Medication and Treatment Reviews

Methylphenidate

Brand Names: Concerta, Ritalin, Daytrana, Aptensio XR, Metadate CD, Methylin, Quillivant XR

Uses

Methylphenidate is a central nervous system stimulant primarily used to treat attention deficit hyperactivity disorder (ADHD) in children ages 6-12, adolescents, and adults up to age 65. Methylphenidate may improve focus, and decrease impulsivity and hyperactive behavior, two hallmark symptoms in some patients with the condition. It contains the same active ingredient as medications like Ritalin and Daytrana. According to the FDA, methylphenidate is a federally controlled substance (CII) because it can be abused or lead to dependence. It has not been studied in children under the age of 6.

The American Academy of Pediatrics recommends treatment with behavioral therapy before medication for children under the age of 6. For children ages 6 to 11, the AAP says “The primary care clinician should prescribe US Food and Drug Administration–approved medications for ADHD and/or evidence-based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both.” Likewise, the National Institute of Mental Health finds the most successful treatment plans use a combination of ADHD medication, like methylphenidate, and behavior therapies.

Methylphenidate can also be used to treat narcolepsy.

How to Use Methylphenidate

Before starting or refilling a methylphenidate prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage

As with all medications, follow your methylphenidate prescription instructions exactly. If patients experience upset stomach as a side effect, this medication can be taken with food. Taking methylphenidate late in the day can disrupt sleep.

The optimal dosage varies patient by patient. It is not determined by age, weight, or height, but rather by how a person metabolizes the medication, and the condition treated. Your doctor may adjust your daily dosage until you or your child experiences the best response — that is, the lowest dosage at which you experience the greatest improvement in symptoms without side effects.

Methylphenidate is available in several formulations:

  • Short-Acting Tablet: (Brand Name: Ritalin) Taken two to three times daily, 30 to 45 minutes before a meal. Available in 5mg, 10mg, and 20mg dosages. Tablets should be swallowed whole with water or other liquids. Tablets should never by crushed or chewed. Dosage should not exceed 60mg daily.
  • Sustained-Release Tablet: (Brand Name: Ritalin SR) Taken once daily in the morning with or without food. Available in 20mg dosage, effective for 8 hours. Tablets should be swallowed whole with water or other liquids. Tablets should never by crushed or chewed.
  • Extended-Release Capsule: (Brand Name: Metadate, Aptensio XR, Ritalin LA) Taken orally, with or without food, once daily. The first dose is typically taken first thing in the morning; it should be taken at the same time each day for the best results. Tablets should be swallowed whole with water or other liquids. If your child is unable to swallow the capsule, it can be opened and sprinkled over a spoonful of applesauce. Taken this way, the mixture should be swallowed whole without chewing, followed by a drink of water or other liquid. Capsules should never by crushed or chewed. Capsules are available in 10mg, 20mg, 30mg, 40mg, 50mg, and 60mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day. Dosage should not exceed 60 mg daily.
  • Chewable Tablet: (Brand Name: Methylin) Taken two to three times daily, 30 to 45 minutes before a meal. Chew each tablet well, and swallow with at least a full glass of water or another liquid. Tablets not taken with enough liquid can swell and become a choking risk. Available in 2.5 mg, 5 mg, and 10mg dosages. Dosage does not typically exceed 60 mg per day.
  • Extended-Release Chewable Tablet: (Brand Name: Quillichew ER) Taken once daily in the morning with or without food. Chew each tablet well, and swallow with a full glass of water or another liquid. Available in 20mg, 30mg, and 40mg tablets. 20mg and 30mg tablets are scored and can be cut in half if necessary to achieve the right dose.
  • Oral Solution: (Brand Name: Methylin) Taken two to three times daily, 30 to 45 minutes before a meal. The liquid should be measured with the included device and swallowed entirely with water or another liquid. Dosage does not typically exceed 60 mg per day.
  • Extended-Release Suspension: (Brand Name: Quillivant XR) Taken once daily in the morning with or without food. Shake the bottle well for at least 10 seconds, and then measure with the included device. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day. Dosage does not typically exceed 60 mg per day.
  • Extended-Release Osmotic Tablet: (Brand Name: Concerta) Taken orally, with or without food, once daily — ususally first thing in the morning. It should be taken at the same time each day for best results. Tablets should be swallowed whole with water or other liquids. If your child is unable to swallow the pill, your doctor may recommend another medication. Tablets should never by crushed or chewed. The tablet is designed to release the medication without dissolving. The empty capsule passes through the digestive tract and out of the body without being digested. Capsules are available in 18mg, 27mg, 36mg, and 54mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day. Dosage should not exceed 54mg daily for children and adolescents, and 72mg daily for adults.
  • Transdermal Patch: (Brand Name: Daytrana) Apply the patch to the hip two hours before you need the medication to take effect. There are four dosage strengths available, each delivered over a maximum of 9 hours a day: 27.5mg, 41.3mg, 55mg, and 82.5mg. The patch size increases as the dosage increases.

