Ritalin Side Effects

Generic name: methylphenidate

Note: This page contains side effects data for the generic drug methylphenidate. It is possible that some of the dosage forms included below may not apply to the brand name Ritalin.

For the Consumer

Applies to methylphenidate: oral capsule extended release, oral powder for suspension extended release, oral solution, oral tablet, oral tablet chewable, oral tablet extended release, oral tablet extended release chewable

As well as its needed effects, methylphenidate (the active ingredient contained in Ritalin) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking methylphenidate, check with your doctor immediately:

More common:

• Fast heartbeat

Less common:

• Chest pain
• fever
• joint pain
• skin rash or hives

Rare

• Black, tarry stools
• blood in the urine or stools
• blurred vision or other changes in vision
• convulsions
• crusting, dryness, or flaking of the skin
• muscle cramps
• pinpoint red spots on the skin
• scaling, severe redness, soreness, or swelling of the skin
• uncontrolled vocal outbursts or tics (uncontrolled and repeated body movements)
• unusual bleeding or bruising

Incidence not known:

• Confusion
• depression
• feeling like surroundings are not real
• numbness of the hands
• painful or difficult urination
• pale skin
• paleness or cold feeling in the fingertips and toes
• red, irritated eyes
• red, swollen, or scaly skin
• seeing, hearing, or feeling things that are not there
• severe or sudden headache
• shortness of breath
• sores, ulcers, or white spots on the lips or in the mouth
• sudden loss of coordination
• sudden slurring of speech
• tingling or pain in the fingers or toes when exposed to cold
• unusual behavior
• unusual tiredness or weakness
• weight loss
• yellow skin or eyes

Minor Side Effects

Some methylphenidate side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:

• Abdominal or stomach pain
• headache
• loss of appetite
• nervousness
• stuffy nose
• trouble sleeping
• unusually warm skin

Less common:

• Anger
• decreased appetite
• dizziness
• drowsiness
• fear
• irritability
• muscle aches
• nausea
• runny nose
• scalp hair loss
• talking, feeling, and acting with excitement
• vomiting

Applies to methylphenidate: transdermal patch extended release

As well as its needed effects, methylphenidate (the active ingredient contained in Ritalin) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking methylphenidate, check with your doctor immediately:

More common:

• Aggressive and violent behavior
• arm, back, or jaw pain
• black, tarry stools
• blistering, peeling, or loosening of the skin
• blood in the urine
• bloody nose
• chest pain or discomfort
• chest tightness or heaviness
• chills
• cold
• confusion
• cough or hoarseness
• cracks in the skin
• crying
• depersonalization
• diarrhea
• dizziness
• dysphoria
• euphoria
• fainting
• fast, pounding, or irregular heartbeat or pulse
• fever
• flu-like symptoms
• heavier menstrual periods
• joint or muscle pain
• loss of heat from the body
• nausea
• nervousness
• paranoia
• pinpoint red spots on the skin
• quick to react or overreact emotionally
• rapidly changing moods
• red, irritated eyes
• red, swollen skin
• scaly skin
• seeing, hearing, or feeling things that are not there
• severe or sudden headache
• skin rash or itching
• sore throat
• sores, ulcers, or white spots in the mouth or on the lips
• sudden loss of coordination
• sudden slurring of speech
• sweating
• twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
• unusual bleeding or bruising
• unusual tiredness or weakness

Rare

• Convulsions
• difficulty with breathing
• high fever
• increased sweating
• loss of bladder control
• severe muscle stiffness
• tiredness
• uncontrolled vocal outbursts or tics (uncontrolled repeated body movements)
• unusually pale skin

Incidence not known:

• Blistering, burning, crusting, dryness, or flaking of the skin
• chest pain
• difficulty with swallowing
• hives, itching, scaling, severe redness, soreness, or swelling of the skin
• large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• painful or difficult urination
• pale skin
• paleness or cold feeling in the fingertips and toes
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• swollen glands
• tingling or pain in the fingers or toes when exposed to cold
• troubled breathing with exertion

Minor Side Effects

Some methylphenidate side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:

• Abdominal or stomach pain
• decreased weight
• difficulty with moving
• drowsiness
• headache
• loss of appetite
• muscle pain or stiffness
• redness of the skin
• trouble sleeping
• vomiting
• welts

Less common:

• Decreased appetite
• stuffy or runny nose
• weight loss

Incidence not known:

• Bigger, dilated, or enlarged pupils (black part of the eye)
• bleeding, bruising, burning, itching, redness, skin rash, swelling, or soreness at the application site
• blurred or loss of vision
• disturbed color perception
• double vision
• hair loss
• halos around lights
• increased sensitivity of the eyes to light
• night blindness
• overbright appearance of lights
• thinning of the hair
• tunnel vision

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 chewable extended release, oral tablet extended release, transdermal film extended release

Nervous system

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.^[Ref]

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.^[Ref]

Gastrointestinal

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. Postmarketing side effects include bruxism.^[Ref]

Cardiovascular

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.^[Ref]

Other

Other side effects have rarely included headache, peripheral coldness, and auricular swelling. A withdrawal syndrome has been reported with the abrupt discontinuation of methylphenidate (the active ingredient contained in Ritalin) ^[Ref]

Hepatic

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.^[Ref]

Hematologic

Hematologic side effects have rarely included leukopenia, anemia, pancytopenia, thrombocytopenic purpura, and thrombocytopenia; however, causality has not been established.^[Ref]

Psychiatric

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. Postmarketing side effects include logorrhea.^[Ref]

Dermatologic

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.^[Ref]

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.^[Ref]

Ocular

Ocular side effects have included visual disturbances, mydriasis, difficulties with accommodation, diplopia, and blurring of vision.^[Ref]

Respiratory

Respiratory side effects associated with methylphenidate (the active ingredient contained in Ritalin) topical patch have frequently included nasopharyngitis and nasal congestion.^[Ref]

Metabolic

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%.^[Ref]

Local

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.

Hypersensitivity

One subject has been reported to have experienced erythema and edema at methylphenidate (the active ingredient contained in Ritalin) 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

Musculoskeletal side effects including arthralgia, myalgia, and muscle twitching have been reported.

Genitourinary

Genitourinary side effects have included in rare instances prolonged and painful erections known as priapism.

It is possible that some side effects of Ritalin may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.