Tuzulby (methylphenidate)
Methylphenidate hydrochloride (prolonged-release chewable tablet)
Tuzulby is a prolonged-release chewable methylphenidate tablet for ADHD at ages 6 to 17. Chew it before swallowing. This guide explains doses, duration, side effects and why it is not a direct swap for Equasym XL.
Written and clinically reviewed by Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
Tuzulby: key facts
- What it is
- Tuzulby is a once-daily prolonged-release chewable tablet containing methylphenidate: a stimulant that keeps dopamine and noradrenaline available longer in the brain areas that regulate focus, motivation, and impulse control. It is the only chewable modified-release methylphenidate in the UK.
- How it's released
- 30% of the dose is released straight away for a quick start; 70% is released gradually to keep the effect going. Coverage lasts about 8 hours.
- How to take it
- Chew each tablet well, then swallow. Do not swallow it whole and do not crush it. With or without food, once each morning.
- Available strengths
- 20 mg, 30 mg and 40 mg chewable tablets, scored so they can be halved (10 mg and 15 mg). Maximum daily dose: 60 mg.
- Caution: Who it is for
- Licensed for children and young people aged 6 to 17 only. It is not licensed for adults.
- Caution: Switching note
- Tuzulby is not on the NHS list of equivalent brands. Equasym XL also releases 30:70, but the two have not been assessed as equivalent. Only change brand with your prescriber.
What is Tuzulby?
Tuzulby (Neuraxpharm UK) is a chewable 30:70 prolonged-release methylphenidate tablet licensed in 2025 for children and young people aged 6 to 17. It is the option when a capsule or whole tablet cannot be swallowed, and it must be prescribed and dispensed by brand name.
Tuzulby at a glance
| Fact | Detail |
|---|---|
| Active ingredient | Methylphenidate hydrochlorideSource: Tuzulby SmPC (eMC) |
| Formulation | Prolonged-release chewable tablet (Neuraxpharm UK)Source: Tuzulby SmPC (eMC) |
| Release pattern | 30% immediate release; 70% prolonged release over the following hoursSource: Tuzulby SmPC (eMC) |
| Strengths | 20, 30 and 40 mg chewable tablets, scored (10 mg and 15 mg by halving the 20 mg and 30 mg tablets)Source: Tuzulby SmPC (eMC) |
| Licensed ages | Children and young people aged 6 to 17 only. Not licensed for adultsSource: Tuzulby SmPC (eMC) |
| Usual starting dose | 20 mg once each morning, adjusted weekly in 10, 15 or 20 mg stepsSource: Tuzulby SmPC (eMC) |
| Maximum licensed dose | 60 mg a daySource: Tuzulby SmPC (eMC) |
| How long it lasts | About 8 hoursSource: Tuzulby SmPC (eMC) |
| Food | With or without foodSource: Tuzulby SmPC (eMC) |
| How to take it | Chew well, then swallow. Do not swallow whole or crushSource: Tuzulby SmPC (eMC) |
| Bioequivalent brands | None listed: Tuzulby is not on the NHS list of equivalent brands. Equasym XL also uses 30:70 but has not been assessed as equivalentSource: NHS list of equivalent brands |
| Contains | Aspartame (a source of phenylalanine): not suitable in phenylketonuriaSource: Tuzulby SmPC (eMC) |
| Controlled drug | Schedule 2Source: BNF: methylphenidate hydrochloride |
Medication class
Tuzulby (Neuraxpharm UK) is a prolonged-release chewable methylphenidate tablet licensed in the UK in July 2025 for children and adolescents aged 6 to 17. It has a 30:70 immediate-release to prolonged-release ratio: a smaller initial effect and a larger, sustained second portion, giving about 8 hours of coverage from one morning dose. It is the only chewable modified-release methylphenidate, so it fills a gap for children who cannot swallow capsules or whole tablets. Equasym XL capsules also use 30:70, but the two have not been assessed as equivalent, and Tuzulby is not on the NHS list of equivalent brands. Methylphenidate modified-release products must be prescribed and dispensed by brand name (MHRA guidance).
When it's prescribed
Prescribed for ADHD in children and young people aged 6 to 17, per NICE NG87 (methylphenidate is the first-choice medicine for children aged 5 and over). Not licensed for adults. Must be prescribed and dispensed by brand name (MHRA guidance).
