Comprehensive medication guide to Dexmethylphenidate/Serdexmethylphenidate including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$60 copay for commercially insured patients using the CoriumCares savings card; many plans require prior authorization and/or step therapy; Tier 3–4 on most formularies without PA; first prescription $0 through CoriumCares for eligible patients.
Estimated Cash Pricing
$545–$598 retail for brand-name Azstarys for a 30-day supply (no generic available); as low as $445–$455 with a GoodRx coupon; or $50 without insurance through the CoriumCares manufacturer savings program.
Medfinder Findability Score
55/100
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Azstarys (serdexmethylphenidate/dexmethylphenidate) is a once-daily prescription central nervous system (CNS) stimulant approved by the FDA on March 2, 2021, for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients aged 6 years and older. It is manufactured by Corium, a Sun Pharmaceutical company.
Azstarys is a combination product containing two ingredients in a fixed 70/30 molar ratio: serdexmethylphenidate (SDX), a novel prodrug that is pharmacologically inactive until converted to dexmethylphenidate in the lower gastrointestinal tract, and immediate-release dexmethylphenidate (d-MPH), which provides rapid onset of action. This dual-component design provides both fast ADHD symptom control (onset within ~30 minutes) and extended coverage throughout the day (up to ~13 hours).
Azstarys is available as oral capsules in three strengths: 26.1 mg/5.2 mg, 39.2 mg/7.8 mg (the recommended starting dose), and 52.3 mg/10.4 mg (the maximum recommended dose), each expressed as serdexmethylphenidate/dexmethylphenidate. There is no generic version available, and none is expected until at least 2037 due to patent protections.
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Azstarys works through a two-stage mechanism. The 30% immediate-release dexmethylphenidate component dissolves in the stomach and upper GI tract, entering the bloodstream within approximately 30 minutes to provide rapid ADHD symptom control at the start of the day. Simultaneously, the 70% serdexmethylphenidate (prodrug) component passes through the upper GI tract unchanged and is gradually converted to dexmethylphenidate by enzymes in the lower intestinal tract over 12–13 hours.
Dexmethylphenidate works in the brain by blocking the reuptake of dopamine and norepinephrine into nerve cells. This increases the availability of these neurotransmitters in the prefrontal cortex — the brain region responsible for attention, executive function, impulse control, and working memory — which are the areas of brain function most affected by ADHD. The mode of therapeutic action in ADHD is not fully understood, but this enhancement of dopamine and norepinephrine signaling is the primary mechanism.
The prodrug design of serdexmethylphenidate is particularly noteworthy because the SDX molecule is pharmacologically inert if snorted or injected — it only activates through the specific enzymatic process in the lower GI tract. This property led to the SDX component being classified as a Schedule IV controlled substance (while the overall Azstarys product is Schedule II due to the d-MPH component).
26.1 mg/5.2 mg — capsule
Serdexmethylphenidate 26.1 mg / dexmethylphenidate 5.2 mg — low dose option for titration
39.2 mg/7.8 mg — capsule
Serdexmethylphenidate 39.2 mg / dexmethylphenidate 7.8 mg — recommended starting dose for all ages
52.3 mg/10.4 mg — capsule
Serdexmethylphenidate 52.3 mg / dexmethylphenidate 10.4 mg — maximum recommended daily dose
Azstarys scores a 55 out of 100 on the medfinder findability scale, meaning it is intermittently difficult to find at local pharmacies. Azstarys is not on the FDA's official drug shortage list as of early 2026 — the manufacturer has not reported a supply disruption. However, patients regularly report difficulty filling their prescriptions because many pharmacies do not routinely stock this brand-only medication.
The primary access challenges are structural: Azstarys is a brand-only Schedule II stimulant with no generic alternative. Pharmacies stock medications based on prescription volume, and as a relatively newer medication (approved March 2021) with a smaller prescriber base than older ADHD medications, many pharmacies don't maintain standing inventory. The ongoing ADHD medication demand surge that began in October 2022 has also created ripple effects across all stimulant medications including Azstarys.
If you're having trouble finding Azstarys at your local pharmacy, medfinder calls pharmacies near you to check which ones have Azstarys in your specific dosage in stock, then texts you the results — eliminating hours of frustrating phone calls.
Azstarys is a Schedule II controlled substance, which means it can only be prescribed by licensed healthcare providers who hold DEA Schedule II prescribing authority. Providers must conduct a thorough cardiovascular assessment and abuse risk evaluation before initiating Azstarys, and must issue prescriptions electronically (EPCS) or on a written form — phone-in prescriptions are not permitted for Schedule II medications in most states.
Common prescriber types for Azstarys include:
Psychiatrists — especially those specializing in ADHD, child/adolescent psychiatry, or adult psychiatry
Pediatricians — for patients ages 6 through adolescence
Primary care physicians (PCPs) — family medicine and internal medicine doctors managing ADHD in both adults and children
Neurologists — particularly for complex or comorbid neurological presentations
Nurse practitioners (NPs) and physician assistants (PAs) — when they hold DEA Schedule II prescribing authority in their state
Telehealth providers can also prescribe Azstarys in many states. DEA regulations on telehealth prescribing of Schedule II controlled substances have been subject to ongoing evolution since the COVID-19 public health emergency waivers. Many telehealth platforms specializing in ADHD — including Done, Cerebral, and others — can evaluate patients and prescribe Azstarys where state regulations permit. Check your specific state and platform for current telehealth prescribing rules.
