Methylphenidate (Oral)

Methylphenidate is used to increase the ability to stay alert and attentive to reduce restlessness in patients with ADHD.

Overview

Methylphenidate is used to treat patients suffering from either attention deficit hyperactive disorder or narcolepsy.

Attention deficit hyperactivity disorder is a condition suffered by both adults and children wherein they struggle to concentrate for long periods of time and cannot focus on tasks. The condition makes them easily distracted and often impulsive. Using Methylphenidate enables the patient to have an increased ability to concentrate and this helps to decrease restlessness.

Narcolepsy is a condition where the patient has an uncontrolled desire to sleep. By stimulating the central nervous system the use of Methylphenidate can help the patient to stay awake to complete normal tasks.

Methylphenidate acts on the central nervous system as a stimulant. The medication is available by prescription only and comes in a wide range of forms. The medication can be attained in the following brands:

  • Ritalin-SR
  • Ritalin LA
  • Ritalin
  • Quillivant XR
  • QuilliChew ER
  • Methylin ER
  • Methylin
  • Metadate ER
  • Metadate CD
  • Concerta
  • Aptensio XR

The medication can be administered in a range of forms including extended release capsules, chewable tablets and solutions.

Condition treated

  • Attention deficit hyperactivity disorder (ADHD)
  • Narcolepsy

Type Of Medicine

  • Central nervous system stimulant

Side Effects

As well as improving the patient's ability to focus or to stay awake, Methylphenidate can also cause some side effects to occur. Some of these side effects may require that you seek immediate medical attention while others will be milder and will generally abate over time. While not all side effects may be experienced, you may still need to seek medical attention.

If you experience any of the following side effects from taking Methylphenidate then you should contact your doctor immediately. These side effects can be very serious and can also indicate the presence of other serious medical conditions that may be developing from use:

Occurring more commonly:

  • Increased heartbeat

Occurring less commonly:

Occurring only rarely:

  • Unusual bleeding or bruising
  • Uncontrolled vocal outbursts or tics
  • Uncontrolled and repeated body movements
  • Scaling, severe redness, soreness or swelling of the skin
  • Pinpoint red spots on the skin
  • Muscle cramps
  • Crusting, dryness, or flaking of the skin
  • Convulsions
  • Blurred vision or other changes in vision
  • Blood in the urine or stools
  • Black, tarry stools

Frequency of incidence not known:

  • Yellow skin or eyes
  • White spots on the lips or in the mouth
  • Weight loss
  • Unusual tiredness or weakness
  • Unusual behavior
  • Tingling or pain in the fingers or toes when exposed to cold
  • Sudden slurring of speech
  • Sudden loss of coordination
  • Sores or ulcers
  • Shortness of breath
  • Severe or sudden headache
  • Seeing, hearing, or feeling things that are not there
  • Red, swollen, or scaly skin
  • Red, irritated eyes
  • Paleness or cold feeling in the fingertips and toes
  • Pale skin
  • Painful or difficult urination
  • Numbness of the hands
  • Feeling like surroundings are not real
  • Depression
  • Confusion

Certain other side effects can occur that are less serious and do not necessarily need medical attention. The following side effects may simply abate over time or may be mild. If any of these are bothersome or are ongoing, however, then you can contact your doctor for advice on how best to reduce some of these potential side effects. You should consult your doctor if you have any questions about the following:

Occurring more commonly:

  • Unusually warm skin
  • Trouble sleeping
  • Stuffy nose
  • Nervousness
  • Loss of appetite
  • Headache
  • Abdominal or stomach pain

Occurring less commonly:

  • Vomiting
  • Talking, feeling, and acting with excitement
  • Scalp hair loss
  • Runny nose
  • Nausea
  • Muscle aches
  • Irritability
  • Fear
  • Drowsiness
  • Dizziness
  • Decreased appetite
  • Anger

Other side effects that have not been listed here could also occur from the use of Methylphenidate. If you experience any other side effects then you should contact your doctor for advice on how to react. If you believe your health to be in immediate danger, however, then you must always contact the emergency services.

