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Methylphenidate

Pronunciation

Generic Name: methylphenidate (oral) (METH il FEN i date)
Brand Names: Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, Quillivant XR, Ritalin, Ritalin LA, Ritalin-SR

What is methylphenidate?

Methylphenidate is a central nervous system stimulant. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.

Methylphenidate is used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and narcolepsy.

Methylphenidate may also be used for purposes not listed in this medication guide.

Important information

You should not use methylphenidate if you have glaucoma, tics or Tourette's syndrome, or severe anxiety, tension, or agitation.

Do not use methylphenidate if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

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Methylphenidate may be habit forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

Before taking this medicine

Do not use methylphenidate if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

You should not use this medication if you are allergic to methylphenidate or if you have:

  • glaucoma;

  • a personal or family history of tics (muscle twitches) or Tourette's syndrome; or

  • severe anxiety, tension, or agitation (methylphenidate can make these symptoms worse).

Tell your doctor if you have any heart problems. Some stimulants have caused sudden death in people with serious heart problems or congenital heart defects.

Tell your doctor if you have:

  • heart disease, heart rhythm disorder;

  • coronary artery disease (hardened arteries); or

  • history of heart attack.

To make sure methylphenidate is safe for you, tell your doctor if you have:

  • high blood pressure;

  • a personal or family history of mental illness, psychotic disorder, bipolar illness, depression, or suicide attempt;

  • peripheral vascular disease such as Raynaud's syndrome;

  • epilepsy or other seizure disorder;

  • tics (muscle twitches) or Tourette's syndrome;

  • a stomach disorder; or

  • a history of drug or alcohol addiction.

Methylphenidate may be habit forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction.

FDA pregnancy category C. It is not known whether methylphenidate will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

See also: Pregnancy and breastfeeding warnings (in more detail)

Methylphenidate can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Long-term use of methylphenidate can slow a child's growth. Tell your doctor if the child using this medication is not growing or gaining weight properly.

Do not give methylphenidate to a child younger than 6 years old without a doctor's advice.

How should I take methylphenidate?

Take methylphenidate exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Some brands of this medicine should be taken at least 30 minutes before a meal. Extended-release methylphenidate can be taken with or without food. Follow the directions on your medicine label.

The chewable methylphenidate tablet must be chewed before you swallow it.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Shake the oral suspension (Quillivant) well just before you measure a dose.

Do not crush, chew, or break an extended-release methylphenidate tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.

You may open the extended-release capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

To prevent sleep problems, take this medication in the morning.

If you need surgery, tell the surgeon ahead of time that you are using methylphenidate. You may need to stop using the medicine for a short time.

Store methylphenidate at room temperature away from moisture and heat.

Keep track of the amount of medicine used from each new bottle. Methylphenidate is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is later than 6:00 p.m. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methylphenidate can be fatal.

What should I avoid?

Methylphenidate may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid drinking alcohol, especially if you take extended-release methylphenidate. Alcohol may cause the medicine to be released into the bloodstream too fast.

Methylphenidate side effects

Get emergency medical help if you have any of these signs of an allergic reaction to methylphenidate: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop taking methylphenidate and call your doctor at once if you have:

  • new or worsening symptoms such as mood swings, aggression, hostility, or changes in personality or behavior;

  • panic, delusion, extreme fear, hallucinations, unusual behavior, motor tics (muscle twitches);

  • chest pain, fast or slow heart rate, pounding heartbeats or fluttering in your chest, feeling like you might pass out;

  • numbness, pain, cold feeling, unexplained wounds, or skin color changes (pale, red, or blue appearance) in your fingers or toes;

  • sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;

  • easy bruising, purple spots on your skin;

  • fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;

  • penis erection that is painful or lasts 4 hours or longer (rare); or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Common methylphenidate side effects may include:

  • feeling nervous or irritable, sleep problems (insomnia);

  • loss of appetite, weight loss;

  • headache, dizziness, drowsiness; or

  • stomach pain, nausea, vomiting, upset stomach.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Methylphenidate dosing information

Usual Adult Dose of Methylphenidate for Attention Deficit Disorder:

Immediate release tablets including chewable tablets (Ritalin, Methylin, methylphenidate):
Initial Dose: 10 mg orally 2 or 3 times daily, preferably 30 to 45 minutes before breakfast and lunch, and a third dose between 2 and 4 PM, if necessary. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM.
Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg per day. In some patients, 10 to 15 mg daily may suffice. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM.