Do not drink alcohol while taking this medication, as it can cause the medicine to be released too quickly.

During treatment, your doctor may periodically ask you to stop taking your methylphenidate so that he or she can monitor ADHD symptoms; check vital statistics including blood, heart, and blood pressure; or evaluate height and weight. If any problems are found, your doctor may recommend discontinuing treatment.

Some patients report developing a tolerance to methylphenidate after long-term use. If you notice that your dosage is no longer controlling your symptoms, talk to your doctor to plan a course of action.

Side Effects

The most common side effects of methylphenidate are as follows: headache, decreased appetite, stomach ache, nervousness, difficulty sleeping, mood swings, sweating, shaking, fever, increased heartrate, weight loss, and dizziness.

The transdermal patch form of methylphenidate can cause skin irritation, and permanent skin discoloration where the patch is applied.

Other serious side effects include slowing of growth in children, seizures, priapism, and eyesight changes or blurred vision.

If side effects are bothersome, or do not go away, talk to your doctor. Most people taking this medication do not experience any of these side effects.

Report to your doctor any heart-related problems or a family history of heart and blood pressure problems. Patients with structural cardiac abnormalities and other serious heart problems have experienced sudden death, stroke, heart attack, and increased blood pressure while taking methylphenidate. Stimulants can increase blood pressure and heart rate. Physicians should monitor these vital signs closely during treatment. Call your doctor immediately if you or your child experiences warning signs such as chest pain, shortness of breath, or fainting while taking methylphenidate.

Also disclose to your physician all mental health issues including any family history of suicide, bipolar illness, tics, or depression. Methylphenidate may create new or exacerbate existing behavior problems, bipolar illness, or Tourette’s syndrome. The FDA recommends evaluating patients for bipolar disorder, tics, and Tourette’s syndrome prior to stimulant administration. It can cause psychotic or manic symptoms in children and teenagers. Call your doctor immediately if you or your child experiences new or worsening mental health symptoms including hallucinations or sudden suspicions.

Discuss circulation problems with your doctor before taking methylphenidate, which has been known to cause numbness, coolness, or pain in fingers or toes, including Raynaud’s phenomenon. Report to your doctor any new blood-flow problems, pain, skin color changes, or sensitivities to temperature while taking methylphenidate.

Stimulants like methylphenidate have a high potential for abuse and addiction, especially among people who do not have ADHD. It is a “Schedule II Stimulant,” a designation that the Drug Enforcement Agency uses for drugs with a high potential for abuse. Other Schedule II drugs include Dexedrine, Ritalin, and cocaine. People with a history of drug abuse should use caution when trying this medication. Taking the medication exactly as prescribed can reduce potential for abuse.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions

Store methylphenidate in a secure place out of the reach of children, and at room temperature. Do not share your methylphenidate prescription with anyone, even another person with ADHD. Sharing prescription medication is illegal, and can cause harm.

You should not take methylphenidate if you have any of the following conditions: allergy or hypersensitivity to methylphenidate HCI or any of the ingredients in methylphenidate medications, anxiety/agitation, glaucoma, tics or history of Tourette’s syndrome, or if you are taking monoamine oxidase inhibitors (MAOIs).

Chewable tablets can contain phenylalanine, and can be harmful to people with phenylketonuria.

You should use caution while taking methylphenidate if you have a history of heart or mental problems, seizures, abnormal brain wave tests, circulation problems, or esophagus/stomach/intestine problems.

If you’re thinking of becoming pregnant, discuss the use of methylphenidate with your doctor. Animal studies indicate a potential risk of fetal harm. Methylphenidate is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

The safety of methylphenidate for children under 6 has not been established.

Interactions

Before taking methylphenidate, discuss all other active prescription medications with your doctor. methylphenidate can have a dangerous, possibly fatal, interaction with antidepressants including MAOIs.

Tell your doctor if you are taking seizure medications, blood thinners, blood pressure medication, or any medication containing a decongestant.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking methylphenidate before having any surgery or laboratory tests. Methylphenidate can have a dangerous interaction with certain anesthetics. The above is not a complete list of all possible drug interactions.

Sources:

http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088635.pdf
http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088575.pdf
http://pi.actavis.com/data_stream.asp?product_group=1707&p=pi
Chewable tabs: http://www.fda.gov/downloads/drugs/drugsafety/ucm088639.pdf
Oral solution: http://www.fda.gov/downloads/drugs/drugsafety/ucm088640.pdf
Extended release suspension: http://www.fda.gov/downloads/drugs/drugsafety/ucm322209.pdf
Extended release chewable tablet: https://www.quillivantxr-quillichewer.com/
Short-acting tablet: http://www.fda.gov/downloads/drugs/drugsafety/ucm089090.pdf
https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/ritalin_ritalin-sr.pdf

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