Ritalin

Ritalin is a prescription medication used to treat Attention-Deficit Hyperactivity Disorder (ADHD) and narcolepsy. Ritalin belongs to a group of drugs called central nervous system (CNS) stimulants, which works by changing the amount of natural substances in the brain to decrease impulsiveness and hyperactivity.

This medication comes in tablet and is usually taken 2 to 3 times a day, preferably 30 to 45 minutes before a meal. 

Common side effects of Ritalin are nervousness, difficulty falling asleep or staying asleep, decreased appetite, and headache. Ritalin can also cause dizziness. Do not drive or operate heavy machinery until you know how Ritalin affects you.

Methylphenidate is a prescription medication used to treat attention-deficit hyperactivity disorder (ADHD).

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your height
• your age
• your gender

• Daytrana (methylphenidate patch)
  • The recommended starting dose for patients new to or converting from another formulation of methylphenidate is 10 mg.
  • Daytrana should be applied to the hip area (using alternating sites) 2 hours before an effect is needed and should be removed 9 hours after application. Daytrana may be removed earlier than 9 hours if a shorter duration of effect is desired or late day side effects appear.
• Ritalin and Methylin (regular release tablets)
  • Adults:
    • Average dosage is 20 to 30 mg daily. Some patients may require 40 to 60 mg daily.
    • In others adults, 10 to 15 mg daily will be adequate.
    • Patients who are unable to sleep if medication is taken late in the day should take the last dose before 6 p.m.
  • Children (6 years and older):
    • Start with 5 mg twice daily (before breakfast and lunch) with gradual increments of 5 to 10 mg weekly.
    • Ritalin should be initiated in small doses, with gradual weekly increments. Daily dosage above 60 mg is not recommended.
• Ritalin SR (extended release tablets): The recommended adult dose is usually taken once every 8 hours.
• Ritalin LA (extended release capsule): ​The recommended starting dose of Ritalin LA is 20 mg once daily. Dosage may be adjusted in weekly 10 mg increments to a maximum of 60 mg/day taken once daily in the morning. Daily dosage above 60 mg is not recommended.
• Metadate CD (methylphenidate extended release capsule) 
  • ​The recommended starting dose is 20 mg once daily. Dosage may be adjusted in weekly 10-20 mg increments to a maximum of 60 mg/day taken once daily in the morning, depending upon tolerability and degree of efficacy observed. Daily dosage above 60 mg is not recommended.
  • ​If improvement is not seen after dose is adjusted over a one-month period, the drug should be discontinued.
• Metadate ER (methylphenidate extended release tablet): The average dosage is 20 to 30 mg daily. Some may require 40 to 60 mg daily. In others, 10 to 15 mg daily will be adequate. Those who are unable to sleep if medication is taken late in the day should take the last dose before 6 pm.
• Methylin (methylphenidate oral solution):
  • ​Adults: The average dosage is 20 to 30 mg daily. Some patients may require 40 to 60 mg daily. In others, 10 to 15 mg daily will be adequate. Patients who are unable to sleep if medication is taken late in the day should take the last dose before 6 p.m.
  • Children (6 years and older): Start with 5 mg twice daily (before breakfast and lunch) with gradual increments of 5 to 10 mg weekly. A daily dose above 60 mg is not recommended. If improvement is not seen after dose is adjusted over a one-month period, the drug should be discontinued.

• Methylin ER (methylphenidate extended release tablet): The recommended adult dose is usually taken once every 8 hours.
• Quillivant (methylphenidate powder for oral suspension): For patients 6 years and above, recommended starting dose is 20 mg given orally once daily in the morning. Dosage may be increased weekly in increments of 10 mg to 20 mg per day. Daily dosage above 60 mg is not recommended. 
• Concerta (methylphenidate extended release tablet): 
  • For children and adolescents new to methylphenidate, the recommended starting dosage is 18 mg once daily. Dosage may be increased by 18 mg/day at weekly intervals and should not exceed 54 mg/day in children and 72 mg/day in adolescents.
  • For adult patients new to methylphenidate, the recommended starting dose is 18 or 36 mg/day. Dosage may be increased by 18 mg/day at weekly intervals and should not exceed 72 mg/day for adults.

