Concerta: 7 things you should know
Medically reviewed by C. Fookes, BPharm Last updated on Mar 14, 2019.
1. How it works
- Concerta is a brand (trade) name of methylphenidate. Experts aren't exactly sure how methylphenidate works in Attention Deficit Hyperactivity Disorder (ADHD) but think it affects the reuptake of the neurotransmitters dopamine and norepinephrine, increasing their concentration in the neural synapse (the space between two nerves). Methylphenidate is composed of 2 enantiomers (optical isomers): d-threo and l-threo. The d-threo enantiomer is more pharmacologically active than the l-threo enantiomer and is available commercially as dexmethylphenidate.
- Concerta belongs to the group of medicines known as central nervous system (CNS) stimulants.
- Concerta may be used to treat attention deficit hyperactivity disorder (ADHD) in people aged 6 to 65.
- May also be given to treat attention deficit disorder (ADD) and narcolepsy.
- Concerta should be used in addition to other treatment modalities such as psychotherapy, education, and social integration advice.
- Concerta is available as an extended-release tablet that is taken once a day.
- Concerta is available as a generic under the name methylphenidate.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- A headache, abdominal pain, a loss of appetite, dry mouth, a fast heartbeat, nausea, nervousness, and insomnia are commonly reported side effects. Rash, pruritus, irritability, an increase in blood pressure or excessive sweating may also occur.
- May precipitate the emergence of psychotic thoughts such as hallucinations, delusions or mania in children and adolescents without a prior history of such thoughts. Discontinuation of treatment may be appropriate.
- Concerta can be addictive and cause dependence. The risk is greater with extended-release tablets and in people with a history of drug dependence and alcoholism. Tolerance can also develop to Concerta's effect.
- May impair judgment or reaction skills; exercise caution before driving or operating machinery until the full effects of Concerta are known.
- May precipitate depression during withdrawal from Concerta, particularly in those who have been overusing it. May also aggravate pre-existing symptoms of anxiety, agitation, tension, behavioral or thought disturbances and is best avoided in people displaying marked levels of these symptoms.
- May not be suitable for people with certain heart conditions, hyperthyroidism, and other psychiatric disorders including bipolar disorder. An increased risk of seizures, peripheral circulation problems, and visual disturbances have been associated with methylphenidate use. Should not be used in people with glaucoma, a history of tics or Tourette's syndrome, severe hypertension or cardiac disease.
- Alcohol may contribute to the side effects and interfere with the release of Concerta tablets. Avoid.
- May interact with a number of other drugs including monoamine oxidase inhibitors (MAO inhibitors) (do not use within 14 days of discontinuation of a MAO inhibitor), halogenated anesthetics (do not take Concerta on the day of surgery), warfarin, anticonvulsants, and some antidepressants.
- Reports indicate some temporary slowing of growth may occur when regular Concerta is given to children aged 7 through 10 years: doctors should monitor height and weight and consider treatment interruption if growth suppression is suspected.
- Has been associated with sudden death; cases were mainly in children and adults with serious structural cardiac abnormalities or other serious heart problems. Avoid in those known to have these risk factors.
- Rare cases of priapism (painful erections more than 6 hours in duration) have been reported.
- Caution when using in people with pre-existing bowel problems (includes those with severe narrowing of the intestinal tract and gut motility disorders) as Concerta tablets maintain their shape and potentially may cause a blockage. May affect blood circulation in the hands and feet. Symptoms may improve after a dosage reduction or discontinuation.
- Periodic blood tests may be required with prolonged dosing.
- Drug testing will reveal a positive result for methylphenidate.
- Classified as a Schedule II controlled substance, meaning that Concerta has a high potential for abuse. Keep personal supplies of Concerta in a safe place, out of view of potential drug seekers.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Take in the morning as a single dose.
- Concerta may be taken with or without food. Do not crush, break or chew Concerta tablets. Swallow whole with a glass of water.
- Take exactly as directed by your doctor and never increase the dosage of Concerta without their advice.
- Seek medical advice if symptoms persist or worsen despite treatment, or you have any side effects that you are worried about.
- Do not drive or operate machinery if Concerta impairs your judgment or reaction skills.
- Seek medical advice if any new numbness, pain, skin color change or sensitivity, or unexplained wounds occur in fingers or toes.
- Do not be concerned if you notice something in your stool that looks like a tablet because Concerta tablets do not fully dissolve.
- If you accidentally forget a dose, take the dose as soon as you remember; however, do not take the dose if it is after 6pm - just skip that dose for the day.
- Never share your Concerta with anybody else.
- Do not drink alcohol while taking Concerta - the alcohol may cause the methylphenidate contained in the Concerta tablets to be released into the bloodstream too fast, increasing the risk of side effects.
- Seek urgent medical attention if you develop any chest pain, shortness of breath or fainting occurs while taking methylphenidate. Call your doctor if you have any new or worsening mental symptoms such as hallucinations, delusions, or hearing voices.
- Seek medical advice if any new numbness, pain, skin color change or sensitivity, or unexplained wounds occur in the fingers or toes. Seek emergency attention if painful, prolonged erections develop.
6. Response and Effectiveness
- Reasonably high blood levels of methylphenidate are reached within an hour of Concerta administration, but it may take six to ten hours to for blood levels to peak.
- Some symptom relief may be noticed within one to two hours; however, it may take up to two weeks for the full effects to be seen.
- Concerta tablets are an extended-release tablet that allow a more gradual release of methylphenidate, minimizing fluctuations in blood levels when compared with normal-release tablets.
Medicines that interact with Concerta may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Concerta. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed. Common medications that may interact with Concerta include:
- Anticoagulants (blood thinners), such as warfarin, or other drugs that have blood thinning effects such as aspirin or NSAIDs
- Anticonvulsants, such as phenytoin, phenobarbital, or primidone
- Antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
- Antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
- Any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
- Cold, flu, or allergy medications that contain decongestants such as phenylephrine or pseudoephedrine
- Heart medications such as clonidine or methyldopa
- HIV medications (fosamprenavir, ritonavir)
- Other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
Avoid drinking alcohol or taking illegal or recreational drugs while taking Concerta.
Note that this list is not all-inclusive and includes only common medications that may interact with Concerta. You should refer to the prescribing information for Concerta for a complete list of interactions.
Concerta (methylphenidate) [Package Insert]. Revised 02/2019. Janssen Pharmaceuticals, Inc. https://www.drugs.com/pro/concerta.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Concerta only for the indication prescribed.
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