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National Alliance on Mental Illness
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Methylphenidate/Dexmethylphenidate

  • Ritalin®, Methylin® (methylphenidate) - Immediate release
    • Tablets: 5 mg, 10 mg, 20 mg
    • Chewable tablets: 2.5 mg, 5 mg, 10 mg
    • Liquid: 5 mg /5 ml and 10 mg/5 ml
  • Metadate ER®, Ritalin SR® (methylphenidate, extended release, wax matrix)
    • Tablets: 10 mg, 20 mg
  • Methylin ER® (methylphenidate, extended release, methylcellulose base)
    • Tablets: 10 mg, 20 mg
  • Ritalin LA® (methylphenidate long-acting)
    • Capsules: 10 mg, 20 mg, 30 mg, 40 mg
    • Tablets: 5 mg, 10 mg, 20 mg
    • Chewable tablets: 2.5 mg, 5 mg, 10 mg chewable
    • Liquid: 5 mg /5 ml and 10 mg/5 ml
  • Metadate ER®, Ritalin SR® (methylphenidate, extended release, wax matrix)
    • Tablets: 10 mg, 20 mg
  • Methylin ER® (methylphenidate, extended release, methylcellulose base)
    • Tablets: 10 mg, 20 mg
  • Ritalin LA® (methylphenidate long-acting)
    • Capsules: 10 mg, 20 mg, 30 mg, 40 mg
  • Metadate CD® (methylphenidate Ritalin®, Methylin® (methylphenidate) - Immediate release
    • Tablets: 5 mg, 10 mg, 20 mg
    • Chewable tablets: 2.5 mg, 5 mg, 10 mg
    • Liquid: 5 mg /5 ml and 10 mg/5 ml
  • Metadate ER®, Ritalin SR® (methylphenidate, extended release, wax matrix)
    • Tablets: 10 mg, 20 mg
  • Methylin ER® (methylphenidate, extended release, methylcellulose base)
    • Tablets: 10 mg, 20 mg
  • Ritalin LA® (methylphenidate long-acting)
    • Capsules: 10 mg, 20 mg, 30 mg, 40 mg
  • Metadate CD® (methylphenidate controlled delivery)
    • Capsules: 10 mg, 20 mg, 30 mg , 40 mg, 50 mg, 60 mg
  • Concerta® (methylphenidate once daily)
    • Caplets: 18 mg, 27 mg, 36 mg, 54 mg bullet shaped
  • Daytrana® (methylphenidate patch)
    • Patch: 10 mg, 15 mg, 20 mg, 30 mg
  • Focalin® (Dexmethylphenidate) - Immediate release
    • Tablets: 2.5 mg, 5 mg, and 10 mg
  • Focalin XR® (dexmethylphenidate extended release)
    • Capsules: 5 mg , 10 mg, 15 mg 20 mg and 30 mg
  • Quillivant XR (methylphenidate HCl extended-release oral suspension)
    • Liquid: 5 mg/mL

All FDA warnings are at the end of this fact sheet. Please consult them before taking this medication.

What are Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR® and what do they treat?

Methylphenidate/dexmethylphenidate is a prescription medication that is used to treat children over 6 years old, adolescents, and adults with attention-deficit hyperactivity disorder (ADHD).

ADHD is associated with severe inattention, hyperactivity, and impulsivity that interfere with an individual's ability to function in school, at work, or in social settings. Examples of ADHD symptoms include making careless mistakes, losing things necessary for tasks, the inability to sit still and focus, and interrupting or intruding on others.

Adults have similar symptoms, but display less hyperactivity compared to children. Adults with ADHD may be more prone to procrastination, becoming easily frustrated and taking on many tasks at once while accomplishing none of them. A person may have severe inattention without hyperactivity or impulsivity and still meet criteria for the diagnosis of ADHD.

Methylphenidate/dexmethylphenidate is used in addition to non-medication treatments to manage ADHD symptoms.

What is the most important information I should know about Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR®?

Although some symptoms may improve within days of starting methylphenidate/dexmethylphenidate, it may take several weeks before you notice the full benefits of the medication.

In order for methylphenidate/dexmethylphenidate to work properly, it should be taken as ordered by your healthcare provider

Do not stop taking methylphenidate/dexmethylphenidate or change your dose without talking to with your healthcare provider first.

Methylphenidate/dexmethylphenidate should not be used at the same time or within 2 weeks of monoamine oxidase inhibitors (MAOIs), usually used to treat depression. MAOIs include phenelzine (Nardil®), tranylcypromine (Parnate®), selegiline (EMSAM®) and isocarboxazid (Marplan®). Some medications also have MAOI-like activity, such as the antibiotic linezolid (Zyvox®), and should be avoided as well. Using methylphenidate/dexmethylphenidate within 2 weeks of, or at the same time as, MAOIs can result in dangerously high blood pressure that can be fatal.