Methylphenidate is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep methylphenidate in a safe place to prevent misuse and abuse. Selling or giving away methylphenidate may harm others, and is against the law.

Tell your doctor if you or your child have (or have a family history of) ever abused or been dependent on alcohol, prescription medicines or street drugs.

Drug Dependence

Methylphenidate should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral abuse. Careful supervision is required during withdrawal from abusive use, since severe depression may occur. Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up.

The following have been reported with use of methylphenidate and other stimulant medicines.

• Heart-related problems:
  • sudden death in patients who have heart problems or heart defects
  • stroke and heart attack in adults
  • increased blood pressure and heart rate

Tell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems.

Your doctor should check you or your child carefully for heart problems before starting methylphenidate.

Your doctor should check your or your child's blood pressure and heart rate regularly during treatment with methylphenidate.

Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking methylphenidate.

• Mental (psychiatric) problems:
  • All Patients
    • new or worse behavior and thought problems
    • new or worse bipolar illness
    • new or worse aggressive behavior or hostility
  • Children and Teenagers
  • new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptoms

Tell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.

Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking methylphenidate, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.

Do not take methylphenidate if you or your child:

• are very anxious, tense, or agitated
• have an eye problem called glaucoma
• have tics or Tourette’s syndrome, or a family history of Tourette's syndrome. Tics are hard to control repeated movements or sounds.
• are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI.
• are allergic to anything in methylphenidate dosage forms

Methylphenidate should not be used in children less than 6 years old because it has not been studied in this age group.

Serious side effects have been reported with methylphenidate. See “Methylphenidate Precautions” section.

Methylphenidate may cause serious side effects, including:

• seizures, mainly in patients with a history of seizures
• slowing of growth (weight and height)
• eyesight changes or blurred vision
• allergic skin rash (patch form) Stop using methylphenidate patch and see your doctor right away if you have swelling or blisters at or around the application site. You may have a skin allergy to the patch. People who have skin allergies to methylphenidate patch may develop an allergy to all medicines that contain methylphenidate, even those methylphenidate medicines that are taken by mouth.

The most common side effects of methylphenidate include:

• poor appetite
• nausea
• vomiting
• stomach pain
• weight loss
• tics
• trouble sleeping
• mood swings
• dizziness
• redness, small bumps, itching where you apply methylphenidate patch

This is not a complete list of methylphenidate side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all of the medicines that you or your child take including prescription and nonprescription medicines, vitamins, and herbal supplements. Methylphenidate and some medicines may interact with each other and cause serious side effects. Sometimes the doses of other medicines will need to be adjusted while taking methylphenidate.

Your doctor will decide whether methylphenidate can be taken with other medicines.

Especially tell your doctor if you or your child takes:

• anti-depression medicines including MAOIs
• seizure medicines
• blood thinner medicines
• blood pressure medicines
• cold or allergy medicines that contain decongestants

Know the medicines that you or your child takes. Keep a list of your medicines with you to show your doctor and pharmacist.

Do not start any new medicine while taking methylphenidate without talking to your doctor first.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if methylphenidate will harm your unborn baby.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Methylphenidate falls into category C. There are no adequate animal or human studies; or studies in animals have shown a harmful and undesired effect on the unborn baby, yet there are no adequate and well-controlled studies in pregnant women.

This medication may be given to a pregnant woman if her healthcare provider believes that its benefits to the pregnant woman outweigh any possible risks to her unborn baby.

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if methylphenidate is excreted in human breast milk or if it will harm your nursing baby.

Methylphenidate is a controlled substance (CII), because it can be abused or lead to dependence. As a result, your doctor will have use a special type of prescription pad which may look different.

Since it is a controlled substance (CII),  you can not refill this medication. You will need to obtain another prescription from your doctor. Based on some state laws, you may only be able to obtain 30 day supply.

Tell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems since Heart-related problems have been reported with use of methylphenidate and other stimulant medicines.

The most common side effects of methylphenidate include:

• poor appetite
• weight loss
• nausea/vomiting
• trouble sleeping
• mood swings