Pros of Tuzulby
- The only chewable modified-release methylphenidate in the UK: an option when a capsule or whole tablet cannot be swallowed
- Scored tablets give 10 mg and 15 mg steps
- Releases 30% of the dose straight away and 70% later, so less of the dose acts first thing and more in the afternoon
- No food requirement, and no known interaction with acid-reducing medicines or antacids
- Cherry flavoured
Cons of Tuzulby
- Licensed for ages 6 to 17 only: not for adults
- Must be chewed: swallowing whole or crushing changes how the dose is released
- Not on the NHS list of equivalent brands: switching to or from any other brand needs specialist review
- Contains aspartame: not suitable for children with phenylketonuria
- 8-hour duration: may not cover a long school day with after-school activities
How does Tuzulby work?
Each chewable tablet holds an immediate-release part (30% of the dose) and a prolonged-release part (70%). Chewing does not spoil the slow part: the slow-release granules are designed to survive chewing, which is why the tablet must be chewed rather than crushed or swallowed whole.
Methylphenidate blocks the brain's recycling transporters for dopamine and noradrenaline: keeping them available longer in the synapse. This helps the prefrontal cortex regulate attention, motivation, and impulse control.
Each Tuzulby chewable tablet has two parts:
• An immediate-release part (30%): starts working within 1–2 hours • A prolonged-release part (70%): released gradually over the following hours
The slow part is built to survive chewing, so chewing is how the tablet is meant to be taken. Swallowing it whole or crushing it changes how the dose is released. So less of the dose acts first thing, and more of it from the middle of the day. The effect lasts about 8 hours.
You can take Tuzulby with acid-reducing medicines such as omeprazole or lansoprazole, and with antacids. None of them is known to affect it.
How Tuzulby works: visual guide
Follow the methylphenidate in Tuzulby from chewable tablet to effect. Use ADHDnotepad's animated visual medication journey to see how methylphenidate blocks the dopamine and noradrenaline transporters. Tuzulby releases 30% of the dose straight away and the larger 70% portion over the following hours.
ClinicalDeeper clinical detail
How do I take Tuzulby?
Take the prescribed dose once each morning, before 9am, with or without food. Chew each tablet well, then swallow: do not swallow it whole and do not crush it. The scored tablets can be halved for 10 mg and 15 mg doses.
Interactive Tuzulby duration & effect chart
See why Tuzulby's effect is weighted towards later in the day. Use ADHDnotepad's interactive Tuzulby effect chart to adjust dose time and strength and explore how its 30:70 profile, a smaller first wave and a larger second wave, may shape when effects start, peak and wear off. The chart is illustrative, as actual onset and duration vary between people.
When to take it
Once in the morning. About 8 hours' duration: take before 9am so it has worn off by bedtime.
Chew it
Chew the tablet well, then swallow. Do not swallow it whole and do not crush it: the prolonged-release part only works as designed when the tablet is chewed.
With or without food
Either is fine: Tuzulby does not require food.
Halving tablets
The tablets are scored and can be broken into equal halves: half a 20 mg tablet gives 10 mg and half a 30 mg tablet gives 15 mg. Only halve a tablet if your child's prescriber has asked for that dose.
Missed dose
If still morning, take as soon as you remember. If mid-afternoon, skip it: never double up.
Alcohol
Not for young people taking Tuzulby. Alcohol reacts with methylphenidate to form ethylphenidate and can change how the dose is released.
Phenylketonuria
Tuzulby contains aspartame, a source of phenylalanine. Tell the prescriber if your child has phenylketonuria (PKU).
ClinicalPrescribing and clinical detail
What should I expect from Tuzulby week by week?
Appetite dips and mild headaches are common in week 1 and mostly settle by week 2. Because 70% of the dose is released later, the main effect builds through the morning and continues into the afternoon.
Adjustment
Appetite dips; mild headache (drinking enough water may help); possibly feeling more alert. Most settle by week 2.
Settling in
Most early side effects reduce. With the 30:70 release, the main effect builds through the morning and continues into the afternoon. Note when the effect starts and when it wears off, and bring this to the next review.
Optimising
Working towards the ideal dose in weekly steps of 10, 15 or 20 mg, up to 60 mg a day. The goal is the lowest dose that covers the school day well, with the fewest side effects.
Maintenance
Reviews every 6 months. BP, HR, height and weight checked at each visit. Your child's prescriber will discuss treatment breaks (for example in school holidays) and whether to continue at least once a year.
What are the side effects of Tuzulby?
Reduced appetite, difficulty sleeping if taken late, mild headache and a faster heartbeat are the most common early effects. Most ease in the first few weeks. Nosebleeds have also been reported.
All expanded by default: tap a category to collapse it. Most of these ease in the first 1–2 weeks.
Reduced appetite; weight loss (long-term)
Very common (reduced appetite); common (weight loss)Weight is monitored at every review.
What helps
- Eat breakfast before or with your dose, before your appetite drops.
