Medication and Treatment Reviews

Ritalin

Generic Name: Methylphenidate hydrochloride

Uses

Ritalin is a central nervous system stimulant medication primarily used to treat attention deficit hyperactivity disorder (ADHD) in children ages 6-12, adolescents, and adults up to age 65. Ritalin 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 Aptensio and Daytrana. According to the FDA, Ritalin 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 Ritalin, and behavior therapies.

Ritalin can also be used to treat narcolepsy.

How to Use Ritalin

Before starting or refilling a Ritalin 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 Ritalin prescription instructions exactly. If a patient experiences upset stomach as a side effect, this medication can be taken with food. Taking Ritalin 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.

Ritalin is available in several formulations:

  • Short-Acting Tablet: Taken two to three times daily, 30 to 45 minutes before a meal. Available in 5mg, 10mg, and 20mg dosages. Each tablet lasts for approximately three to four hours. 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 (Ritalin SR): Taken 30 to 45 minutes before a meal. Each tablet lasts for approximately eight hours. Available in 20mg dosage. Tablets should be swallowed whole with water or other liquids. Tablets should never by crushed or chewed.
  • Extended-Release Capsule (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. 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, and 60mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day, or for approximately eight to ten hours. Dosage should not exceed 60 mg daily.

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 Ritalin 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 Ritalin 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 Ritalin are as follows: headache, decreased appetite, stomach ache, nervousness, difficulty sleeping, mood swings, sweating, shaking, fever, increased heartrate, weight loss, and dizziness.

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 Ritalin. 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 Ritalin.

Also disclose to your physician all mental health issues including any family history of suicide, bipolar illness, tics, or depression. Ritalin 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 Ritalin, 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 Ritalin.

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

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

You should use caution while taking Ritalin 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 Ritalin with your doctor. Animal studies indicate a potential risk of fetal harm. Ritalin is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

The safety of Ritalin for children under age six has not been established.

Interactions

Before taking Ritalin, discuss all other active prescription medications with your doctor. Ritalin 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 Ritalin before having any surgery or laboratory tests. Ritalin can have a dangerous interaction with certain anesthetics. The above is not a complete list of all possible drug interactions.

Sources:

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cd83fc91-47a3-4be4-9727-caf9ec0371e8
https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/ritalin_ritalin-sr.pdf

22 reviews

  1. I was diagnosed with ADD – Inattentive 16 years ago and started on 5 mg of Ritalin once a day. I also went through heavy training how to deal with the ADD. For 15 years the training the therapist gave me worked wonders. A year ago I noticed I was not at my best, time management and organization skills were being lost. Went to the VA, was assigned to a really great psychiatrist and started on Ritalin 5 mg twice a day. The only thing I noticed is I dropped a couple of pounds. She upped it to 10 mgs and I noticed that sleepiness after lunch had decreased. I am starting to improve in time management and organization again but not where I should be. In two week I see my doctor again and will probably go to 20 mg in the morning and 10 in the afternoon. I am just waiting for the moment I can say “So this is what it is like to be neurotypical again.”

  2. We trialed my 8 year old son on Ritalin twice on the doctor’s recommendation. For us, Ritalin was a total disaster. We saw zero positive effects, but the negative side-effects were horrendous. He became a wildcat.

    Like one other reviewer put it so eloquently “he is almost psychotic. He lashes out in anger, has no impulse control, is negative and down right mean to everyone and everything around him.”. My son suffered the same symptoms on Ritalin.

    When the doctor wouldn’t listen, we took him off and gave up the idea of meds for another 2 years (he’s now 10). We recently saw another doctor as the poor little guy was struggling so much in school I felt I had to give it one last try. He’s now been on Vyvanse for 3 months and it is working really well for him. He is able to concentrate, focus on tasks and his schoolwork is improving. There are very little side-effects for him on Vyvanse and, provided we take it early enough in the morning, he has no problems sleeping.

    As a parent, you know when your child is right or not right and I would urge everyone to find a good doctor who is willing to listen and work with you. The right medication can make a world of difference.

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