Class
- Central Nervous System (CNS) Stimulant
Indications
- Attention Deficit Hyperactivity Disorder (ADHD) in children (6+ years) and adults
- Narcolepsy
Mechanism of Action
- Blocks reuptake of dopamine and norepinephrine in the brain
- Increases concentration of these neurotransmitters
- Enhances attention and focus, reduces impulsivity and hyperactivity
Dosage and Administration
- Immediate-Release Tablets:
- Start with low dose; adjust based on response
- Typically taken 2–3 times daily
- Extended-Release Tablets/Capsules:
- Taken once daily in the morning
- Provides symptom control throughout the day
- Transdermal Patch:
- Applied once daily to the skin
- Worn for a specified duration; provides continuous medication release
- Dosage individualized; follow healthcare provider’s instructions
- Can be taken with or without food; food may help reduce stomach upset
- Avoid late-day doses to prevent insomnia
Forms Available
- Immediate-release tablets: 5 mg, 10 mg, 20 mg
- Extended-release tablets/capsules: 10 mg to 80 mg
- Chewable tablets, oral solution, and transdermal patch also available
Brand Names and Manufacturers
- Ritalin (Novartis)
- Concerta (Janssen Pharmaceuticals)
- Metadate (UCB Inc.)
- Daytrana (transdermal patch, Noven Pharmaceuticals)
- Quillivant XR (Pfizer)
- Generic versions available
Cost
- Varies by brand, formulation, and insurance coverage
- Generic versions generally more affordable
- Extended-release formulations typically more expensive than immediate-release
Contraindications
- Known hypersensitivity to methylphenidate or product components
- Glaucoma
- Severe anxiety, tension, or agitation
- Family history or diagnosis of Tourette syndrome or tics
- Concurrent or recent (within 14 days) use of monoamine oxidase inhibitors (MAOIs)
Precautions
- Monitor for cardiovascular issues; caution in patients with heart defects or high blood pressure
- Potential for abuse and dependence; assess risk before prescribing
- May exacerbate anxiety, agitation, or psychosis
- Monitor growth in pediatric patients; may cause slowed growth
- Use caution in patients with a history of seizures
- Avoid alcohol; may exacerbate side effects
Side Effects
- Common:
- Decreased appetite
- Insomnia
- Headache
- Stomach ache
- Nervousness
- Weight loss
- Less Common:
- Increased heart rate
- Elevated blood pressure
- Mood swings
- Dizziness
- Dry mouth
- Rare but Serious:
- Cardiac events (e.g., heart attack, stroke)
- Psychiatric symptoms (e.g., hallucinations, mania)
- Peripheral vasculopathy, including Raynaud’s phenomenon
- Priapism (prolonged erections)
Drug Interactions
- Anticoagulants: May enhance effects; monitor for bleeding
- Antihypertensives: May reduce effectiveness; monitor blood pressure
- MAOIs: Contraindicated; risk of hypertensive crisis
- SSRIs: Increased risk of serotonin syndrome
- Antipsychotics: May reduce efficacy of both medications
- Alcohol: May exacerbate side effects; avoid concurrent use
Monitoring Parameters
- Before Starting Treatment:
- Baseline cardiovascular evaluation
- Assessment for history of substance abuse
- Evaluation for psychiatric disorders
- During Treatment:
- Regular monitoring of blood pressure and heart rate
- Assessment of growth in children
- Monitoring for signs of misuse, abuse, or dependence
- Periodic evaluation of efficacy and side effects
- Regular follow-ups to assess symptom improvement and side effects
Patient Counseling Points
- Take medication exactly as prescribed; do not adjust dose without consulting healthcare provider
- Do not crush or chew extended-release formulations; swallow whole
- Apply transdermal patch to clean, dry area; rotate application sites
- Report any chest pain, shortness of breath, or fainting immediately
- Inform healthcare provider of any new or worsening psychiatric symptoms
- Store medication securely to prevent misuse or abuse
- Keep track of medication to prevent accidental overdose
- Discuss potential for drug interactions; provide a list of all current medications
- Do not share medication with others; it is prescribed based on individual needs
- Attend all scheduled follow-up appointments for monitoring
FAQs About Methylphenidate
Q1: How long does it take for methylphenidate to start working?
- Immediate-release forms: Effects can be felt within 30 to 60 minutes
- Extended-release forms: May take longer to feel effects; designed for prolonged action
Q2: Can adults take methylphenidate for ADHD?
- Yes, methylphenidate is approved for use in adults with ADHD
Q3: Is methylphenidate addictive?
- It has potential for abuse and dependence; use only as prescribed and monitor for signs of misuse
Q4: Can methylphenidate be taken during pregnancy?
- Consult your healthcare provider; potential risks should be weighed against benefits
Q5: What should I do if I miss a dose?
- Take as soon as you remember, but skip if it’s close to the next dose; do not double doses
Q6: Are there dietary restrictions while taking methylphenidate?
- Avoid alcohol; no specific food restrictions, but maintain a balanced diet to support overall health
Q7: Can methylphenidate cause growth suppression in children?
- It may slow growth; regular monitoring of height and weight is recommended
Q8: How should methylphenidate be stored?
- Store at room temperature, away from moisture and heat; keep out of reach of children
Q9: Can methylphenidate be used for conditions other than ADHD and narcolepsy?
- Off-label uses exist but should only be considered under close medical supervision
Q10: What are the signs of methylphenidate overdose?
- Symptoms may include vomiting, agitation, tremors, muscle twitching, seizures, confusion, hallucinations, sweating, flushing, headache, fever, fast or irregular heartbeat; seek immediate medical attention if overdose is suspected
Q11: Can methylphenidate be taken with other medications?
- Some medications may interact; always inform your healthcare provider of all medications and supplements you are taking
Q12: Is it safe to drive or operate machinery while taking methylphenidate?
- Methylphenidate may impair your ability to perform these activities; avoid until you know how the medication affects you
