methylphenidate (Ritalin, Concerta, Methylin, Daytrana)

Methylphenidate is a medication that stimulates the central nervous system (CNS or brain) in a manner that is similar to the amphetamines; however, its actions are milder than those of the amphetamines. An additional difference is that methylphenidate produces more noticeable effects on mental activities than on motor activities. Methylphenidate and amphetamines both have abuse potential. In treating children with attention-deficit hyperactivity disorder (ADHD), methylphenidate produces a calming effect. This results in a reduction in hyperactivity and an improvement in attention span. Methylphenidate also is used to treat excessive sleepiness. Methylphenidate was approved by the FDA in 1955.

Ritalin, Ritalin SR, Ritalin LA, Concerta, Methylin, Methylin ER, Daytrana, Quillivant XR Metadate CD, Metadate ER

Yes.

yes

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 important side effects of methylphenidate 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 occurring with methylphenidate use. 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.

Methylphenidate is habit forming and should be used cautiously in individuals with a history of drug or alcohol abuse. Chronic abuse can lead to tolerance and psychological dependence leading to abnormal behavior.

Priapism defined as painful and nonpainful penile erection lasting more than 4 hours, have been reported in pediatric and adult patients treated with stimulants. The erection usually resolves when the drug is stopped. Prompt medical attention is required in the event of suspected priapism.

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.

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.