- Appetite usually returns in the evening: plan your main meal for then.
- If you can, prepare it earlier in the day, while the medicine is working.
- Balanced ready-to-heat meals (freshly made, not processed microwave meals) save the planning that stops many people eating.
Difficulty sleeping if taken late
Very commonWhat helps
- Take before 9am.
- Cut down on caffeine, especially after midday: it often makes stimulant side effects worse.
- The interactive Tuzulby duration & effect chart shows how a change of timing affects when it wears off.
- Tell your prescriberStill disrupted at 4 weeks: discuss with your prescriber.
Increased heart rate and blood pressure; palpitations
CommonModest increases are expected and monitored at every review.
Brief awareness of your heartbeat is usually normal in the first few weeks.
What helps
- Cut down on caffeine and avoid cold and flu remedies that contain a decongestant.
- Keep salt and alcohol down, and keep up regular moderate exercise.
- Tell your prescriberTell your prescriber within a few days if your resting pulse stays above 100. The same if your blood pressure stays at 140/90 or higher (135/85 at home).
- Get help todayA reading of 180/120 or higher after 5 minutes' rest, or a resting pulse above 120: contact your prescriber or 111 today.
- Tell your prescriberContact your prescriber if it's sustained or comes with dizziness.
Anxiety, irritability, low mood
CommonWhat helps
- Note when it happens: as the dose is kicking in, while it is working, or as it wears off.
- Tell your prescriberTell your prescriber if persistent.
Suicidal thoughts
Uncommon- Get help todayContact prescriber or crisis support immediately.
- Call 999If your child might act on these thoughts, or has harmed themselves, call 999 or go to A&E.
Psychosis symptoms; mania
Uncommon/Rare- Get help todayStop and seek urgent review.
Headache
Very commonUsually settles by week 2.
What helps
- Drink more water.
Dizziness, tremor
CommonUsually settles in the first few weeks.
Tics
Uncommon- Tell your prescriberContact your prescriber.
Nosebleeds (epistaxis)
Frequency not known (added to the leaflet in 2026)- Tell your prescriberMention frequent or heavy nosebleeds at your next review.
Nausea, dry mouth, sweating, hair thinning, teeth grinding
Very common (nausea, dry mouth); common (sweating, hair thinning, teeth grinding)Nausea is most common in the first weeks.
What helps
- Eating soon after your dose may help.
- Drinking enough water and eating regular, smaller meals may help.
- For a dry mouth, sip water and use sugar-free gum or mints.
- Tell your prescriberMention it at your review if it bothers you or is severe.
- Tell your prescriberMention the others at your next review if troublesome.
Priapism (painful erection more than 2 hours)
Frequency not known: medical emergency- Call 999Attend A&E immediately.
This is the full list for this guide, including uncommon and rare effects. For step-by-step tips on managing the common ones, and when to speak to your prescriber, see Tuzulby side effects: what helps.
When should I get help while taking Tuzulby?
Call 999 for severe or spreading chest pain, severe breathlessness, signs of a stroke, a seizure or a suspected overdose. Call 999 too for a severe allergic reaction: sudden swelling of the lips, mouth or throat, or difficulty breathing. Contact your child's prescriber or 111 today for mild chest pain, a resting heart rate above 120, fainting, hallucinations or thoughts of self-harm (call 999 if your child might act on them). Most other early effects can wait for the next review.
Emergency: call 999 or go to A&E
- Severe chest pain, or chest pain spreading to the arm, jaw or back
- Severe shortness of breath or struggling to breathe
- Suspected stroke (FAST)
- Seizures; loss of consciousness; suspected overdose
- Priapism (a painful erection lasting more than 2 hours): go to A&E straight away
- Your child might act on thoughts of harming themselves or someone else, or has harmed themselves
- Severe allergic reaction (anaphylaxis): sudden swelling of the lips, mouth, throat or tongue, or difficulty breathing or swallowing. Call 999.
Expected: mention at next review
Common in the first few weeks: no action usually needed
- Mild appetite reduction
- Mild headache weeks 1–2
- Dry mouth
- Mild sleep difficulty
- Mild irritability improving
Contact your prescriber within a few days
Not urgent: but worth discussing if ongoing
- Resting HR >100 bpm
- BP persistently raised
- Headaches beyond 2 weeks
- Mood not settling at 4 weeks
- Sleep severely disrupted beyond 4 weeks
- Significant weight loss
- Tics
- Blurred vision; Raynaud's
Contact prescriber or 111 today
Do not wait for a routine appointment
- Mild chest pain or chest tightness
- Resting HR >120 bpm
- Fainting
- Suicidal thoughts
- Hallucinations/psychosis
- New mania
- A new rash, without swelling or breathing problems
- Signs of very high blood pressure (severe headache, vision changes, confusion)
What you can safely try while waiting for a review
- Headache: drink more water; avoid caffeine after midday
- Appetite: eat breakfast before your dose; keep nutritious snacks for the evening
- Sleep: take your dose 30 minutes earlier; avoid screens after 10pm
- Anxiety: track whether worse on dose days vs off days: helps your prescriber
- Dry mouth: sugar-free gum; frequent small sips of water
Frequently asked questions about Tuzulby
Is Tuzulby the same as Equasym XL?