Sustained release tablets (Ritalin SR, Metadate ER):
Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets.
Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed.

Extended release capsules (Metadate CD):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 20 mg up to a maximum of 60 mg once daily in the morning. The capsules should not be opened, chewed, or crushed.

Extended release oral suspension (Quillivant XR):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 10 mg to 20 mg up to a maximum of 60 mg once daily in the morning.
Comments: Vigorously shake for at least 10 seconds before each dose. Administer only with the dosing dispenser provided. Wash dispenser after each use (dishwasher safe).

Extended release capsules (Ritalin LA):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
For patients already receiving methylphenidate:
If switching from immediate release tablets 10 mg twice a day or sustained release tablets 20 mg/day: 20 mg once daily.
If switching from immediate release tablets 15 twice a day: 30 mg once daily.
If switching from immediate release tablets 20 mg twice a day or sustained release tablets 40 mg/day: 40 mg once daily.
If switching from immediate release tablets 30 twice a day or sustained release tablets 60 mg/day: 60 mg once daily.
Maintenance Dose: Doses may be increased weekly in increments of 10 mg up to a maximum of 60 mg once daily in the morning. For patients unable to swallow the capsule, the contents may be sprinkled on applesauce and administered.

Extended release tablets (Concerta):
Initial: (Methylphenidate- naive patients) 18 mg once daily in the morning before breakfast.
For patients already receiving methylphenidate:
If switching from immediate release tablets 5 mg 2 or 3 times a day: 18 mg once daily.
If switching from immediate release tablets 10 mg 2 or 3 times a day: 36 mg once daily.
If switching from immediate release tablets 15 mg 2 or 3 times a day: 54 mg once daily.
If switching from immediate release tablets 20 mg 2 or 3 times a day: 72 mg once daily.
.
Maintenance: May increase by 18 mg increments at weekly intervals up to a maximum of 72 mg once daily in the morning before breakfast. Tablets should not be chewed, divided, or crushed.

Transdermal system (Daytrana):
Dose should be titrated to effect based on the following recommended titration schedule:
Week 1: 10 mg/9 hour patch daily
Week 2: 15 mg/9 hour patch daily
Week 3: 20 mg/9 hour patch daily
Week 4: 30 mg/9 hour patch daily
It is recommended to apply the patch topically to hip area 2 hours before an effect is needed and to remove the patch 9 hours after application. However, wear time should be individualized according to the needs and response of the individual patient.

Usual Adult Dose for Narcolepsy:

Immediate release tablets (Ritalin, Methylin, methylphenidate):
Initial Dose: 10 mg orally 2 or 3 times daily, preferably 30 to 45 minutes before meals.
Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg per day. In some patients, 10 to 15 mg daily may suffice. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM.

Sustained release tablets (Ritalin SR, Metadate ER):
Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets.
Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed.

Extended release capsules (Metadate CD):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 20 mg up to a maximum of 60 mg once daily in the morning. The capsules should not be opened, chewed, or crushed.

Extended release tablets (Concerta):
Initial: (Methylphenidate- naive patients) 18 mg once daily in the morning before breakfast.
For patients already receiving methylphenidate:
If switching from immediate release tablets 5 mg 2 or 3 times a day: 18 mg once daily.
If switching from immediate release tablets 10 mg 2 or 3 times a day: 36 mg once daily.
If switching from immediate release tablets 15 mg 2 or 3 times a day: 54 mg once daily.
If switching from immediate release tablets 20 mg 2 or 3 times a day: 72 mg once daily.
.
Maintenance: May increase by 18 mg increments at weekly intervals up to a maximum of 72 mg once daily in the morning before breakfast. Tablets should not be chewed, divided, or crushed.

