1. Introduction
Methylphenidate is a central nervous system stimulant commonly used to manage attention deficit hyperactivity disorder (ADHD) and narcolepsy in children. It improves focus, attention, and impulse control by increasing the availability of neurotransmitters such as dopamine and norepinephrine in the brain. Common brand names include Ritalin, Concerta, and Medikinet.
2. Indications
- Attention deficit hyperactivity disorder (ADHD)
- Narcolepsy (less common in children)
3. Dosage
For ADHD (Children ≥6 years):
- Immediate-release (IR): Start with 5 mg twice daily (before breakfast and lunch). Increase by 5–10 mg weekly as needed.
- Maximum: 60 mg/day.
- Extended-release (ER): Start with 18–20 mg once daily in the morning. Adjust in increments of 10–20 mg weekly.
- Maximum: 60 mg/day.
For Narcolepsy (Children ≥6 years):
- Start with 10 mg/day in divided doses. Increase gradually based on response.
4. Administration
- Administer in the morning to avoid sleep disturbances.
- Immediate-release formulations should be given 30–45 minutes before meals.
- Extended-release tablets should be swallowed whole; do not crush or chew.
- Avoid taking late in the afternoon or evening.
5. Forms Available
- Immediate-release tablets: 5 mg, 10 mg, 20 mg
- Extended-release tablets/capsules: 18 mg, 27 mg, 36 mg, 54 mg (Concerta); 10 mg to 60 mg (Medikinet)
- Oral solution: 5 mg/5 mL, 10 mg/5 mL
- Chewable tablets: 5 mg, 10 mg
6. Side Effects
6.1 Common Side Effects:
- Loss of appetite
- Insomnia
- Stomach pain
- Headache
- Irritability
6.2 Less Common Side Effects:
- Increased heart rate
- Anxiety
- Weight loss
- Dizziness
6.3 Rare but Serious Side Effects:
- Growth suppression (with prolonged use)
- Severe mood swings or aggression
- Tics or exacerbation of pre-existing tics
- Cardiovascular complications (e.g., hypertension, arrhythmias)
- Psychosis (hallucinations, paranoia)
7. Warnings
- Cardiovascular Risks: Avoid use in children with pre-existing heart conditions or structural abnormalities.
- Psychiatric Risks: Can exacerbate anxiety, depression, or bipolar disorder.
- Abuse Potential: Methylphenidate is a controlled substance with potential for misuse or dependency.
- Growth Suppression: Monitor height and weight periodically in children.
8. Precautions
- Ensure a comprehensive diagnosis of ADHD before initiating treatment.
- Use with caution in children with a history of seizures or tics.
- Avoid abrupt discontinuation to prevent withdrawal symptoms.
9. Interactions
- Monoamine oxidase inhibitors (MAOIs): Risk of hypertensive crisis. Avoid concurrent use or within 14 days of MAOI discontinuation.
- Antihypertensives: Reduced efficacy due to opposing effects on blood pressure.
- CNS stimulants or caffeine: Increased risk of side effects like insomnia and restlessness.
- Antipsychotics: Reduced efficacy of both drugs due to opposing mechanisms.
10. Monitoring Parameters
- Monitor for improvement in ADHD symptoms (e.g., attention, impulsivity).
- Regularly check height, weight, and appetite to assess growth.
- Assess blood pressure, heart rate, and signs of cardiovascular issues.
- Watch for mood or behavioural changes, including increased aggression or anxiety.
11. Use in Children
- Approved for use in children aged 6 years and older.
- Not recommended for children under 6 years due to limited safety and efficacy data.
12. Use in Pregnancy
- Not applicable for children.
13. Use in Elderly
- Not applicable for children.
14. Use in Kidney Disease
- No specific dosage adjustment required, but caution is advised in severe renal impairment.
15. Use in Liver Disease
- Use with caution in moderate to severe liver impairment, as metabolism may be affected.
16. Patient Counselling Points
- Administer methylphenidate exactly as prescribed. Do not increase or skip doses without consulting your doctor.
- Take in the morning to minimise the risk of insomnia.
- Report any unusual mood changes, aggression, or chest pain immediately.
- Encourage healthy eating habits to address appetite suppression and monitor growth.
- Store securely to prevent misuse or accidental ingestion by others.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Ritalin | Novartis | 10 mg Immediate-Release Tablet | $25 (30 tablets) |
Concerta | Janssen | 36 mg Extended-Release Tablet | $300 (30 tablets) |
Medikinet | Flynn Pharma | 20 mg Extended-Release Capsule | $200 (30 capsules) |
Quillivant XR | Pfizer | 5 mg/mL Oral Solution | $250 (150 mL) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Methylphenidate?
Methylphenidate is a central nervous system stimulant used to treat ADHD and narcolepsy in children.
2. How does Methylphenidate work?
It increases dopamine and norepinephrine levels in the brain, improving focus, attention, and impulse control.
3. What is the recommended dosage for children?
Dosages vary by formulation and age, starting at 5 mg twice daily (IR) or 18 mg once daily (ER).
4. At what age can children start Methylphenidate?
It is approved for children aged 6 years and older.
5. Can Methylphenidate affect growth in children?
Yes, it may cause growth suppression with long-term use. Regular monitoring of height and weight is essential.
6. What are the common side effects of Methylphenidate?
Loss of appetite, insomnia, stomach pain, and headaches are common side effects.
7. Can Methylphenidate worsen anxiety?
Yes, it can exacerbate pre-existing anxiety or mood disorders in some children.
8. How should Methylphenidate be administered?
Administer in the morning, with or without food. Extended-release tablets should not be crushed or chewed.
9. Is Methylphenidate addictive?
Yes, it has a potential for misuse and dependency, especially if not taken as prescribed.
10. Can Methylphenidate be taken with other ADHD medications?
Combination therapy is rare; consult a healthcare provider before combining medications.
11. How long does Methylphenidate take to work?
It typically starts working within 30–60 minutes after administration.
12. What should I do if my child misses a dose?
Skip the missed dose and continue with the next scheduled dose. Do not double up doses.
13. Can Methylphenidate be stopped suddenly?
No, abrupt discontinuation may cause withdrawal symptoms. Discuss tapering with your doctor.
14. Is Methylphenidate safe for long-term use?
Yes, with regular monitoring of growth, mood, and cardiovascular health.
15. Can my child take Methylphenidate with food?
Yes, it can be taken with or without food. Food may help minimise stomach upset.