No. Both release methylphenidate in a 30:70 pattern over about 8 hours, but Tuzulby is a chewable tablet and Equasym XL is a capsule, they are made by different companies, and they have not been assessed as equivalent. Tuzulby is not on the NHS list of equivalent brands at all. Do not swap between them without your child's prescriber.
Can my child swallow Tuzulby whole instead of chewing it?
No. Tuzulby must be chewed, not swallowed whole or crushed. The prolonged-release granules are designed to survive chewing; swallowing the tablet whole changes how the dose is released. If chewing is a problem, talk to the prescriber about other options.
Can adults take Tuzulby?
No. Tuzulby is licensed for children and young people from 6 to under 18. It is not licensed for adults: methylphenidate in this form is not indicated for adults because safety and effectiveness have not been established in that age group. Adults are prescribed a brand whose licence includes adults.
Can the tablets be halved?
Yes. The tablets are functionally scored and can be divided into equal halves, which is how the 10 mg (half of 20 mg) and 15 mg (half of 30 mg) doses are given. Only halve a tablet when the prescriber has asked for that dose.
Is Tuzulby being recalled? (MHRA notice, July 2026)
No. On 23 July 2026 the MHRA issued a Class 4 medicines defect notification (EL(26)A/36) because the patient leaflet and SmPC supplied with certain batches did not list nosebleeds (epistaxis) as a possible side effect. The tablets themselves are not affected and were not recalled. The updated leaflet and SmPC include nosebleeds; if your child has frequent or heavy nosebleeds, mention it to the prescriber.
My pharmacy gave me a different brand. Is that okay?
Not without speaking to the prescriber first. Tuzulby is not on the NHS list of equivalent brands, so no other brand is listed as a match for it by the NHS, and it is the only chewable one. Ask your pharmacy to order Tuzulby specifically, and contact the prescriber if they cannot.
Does it interact with omeprazole or antacids?
No: Tuzulby is not known to interact with acid-reducing medicines such as omeprazole or famotidine, or with antacids.
I'm pregnant or breastfeeding: what do I need to know?
Pregnancy: Speak to your prescriber before changing anything, and do not stop without advice. The current evidence is summarised in the BUMPS leaflet on methylphenidate in pregnancy.
Breastfeeding: Methylphenidate is considered the stimulant of choice during breastfeeding (Breastfeeding Network). Milk levels are very low. You do not need to stop breastfeeding. Use the lowest effective dose, time doses after feeds where possible, and monitor your baby.
What should I ask my prescriber about Tuzulby?
Questions worth raising at your next review. You don't need to cover all of them: pick the ones that feel most relevant.
- Why Tuzulby for my child: is it mainly because of swallowing, or the 30:70 release pattern?
- What dose are we starting at, how will it go up, and what is the maximum?
- Which tablets can be halved, and when?
- What if the pharmacy can't get Tuzulby: I've heard it can't just be switched?
- Does my child's school day fit an 8-hour medicine, or would 12 hours be better?
- What side effects should I call you about?
Tuzulby: notes for GPs and clinicians
Clinical notes by Adam Odushola, ADHD Advanced Practitioner and Clinical Prescribing Pharmacist.
ClinicalBrand and mechanism
Tuzulby (Neuraxpharm UK Ltd; marketing authorisation July 2025; SmPC text 30 October 2025, eMC updated July 2026): prolonged-release chewable tablet, 30% IR / 70% PR, designed to deliver therapeutic plasma levels for approximately 8 hours; must be chewed, not swallowed whole or crushed. 20, 30 and 40 mg, functionally scored (10 and 15 mg by halving). Cherry flavour; contains aspartame (6.1 to 12.2 mg per tablet; PKU warning). SmPC lists no interaction with PPIs, H2-blockers or antacids. No food requirement.
