different from Similar Medications?

There are many ADHD medications on the market. Here's what sets Azstarys apart:

Prodrug Design vs. Physical Extended-Release

Most long-acting ADHD medications (like Concerta or Focalin XR) use physical mechanisms — osmotic pumps, bead technology, or multi-layer coatings — to release the drug slowly. Azstarys takes a different approach by using a prodrug (serdexmethylphenidate) that your body chemically converts into the active drug over time.

This prodrug approach is similar to how Vyvanse works, except Vyvanse is amphetamine-based while Azstarys is methylphenidate-based. If you've done well on methylphenidate medications but want the smoother, longer-lasting profile of a prodrug, Azstarys may be a good option.

Compared to Specific Medications

• Concerta (Methylphenidate ER) — Uses an osmotic-controlled release system (OROS). Available as generic. Azstarys's prodrug mechanism may provide a different release curve.
• Focalin XR (Dexmethylphenidate ER) — Contains the same active ingredient as Azstarys but uses bead technology for extended release rather than a prodrug. Available as generic, so significantly cheaper.
• Vyvanse (Lisdexamfetamine) — Also a prodrug, but converts to amphetamine rather than methylphenidate. Now available as generic. Some patients respond better to methylphenidate-based vs. amphetamine-based stimulants.
• Jornay PM (Methylphenidate) — Taken at night with a delayed release so it kicks in the next morning. Brand-only. Different use case than Azstarys.

For a full comparison of alternatives, see our guide on alternatives to Azstarys.

Final Thoughts

Azstarys combines proven methylphenidate science with a modern prodrug delivery system to provide up to 13 hours of ADHD symptom control from a single morning dose. Its unique two-part mechanism — immediate-release plus gradual prodrug conversion — gives patients a fast start with smooth, sustained coverage throughout the day.

If you'd like to learn more, read about what Azstarys is and how to take it, or check Azstarys side effects to understand potential reactions. Ready to fill your prescription? Use Medfinder to find a pharmacy with Azstarys in stock near you.