Dosage

This medication should only ever be taken as you have been directed by your doctor. You should never take a greater dose than prescribed nor take it more often or for longer than ordered by your doctor. This medication can become habit forming if it is taken in too great doses.

If you do not think that this medication is working after a few weeks then you should consult your doctor. You should never increase your own dose of medication.

Methylphenidate will always be prescribed with a medication guide that you should read and ensure that you fully understand before you begin use. If you have any questions following reading then you should ask your doctor for advice.

When taking this medication for the treatment of narcolepsy, you should ensure that the last dose of short-action medication is taken before 6pm so that you can sleep at night. Do so unless otherwise directed by your doctor.

Chewable tablets should be taken with a large glass of water or another liquid. You should take these tablets 30-45 minutes before you eat.

When taking long-acting versions of the medication follow this advice:

  • Swallow these tablets whole with a liquid. You should never damage the tablets in any way nor crush or dissolve them:
    • Concerta extended release tablets
    • Aptensio
    • Metadate CD
    • Ritalin LA capsules
    • Ritalin SR tablets

If you are unable to swallow the following tablets then you should break them open and sprinkle the medication onto a spoonful of apple sauce. This mixture should be taken immediately and without chewing. Swallow the treatment and then drink a liquid. Do not mix the medication and store for future use.

  • Aptensio XR
  • Metadate CD
  • Ritalin LA extended-release capsule

You may notice parts of the following extended release tablet in your stools. This is normal and is only an empty shell. This is not something to be concerned about.

  • Concerta extended release tablet

The following tablets can be taken either with or without a meal.

  • Aptensio XR capsules
  • Comcerta extended release tablets

Shake the bottle of suspension vigorously for at least 10 seconds before measuring a dose of the following medication. You should only ever use the provided dispenser to measure each dose as other devices or kitchen items may not be accurate for dosing. This medication can be taken with or without food.

  • Quillivant XR extended release suspension

The following chewable tablets may be cut in half along the marked scoreline on the tablet if this is required for easier consumption.

  • Quillichew ER tablets

The dose of this medication given will be different depending on the patient. You should only ever take your prescribed medication as you have been ordered. Do not ever change brands of medication unless ordered to as they can work differently and have different strengths and effects. You should never share your medication with anyone else.

The following dosing information is intended only as a guide and should not be used to change your dose or to self-medicate under any circumstances.

When treating patients who are suffering from narcolepsy with short-acting dosage forms:

With chewable tablets or solution:

  • Adults should take an average dose of 20-30mg per day. This dose should be spilt over 2-3 doses and each should be taken 30-45 minutes before meals. The doctor can increase the dose to a maximum of 60mg taken daily.
  • Children over the age of 6 should be treated with 5mg twice daily. These doses should be taken 30-45 minutes before breakfast and lunch. The dose may be increased by the doctor up to a maximum of 60mg taken daily.

With tablets:

  • Adults should be treated with 5-20mg 2-3 times daily. Each dose should be taken 30-45 minutes before a meal is consumed.
  • Children over the age of six can be treated with 5mg taken twice daily. These should be taken 30-45 minutes before breakfast and lunch. The dose may be increased by the doctor to a maximum of 60mg taken per day.

When treating patients who are suffering from ADHD with short acting dosage forms:

With chewable tablets or solution:

  • An adult can be treated with 20-30mg per day in 2-3 spilt doses. These doses should be taken 30-45 minutes before consuming a meal. The dose can be increased by the doctor up to a maximum of 60mg taken per day.
  • Children aged 6+ can be given 5mg of treatment twice daily. These doses should be taken 30-45 minutes before meals. The dose can be increased by the doctor to a maximum dose of 60mg per day.

With tablets:

  • Adults may be treated with 5-20mg 2-3 times daily. These doses should be taken 30-45 minutes before meals.
  • Children aged 6+ should be given 5mg of treatment 30-45 minutes before breakfast and lunch. The dose may be increased as required to a maximum of 60mg taken per day.

When treating patients who are suffering from ADHD with long acting dosage forms:

With extended release capsules when patients have not previously been treated with Methylphenidate:

  • Children aged 6+ and adults can be treated with 10-20mg once daily. This should be taken in the morning. The doctor may adjust this dose up to 60mg taken daily.

