methylphenidate, Ritalin, Ritalin SR, Ritalin LA, Concerta, Methylin, Methylin ER (cont.)

Pharmacy Author:
Medical and Pharmacy Editor:

PRESCRIBED FOR: Methylphenidate is used in the treatment of narcolepsy (uncontrollable sleepiness) and children with ADHD.

DOSING: The dose of methylphenidate is adjusted based on patients' responses. It may be given once, twice, or three times daily depending on formulation.

The recommended dose for Concerta is 18-72 mg once daily.

The recommended dose for Ritalin LA is 10-60 mg once daily and for regular Ritalin the recommended dose is 10-60 mg daily in 2 or 3 divided doses.

DRUG INTERACTIONS: The stimulation effects of methylphenidate on the CNS can be additive when used with other chemicals and medications that stimulate the CNS, such as caffeine (found in coffee, tea, or cola drinks), and pseudoephedrine or phenylpropanolamine (found in many cough-and-cold preparations). The combination of methylphenidate and monoamine oxidase inhibitors (MAOIs), for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane), should not be taken with methylphenidate since a hypertensive crisis (severely high blood pressure) may occur. Moreover, methylphenidate should not be given to any patient within 14 days of receiving such an inhibitor. The blood pressure lowering effects of medications used to treat hypertension may be reduced by methylphenidate. As a result, blood pressure needs to be monitored when starting or stopping methylphenidate in patients who are receiving medications for controlling their blood pressure.

PREGNANCY: There are no adequate studies of methylphenidate in pregnant women.

NURSING MOTHERS: It is not known if methylphenidate is secreted in breast milk.

SIDE EFFECTS: The most common side effects with methylphenidate are nervousness, agitation, anxiety, and insomnia. Insomnia can be limited by taking the drug before noon. For children taking methylphenidate for ADHD, the most common side effects are loss of appetite, abdominal pain, weight loss, and sleep problems. The rate and severity of these side effects are less than that seen with dextroamphetamine (Dexedrine). Other side effects include nausea, vomiting, dizziness, palpitations, headache, involuntary movements, chest pain, increased heart rate, increased blood pressure, and psychosis. There have been rare reports of Tourette's syndrome, a syndrome in which there are uncontrollable tics such as grimacing. Because of the potential for side effects, methylphenidate should be used with caution by patients who have relatives with Tourette's syndrome or have the syndrome themselves or who have severe anxiety, seizures, psychosis, emotional instability, major depression, glaucoma, or motor tics. Sudden discontinuation of long-term methylphenidate therapy may unmask depression. Gradual withdrawal, under supervision, is recommended.

Medically Reviewed by a Doctor on 2/4/2014


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