Yes. Azstarys is classified as a Schedule II (CII) controlled substance by the DEA — the same classification as Adderall, Vyvanse, Concerta, Focalin XR, and other stimulant ADHD medications. This is because Azstarys contains dexmethylphenidate, which has recognized potential for abuse, misuse, and dependence. The prodrug component (serdexmethylphenidate) is itself a Schedule IV substance because it is pharmacologically inert unless metabolized by the body.
As a Schedule II controlled substance, Azstarys comes with important prescribing and dispensing restrictions:
Prescriptions must be sent electronically (EPCS) or on a written prescription — they cannot be called in to a pharmacy
No automatic refills — a new prescription from your provider is required each month
Pharmacies are subject to DEA annual manufacturing quotas, which can limit supply
Azstarys must be stored securely — never share with others, as it carries recognized potential for misuse and addiction
The most common side effects of Azstarys (occurring in more than 5% of patients at twice the rate of placebo in clinical data accumulated from methylphenidate products) include:
Decreased appetite / reduced hunger
Insomnia / difficulty falling or staying asleep
Nausea and vomiting
Abdominal pain and dyspepsia (indigestion)
Weight loss / decreased weight gain (especially in children)
Anxiety and irritability
Dizziness
Affect lability (mood swings, emotional sensitivity)
Tachycardia (increased heart rate)
Increased blood pressure
Cardiovascular events: chest pain, shortness of breath, fainting, sudden death (in patients with pre-existing cardiac conditions)
Psychiatric reactions: hallucinations, psychosis, mania, aggressive behavior, suicidal ideation
Peripheral vasculopathy / Raynaud's phenomenon (numbness, color changes in fingers/toes)
Priapism (prolonged painful erection — seek emergency care immediately)
Growth suppression in children (monitor height and weight regularly)
Severe hypersensitivity reactions: angioedema, anaphylaxis, bronchospasm
Worsening of tics or Tourette's syndrome
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Focalin XR (dexmethylphenidate ER)
Closest alternative — same active metabolite (dexmethylphenidate); bimodal release profile (not bioequivalent to Azstarys); generic available at ~$30–$150/month
Vyvanse (lisdexamfetamine)
Also a prodrug-based once-daily stimulant; amphetamine class; generic available since 2023; approved for ADHD and binge eating disorder
Adderall XR (amphetamine salts ER)
Once-daily amphetamine-class stimulant; generic widely available; DEA quota increases in 2025 are improving supply
Concerta (methylphenidate ER)
Racemic methylphenidate extended-release; OROS delivery system; generic available; well-established efficacy in ADHD
Strattera (atomoxetine)
Non-stimulant ADHD medication; SNRI mechanism; not scheduled; generic available; 4–6 weeks to full effect
Prefer Dexmethylphenidate/Serdexmethylphenidate? We can find it.
MAO inhibitors (MAOIs)
majorCONTRAINDICATED — combining with MAOIs (phenelzine, tranylcypromine, selegiline, linezolid, methylene blue) can cause potentially fatal hypertensive crisis. Do not use within 14 days of MAOI discontinuation.
Halogenated anesthetics (sevoflurane, desflurane, halothane)
majorRisk of dangerously elevated blood pressure and cardiac arrhythmias during surgery. Discontinue Azstarys morning of surgical procedures requiring halogenated anesthesia.
Blood pressure medications (antihypertensives)
moderateAzstarys can antagonize the blood pressure-lowering effect of antihypertensives including ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, and thiazide diuretics. Monitor blood pressure; dose adjustment may be needed.
Tricyclic antidepressants (TCAs)
moderateTCAs can unpredictably alter the effects of stimulants by blocking norepinephrine reuptake. May increase or decrease efficacy. Use with caution and monitor closely.
SSRIs and SNRIs
moderateAzstarys may inhibit metabolism of some SSRIs/SNRIs, increasing their plasma levels. Theoretical risk of serotonin syndrome. Monitor for signs including agitation, diaphoresis, tachycardia, fever.
Antipsychotics (risperidone, haloperidol)
moderateAntipsychotics may diminish the stimulant effect of Azstarys. Stimulants may worsen extrapyramidal symptoms. Monitor therapeutic response and adverse effects.
Acid-reducing medications (cimetidine, famotidine, PPIs)
moderateAgents that raise gastric pH may increase absorption and plasma levels of dexmethylphenidate. Monitor for enhanced stimulant effects with concomitant use.
Opioid medications
majorConcomitant use of CNS stimulants and opioids may mask signs of respiratory depression. Use only when necessary; limit doses and duration; monitor closely.
Azstarys represents a meaningful pharmacological innovation in ADHD treatment — a once-daily stimulant that combines rapid onset with smooth, sustained coverage through its unique prodrug delivery system. For patients who have struggled with the peaks and valleys of other ADHD medications, the smooth pharmacokinetic profile of Azstarys may offer a noticeable improvement in symptom control throughout the day.
The main challenges with Azstarys are its high cash price ($545–$598 per month without insurance), its brand-only status (no generic until at least 2037), and the intermittent difficulty finding it in stock at local pharmacies. The CoriumCares manufacturer savings program can dramatically reduce cost for commercially insured patients. Insurance prior authorization is frequently required and step therapy through generic alternatives is common.
If you've been prescribed Azstarys and are having trouble finding it at a pharmacy near you, medfinder can help. medfinder calls pharmacies near you to find which ones have Azstarys in stock in your specific dosage, and texts you the results — saving you the frustration of calling around on your own.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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