ClinicalLicensing: 6 to under 18 only
Indicated as part of a comprehensive treatment programme for ADHD in children and adolescents 6–17 years old when remedial measures alone prove insufficient; treatment initiated under a specialist in childhood and/or adolescent behavioural disorders. SmPC: 'Methylphenidate is not indicated for use in adults in ADHD. Safety and efficacy have not been established in this age group.' Not for the elderly.
ClinicalDosing and Immediate Release Conversion
Start 20 mg once daily in the morning; titrate up or down weekly in 10, 15 or 20 mg increments; maximum 60 mg/day. Stop if no improvement after appropriate dose adjustment over one month. De-challenge at least yearly (preferably in school holidays) to assess continuing need.
Switching from immediate-release methylphenidate
| Immediate-release dose | Total daily dose | Tuzulby once each morning |
|---|---|---|
| 10 mg twice a day | 20 mg | 20 mg |
| 15 mg twice a day | 30 mg | 30 mg |
| 20 mg twice a day | 40 mg | 40 mg |
| 30 mg twice a day | 60 mg | 60 mg |
Give the same total daily dose as one morning dose (SmPC).
ClinicalNot in the SPS switching guidance
SPS (August 2025) does not list Tuzulby. Equasym XL is the only other 30:70 product and SPS states no other MR product is bioequivalent to Equasym XL; no equivalence between the two is assumed here. Prescribe and dispense by brand; any switch is a specialist decision with dose reassessment.
ClinicalMHRA Class 4 notice, 23 July 2026 (EL(26)A/36)
ClinicalKey interactions
MAOIs (contraindicated, 14-day washout); alcohol (ethylphenidate formation, dose-dumping); antihypertensives (reduced efficacy); coumarin anticoagulants (monitor INR).
ClinicalMonitoring
BP and HR at baseline, dose changes, minimum every 6 months. Height and weight on a growth chart at each review; consider treatment breaks if growth or appetite is affected.
ClinicalPregnancy and breastfeeding
Pregnancy (BUMPS/UKTIS January 2023): Individual risk-benefit; do not advise abrupt discontinuation.
Breastfeeding (BfN April 2025): Stimulant of choice; very low RID; no need to stop breastfeeding.
This guide is written for educational purposes and does not constitute medical advice. Always follow the guidance of your prescriber or pharmacist. If you have concerns about your medication, contact your clinical team.
Sources
- NICE guideline NG87: Attention deficit hyperactivity disorder: diagnosis and management. NICE
- Methylphenidate hydrochloride (BNF drug monograph). BNF, NICE
- Tuzulby 20 mg prolonged-release chewable tablets: Summary of Product Characteristics (SmPC). electronic medicines compendium (eMC)
- Prescribing and switching between modified-release methylphenidate. Specialist Pharmacy Service (SPS)
- MHRA Class 4 Medicines Defect Notification EL(26)A/36: Tuzulby prolonged-release chewable tablets (Neuraxpharm UK Ltd), 23 July 2026. Community Pharmacy England
- Use of methylphenidate in pregnancy (patient leaflet). BUMPS / UK Teratology Information Service
- ADHD and breastfeeding (factsheet). The Breastfeeding Network
About this guide
- Written and clinically reviewed by
- Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
- First published
- Last updated
- Last reviewed
- Next review
- What changed
- October 2026: clearer advice on when to call 999 (severe or spreading chest pain, severe breathlessness, or thoughts of self-harm you might act on) and when to get help the same day. Side effect frequencies now use the categories in the product information (SmPC). The headache advice now says drinking enough water may help, instead of naming dehydration as the cause. Unsupported comparisons with 50:50 brands (a gentler start, a smaller first peak, a more sustained afternoon, who it suits) were removed.
“Last updated” is when the content last changed. “Last reviewed” is when it was last checked against current sources.
How this content is written, sourced and checked: editorial policy
Spotted an error? Report it by email. This is for website feedback only. It can’t give advice about your own treatment.
Changing from Tuzulby? Check the dose conversion
See how your dose lines up with immediate-release methylphenidate or another brand, and how the day’s doses would be spaced. It is a guide for the conversation with your prescriber, not a prescription.
20 mg a day of immediate-release methylphenidate, for example 10 mg twice a day
Tuzulby 20 mg is listed against a total of 20 mg a day of immediate-release methylphenidate, taken twice a day, in the manufacturer’s conversion table. Each immediate-release dose lasts about 3 to 5 hours, so the day’s cover changes.
- Immediate-release doses are spaced through the day; the last one is usually taken by mid-afternoon to protect sleep.
- This is a guide for the conversation with your prescriber, not a prescription. Your prescriber sets the dose, the start date and the review.
Doses from each product’s manufacturer conversion table and the NHS list of equivalent brands. Read more about switching methylphenidate brands safely.