With extended release capsules when patients have previously been treated with Methylphenidate:

  • Children aged 6+ and adults may be treated with 10-60mg taken once daily at the start of the day. The dose may be increased up to a maximum dose of 60mg taken per day.

With extended release suspension form:

  • Children aged 6+ and adults should start with a dose of 20mg taken once daily in the morning. This dose can be increased by the doctor up to a maximum of 60mg taken once per day.

With extended release chewable tablets:

  • Children aged 6+ and adults can be given 20mg once daily to start with. This dose may then be increased to a maximum of 60mg per day.

With extended release tablets when patients have not previously been treated with Concerta:

  • Initially adults should be treated with 18-36mg once daily in the morning. The dose may be increased but should not exceed 72mg taken daily.
  • Children aged 6+ can be treated with 18mg once daily at the start of the day. This dose may be adjusted up to a maximum of 73mg per day.

With extended release tablets when patients have previously been treated with Concerta:

  • Children aged 6+ and adults may be treated with 18-72mg once per day. This dose should be taken in the morning. The dose may be adjusted to a maximum dose of 73mg taken once daily.

For all forms of this medication and for the treatment of all conditions the use of this medication in children below the age of 6 is not recommended. The prescribing doctor will determine any use in children under the age of 6.

If a dose of this medication has been missed then it should be taken as soon as possible. If you are close to your next dose being due, however, then you will need to skip the dose and return to your normal schedule. Do not ever take a double dose of this medication.

Interactions

Methylphenidate can interact with other medications in the body. Certain medications should never be used together because they can cause severe medical problems to occur. Other treatments may prevent one another from working or may increase the likelihood of certain side effects occurring.

Before you begin use of Methylphenidate it is vital that you inform your doctor of all other medications you are taking. This includes all prescribed treatments, over the counter medications and any other substances. This is especially important in the following cases:

The use of Methylphenidate with the following treatments is not recommended and your doctor may decide to prescribe a different treatment:

  • Tranylcypromine
  • Toloxatone
  • Selegiline
  • Rasagiline
  • Procarbazine
  • Phenelzine
  • Pargyline
  • Nialamide
  • Moclobemide
  • Linezolid
  • Lazabemide
  • Isocarboxazid
  • Iproniazid
  • Furazolidone
  • Clorgyline
  • Brofaromine

The use of the following medications is not normally recommended with Methylphenidate. Your doctor may prescribe both but may need to make adjustments to the dose or frequency of use of one or both of the treatments:

  • Donepezil
  • Bupropion

Using the following treatments in conjunction with Methylphenidate can increase the risk of certain side effects occurring. Use of both may still be the best treatment for you but the dose or frequency of use may be adjusted:

  • Carbamazepine

Other medications that have not been listed here can also interact with Methylphenidate. Ensure that you have informed your doctor of all medications you are taking before beginning use.

As Methylphenidate is a central nervous system stimulant, the use of central nervous system suppressants can counteract the effect of the medication. Patients taking this treatment should avoid the consumption of alcohol. If this is a problem for you then you should discuss this with your doctor before you begin using Methylphenidate for treatment.

Other medical problems from which you suffer can also affect your use of this medication. You should inform your doctor of all medical conditions from which you suffer. This is especially important if you have any of the following conditions

Dependency on Methylphenidate is more likely to develop in patients with a history of or present:

These conditions may be worsened by the use of Methylphenidate:

The side effects can be worsened with use of the following in conjunction with Methylphenidate:

The following condition may be worsened by the use of the methylin chewable tablet as it contains aspartame:

Methylphenidate use may also be affected by other medical conditions that have not been listed herein. Ensure that your doctor is fully aware of your full medical history before use.

Warnings

Before you begin taking Methylphenidate it is important that you consider the benefits of use in relation to the risks of taking the medication. You should take all of the side effects and risks of use into account before beginning treatment and should ensure that you have considered all of the following with your doctor in deciding to use Methylphenidate:

Allergies You should inform your doctor of all allergies from which you suffer. It is especially important that you inform your doctor if you have ever suffered a bad or unusual reaction to any medications in the past. Allergies to foods, dyes, preservatives and other substances must also be reported to your doctor before you begin use. Allergic reactions to medications can be very serious and must be avoided.