Usual Adult Dose of Methylphenidate for Depression:

The manufacturers warn that methylphenidate should not be used for severe depression of either exogenous or endogenous origin.

Some studies have shown methylphenidate to be an effective adjuvant medication when used along with other standard antidepressant drug therapy (SSRIs or TCAs) for depression. However, no specific coadministered antidepressant medication or dose of methylphenidate has been generally accepted as optimum therapy. Therefore, no specific therapy or dose of methylphenidate can be recommended at this time for use in patients with depression.

Usual Pediatric Dose of Methylphenidate for Attention Deficit Disorder:

6 years or older:
Immediate release tablets including chewable tablets (Ritalin, Methylin, methylphenidate):
Initial Dose: 2.5 to 5 mg orally twice daily, taken 30 to 45 minutes before breakfast and lunch.
Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg/day in 2 or 3 divided doses. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM.

Sustained release tablets (Ritalin SR, Metadate ER):
Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets.
Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed.

Extended release capsules (Metadate CD):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 20 mg up to a maximum of 60 mg once daily in the morning. Capsules should not be opened, chewed, or crushed.

Extended release oral suspension (Quillivant XR):
Initial Dose: 20 mg orally once a day in the morning before breakfast.
Maintenance Dose: Doses may be increased weekly in increments of 10 mg to 20 mg up to a maximum of 60 mg once daily in the morning.
Comments: Vigorously shake for at least 10 seconds before each dose. Administer only with the dosing dispenser provided. Wash dispenser after each use (dishwasher safe).

Extended release tablets (Concerta):
Initial: (Methylphenidate- naive patients) 18 mg once daily in the morning before breakfast.
If switching from immediate release tablets 5 mg 2 or 3 times a day: 18 mg once daily.
If switching from immediate release tablets 10 mg 2 or 3 times a day: 36 mg once daily.
If switching from immediate release tablets 15 mg 2 or 3 times a day: 54 mg once daily.
If switching from immediate release tablets 20 mg 2 or 3 times a day: 72 mg once daily.
Maximum dose: 6 years to 12 years: 54 mg/day, over 12 years: 72 mg/day; do not exceed 2 mg/kg/day.
Maintenance: May increase by 18 mg increments at weekly intervals up to a maximum of 72 mg once daily in the morning before breakfast. Tablets should not be chewed, divided, or crushed.

Transdermal system (Daytrana):
Dose should be titrated to effect based on the following recommended titration schedule:
Week 1: 10 mg/9 hour patch daily
Week 2: 15 mg/9 hour patch daily
Week 3: 20 mg/9 hour patch daily
Week 4: 30 mg/9 hour patch daily
It is recommended to apply the patch topically to hip area 2 hours before an effect is needed and to remove the patch 9 hours after application. However, wear time should be individualized according to the needs and response of the individual patient.

What other drugs will affect methylphenidate?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with methylphenidate, especially:

  • clonidine;

  • guanethidine;

  • a blood thinner such as warfarin, Coumadin;

  • an antidepressant--amitriptyline, citalopram, doxepin, fluoxetine, nortriptyline, paroxetine, sertraline, and others;

  • cold or allergy medicine that contains a decongestant;

  • medications to treat high or low blood pressure;

  • seizure medicine--phenobarbital, phenytoin, primidone; or

  • stimulant medications or diet pills.

This list is not complete. Other drugs may interact with methylphenidate, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about methylphenidate.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use methylphenidate only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2014 Cerner Multum, Inc. Version: 14.03. Revision Date: 2014-01-03, 4:43:19 PM.

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