Methylphenidate Side Effects
Some side effects of methylphenidate may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to methylphenidate: oral capsule extended release, oral powder for reconstitution extended release, oral solution, oral tablet, oral tablet chewable, oral tablet extended release
Other dosage forms:
Get emergency medical help if you have any of these signs of an allergic reaction while taking 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;
a light-headed feeling, like you might pass out;
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; or
dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).
Common 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.
For Healthcare Professionals
Applies to methylphenidate: oral capsule extended release, oral powder for reconstitution extended release, oral solution, oral tablet, oral tablet chewable, oral tablet extended release, transdermal film extended release
Nervous system side effects have frequently included tic. Convulsions and migraine have also been reported. Dizziness, drowsiness, dyskinesia, and Tourette's syndrome have been reported rarely. Neuroleptic malignant syndrome (NMS) and reversible ischemic neurological deficit have been reported very rarely.
Most reported cases of neuroleptic malignant syndrome (NMS) involved patients who were treated concomitantly with other drugs associated with NMS.
Nervousness and insomnia may be controllable by reducing the dosage and omitting the drug in the afternoon or evening.
It is unclear whether CNS stimulant drugs (i.e., dextroamphetamine, methylphenidate, amphetamine-dextroamphetamine) have a role in either the development or worsening of tic disorders such as Tourette's syndrome. According to several case reports, use of CNS stimulant medications may have precipitated or exacerbated tic disorders in some patients with ADHD. Based on these cases, in Tourette's-susceptible patients, CNS stimulants may exacerbate motor and phonic tics that do not subside following discontinuation of the offending agent. In several controlled studies involving patients with ADHD and tic disorders, in the majority of patients, tics did not increase following use of CNS stimulants. In addition, controlled studies have not found that methylphenidate worsens motor tics in Tourette's syndrome nor has it increased tics in patients without Tourette's. However, it should be noted that tics were reported in 7% of patients using the methylphenidate patch compared to 1% to those taking it orally. Additional studies are required in order to clarify this association.
Gastrointestinal side effects have included nausea, vomiting, and abdominal pain. Nausea and vomiting appears to occur more frequently with the transdermal patch compared with oral administration.
Cardiovascular side effects have rarely included changes in blood pressure and pulse rate, cerebral arteritis, occlusion, angina, arrhythmia, palpitations, bradycardia, extrasystoles, ventricular extrasystoles, supraventricular tachycardia, Raynaud's phenomenon, and tachycardia. A case of cardiac arrest has also been reported. Additionally, cerebrovascular vasculitis, cerebral hemorrhages, and cerebrovascular accidents have been reported.
Other side effects have rarely included headache, peripheral coldness, and auricular swelling. A withdrawal syndrome has been reported with the abrupt discontinuation of methylphenidate.
Hepatic side effects have rarely included abnormal liver function ranging from transaminase elevation to hepatic coma; however, causality has not been established. Increased blood alkaline phosphatase, increased blood bilirubin, and increased hepatic enzymes have also been reported.
Hematologic side effects have rarely included leukopenia, anemia, pancytopenia, thrombocytopenic purpura, and thrombocytopenia; however, causality has not been established.
Psychiatric side effects have frequently included emotional lability and insomnia. Hallucination, mania, obsessive-compulsive disorder, and nervousness have also been reported. Emotional lability and insomnia appear to occur more frequently with the transdermal patch compared with oral administration. In patients wearing the transdermal patch for 12 hrs a day, the incidence of insomnia was 30%. Transient depressed mood and aggressive behavior have been reported rarely; however, causality has not been determined.
Dermatologic side effects have included bullous conditions, exfoliative conditions, urticarias, pruritus, rashes, eruptions, erythema, and exanthemas. Scalp hair loss has been reported rarely; however, causality has not been determined.
Methylphenidate topical patch is a dermal irritant. The resulting erythema does not typically cause an interference or discontinuation of treatment. However, further evaluation should be sought, if erythema, edema, and/or papules do not resolve or significantly reduce within 24 hours of patch removal. Consideration should be given to sensitization if erythema is accompanied by edema, papules, vesicles, or other evidence of more intense local reactions. Diagnosis of allergic contact dermatitis should include appropriate diagnostic testing.
Ocular side effects have included visual disturbances, mydriasis, difficulties with accommodation, diplopia, and blurring of vision.
Respiratory side effects associated with methylphenidate topical patch have frequently included nasopharyngitis and nasal congestion.
Metabolic side effects have included anorexia, decreased appetite, and weight loss (primarily with prolonged therapy). Anorexia, decreased appetite, and weigh loss appears to occur more frequently with the transdermal patch compared with oral administration. In patients wearing the transdermal patch for 12 hrs a day, the incidence of anorexia was 46%.
Local side effects associated with the topical patch have included application site reactions such as bleeding, bruising, burn, burning, dermatitis, discharge, discoloration, discomfort, dryness, eczema, edema, erosion, erythema, excoriation, exfoliation, fissure, hyperpigmentation, hypopigmentation, induration, infection, inflammation, irritation, pain, papules, paresthesia, pruritus, rash, scab, swelling, ulcer, urticaria, vesicles, and warmth.
One subject has been reported to have experienced erythema and edema at methylphenidate transdermal system application sites with concurrent urticarial lesions on the abdomen and legs resulting in treatment discontinuation. This subject was not transitioned to oral methylphenidate.
Hypersensitivity side effects including generalized erythematous and urticarial rashes, allergic contact dermatitis, angioedema, and anaphylaxis have been reported.
Musculoskeletal side effects including arthralgia, myalgia, and muscle twitching have been reported.
More methylphenidate resources
- methylphenidate MedFacts Consumer Leaflet (Wolters Kluwer)
- methylphenidate Oral, Transdermal Advanced Consumer (Micromedex) - Includes Dosage Information
- Concerta extended-release tablets MedFacts Consumer Leaflet (Wolters Kluwer)
- Concerta Consumer Overview
- Concerta Prescribing Information (FDA)
- Daytrana system MedFacts Consumer Leaflet (Wolters Kluwer)
- Daytrana Prescribing Information (FDA)
- Daytrana Consumer Overview
- Metadate CD controlled-release capsules MedFacts Consumer Leaflet (Wolters Kluwer)
- Metadate CD Prescribing Information (FDA)
- Metadate ER Prescribing Information (FDA)
- Methylin Prescribing Information (FDA)
- Methylin ER controlled-release tablets MedFacts Consumer Leaflet (Wolters Kluwer)
- Methylphenidate Hydrochloride Monograph (AHFS DI)
- Quillivant XR Prescribing Information (FDA)
- Quillivant XR suspension MedFacts Consumer Leaflet (Wolters Kluwer)
- Quillivant XR Consumer Overview
- Ritalin Prescribing Information (FDA)
- Ritalin Consumer Overview
- Ritalin LA Prescribing Information (FDA)
- Ritalin LA extended-release capsules MedFacts Consumer Leaflet (Wolters Kluwer)
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