Pediatric The use of Methylphenidate has been tested and approved in children aged 6 and older. Below this age, however, safety and efficiency have not been demonstrated. Other treatments may need to be found below this age.

Geriatric No specific tests have been carried out on the use of Methylphenidate in the elderly population. There are no anticipated limitations to use but elderly patients may be more likely to be suffering from other conditions that may limit the use of this treatment.

Pregnancy There is a risk to the use of Methylphenidate during pregnancy. You must inform your doctor if you are pregnant before beginning use and must inform your doctor if you think you may have become pregnant during use.

Breastfeeding The risks of breastfeeding during the use of this medication are unknown. You should discuss this with your doctor before you begin use of this medication and should ensure that you have considered all of the risks of use in relation to the benefits of continuing to breastfeed.

Your doctor will need to regularly see you or your child to ensure that the medication is working effectively. The doctor will also look for unwanted side effects and may take blood and urine samples to check for this. The doctor will also need to test blood pressure and heart rate before beginning this treatment. If any changes to these levels occur then your doctor should be informed straight away and further treatment may be required. Your medication may also be stopped in this case but you must contact the doctor.

This medication should not be used if a MAO inhibitor, which is a drug for depression, has been used within 14 days previously. The use of these medications too close together can be very dangerous.

The use of Methylphenidate can make you unsafe to drive because it affects vision and coordination in some cases. Patients should only drive, ride a bike and operate machinery if they are completely safe to do so. Remember that it is your legal responsibility not to put yourself or others at risk through these actions.

Methylphenidate can cause serious medical conditions of the heart and blood vessels to occur. These are more likely when family members have heart disease. Any signs of chest pain, fainting, changed heart rate and shortness of breath should be reported to the doctor immediately so that you can be assessed.

If any unusual changes to behaviour occur from the use of this medication then you must inform the doctor immediately. An increase in hostility, agitation or suicidal thoughts should be reported right away. This is especially important if they are rapidly worsening or have only newly occurred.

Methylphenidate can cause a slowing of growth that can be concerning to patients. If your child is taking this medication then the doctor will need to track height and weight to ensure that proper and normal growth is continuing. This will be checked at each visit.

Raynaud phenomenon may occur with the use of Methylphenidate. You must consult your doctor immediately if your child is experiencing tingling pains when exposed to the cold. Changed skin colour in the fingers or toes should also be reported to the doctor.

You must inform any medical professional attending you that you are taking this medication before you undergo any treatment or surgery. You must stop this medication before having any kind of surgery and must inform your doctor that you are taking it.

You should not consume alcohol with this medication. This is especially important when taking the extended release tablets. Doing so can cause complications and can lead to alcohol or drug dependency.

This medication can cause prolonged erections to occur. If you experience a prolonged and painful erection for more than 4 hours then you should seek medical advice from your doctor straight away.

You should not ever take any other medications with Methylphenidate unless they have been discussed with and approved by your doctor. To do so may put you at serious risk.

Storage

This medication should be stored at room temperature but must always be keep out of direct light and away from both moisture and heat.

You should prevent this from freezing.

Keep this medication out of the reach of children at all times, even when the treatment is intended for the use of children.

You should dispose of any outdated medication safely as directed by your doctor. Always ensure that medication remains out of the reach of children and pets when disposing of it.

Any remaining extended release suspension should be discarded after 4 months of opening.

Summary

Methylphenidate works by stimulating the central nervous system and is used in the treatment of patients suffering from attention deficit hyperactivity disorder and narcolepsy.

In the treatment of ADHD it helps the patient to focus and concentrate, reducing restlessness and agitation.

In the treatment of narcolepsy the medication can help the patient to focus and in doing so prevents the uncontrolled desire to sleep.

This medication has been approved for the use of children aged 6+ and adults. Below the age of 6 the safety and efficiency of use has not been determined.

Patients should not consume alcohol with this medication and should not take increased doses of this medication. To do so can increase side effects and can cause habits to form.