Are there specific concerns about Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR® and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with ADHD who wish to become pregnant face important decisions, each with risks and benefits as they relate to how the illness, medications, and risks to the fetus may interact. This is a complex decision as untreated ADHD has risks to the fetus as well as the mother. Therefore, it is important to discuss this with your doctor and caregivers.

Regarding breast-feeding, caution is advised since there is limited information available about the safety of methylphenidate/dexmethylphenidate while breastfeeding.

What should I discuss with my healthcare provider before taking Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR®?

  • The most bothersome symptoms of your condition
  • If you have thoughts of suicide
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
  • If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require an adjustment in the medication.
  • Any other psychiatric or medical problems you have
  • All other medications you are currently taking and any medication allergies you have. This will help your prescriber assess for potential drug interactions.
  • Other non-medication treatment you are receiving (such as psychotherapy (i.e., talk therapy) or substance abuse treatment). Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breast-feeding
  • If you drink alcohol or use drugs

How should I take Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR®?

Methylphenidate/dexmethylphenidate is usually taken one to three times per day with our without food.

While the dose usually varies, your healthcare provider will determine the dose that is right for you based upon your response.

  • Immediate release formulations should be given two or three times a day to provide symptom coverage throughout the day.
  • Extended release and long-acting medications that last for 8 to 12 hours should be taken once a day in the morning. The capsules with beads may be opened if a person has trouble swallowing, however, the beads should be swallowed whole without chewing. If the beads are chewed, too much medicine is absorbed at once and the effects will not last as long.
  • The tablet shell from the Concerta® tablet is not changed in the intestines and may appear in the stool intact. It should not be given to individuals with narrowing of the intestines or in those who have undergone stomach bypass surgery.
  • The methylphenidate patch should be applied to a clean, hair-free area in the morning before school and removed approximately 9 hours later for an approximate 12 hour duration of action.
  • Quillivant XR is a long-acting medication that releases medicine into your body throughout the day. Because of this, the daily dose should not be divided or taken multiple times a day. Before taking your daily dose, shake the bottle vigorously for at least 10 seconds to make sure the medication is mixed properly. Be sure to use the oral dose dispenser provided and to clean the dispenser after each use.

Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or friend to remind you or check in with you to be sure you are taking you medication.

What happens if I miss a dose of Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR®?

If you miss a dose of methylphenidate/dexmethylphenidate, take it as soon as you remember it, if it is not too close to when your next dose is due-discuss this with your health care provider. Do not double your next dose or take more than what is prescribed. Do not take a missed dose after 5:00 PM, as this may interfere with sleep.

What should I avoid while taking Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR®?

Avoid drinking alcohol or using illegal drugs while you are taking methylphenidate/dexmethylphenidate the beneficial effects of the medication may be decreased and adverse effects may be increased.

What happens if I overdose with Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR®?

If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary. Call your doctor or emergency medical service (911). You may also contact the poison control center (1-800-222-1222).

Overdosing with methylphenidate/dexmethylphenidate may lead to nausea and vomiting, rapid heart beat, abnormal heart rhythms, paranoia, hallucinations and seizures.

What are the possible side effects of Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR®?

Common

Upset stomach, loss of appetite, insomnia, and mild anxiety

Rare

Methylphenidate and dexmethylphenidate should be avoided in individuals who have a heart defect (structural abnormalities), uncontrolled high blood pressure, or a disorder of the heart or blood vessels.

Methylphenidate/dexmethylphenidate are rarely associated with clinically significant increases in blood pressure or heart rate. Blood pressure and heart rate should be monitored before starting medication, and then weekly while adjusting the dose and then every 1 to 3 months or when side effects like "racing heart", shortness of breath or exercise fatigue become problematic.

Severe anxiety, panic attacks, mania, hallucinations, paranoia and delusions are all possible. If they occur, the medication should be discontinued, and the individual should be evaluated by their health care provider.

Talk to your prescriber if you have concerns. Young males who have not yet reached puberty may not recognize the problem or may embarrassed to tell anyone. Know the signs and symptoms of priapism and seek immediate medical treatment if it occurs.

Are there any risks for taking Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR® for long periods of time?

Methylphenidate/dexmethylphenidate is a Schedule II controlled substance, similar to other stimulant medications, such as amphetamine, mixed amphetamine salts, dextroamphetamine and lisdexamfetamine. There is a risk of physical and/or emotional dependence (addiction) when it is taken for long periods of time.

Although treatment with these medications can slow growth, many studies have shown that these changes are small, and children may catch-up with growth over time, therefore should not be a concern for most children. Height, weight, and eating habits should be discussed before treatment starts and regularly during treatment. If you are concerned about a child's growth, discuss other possible treatments with your child's doctor.

What other medications interact with Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR®?

Medications used to treat depression such as tricyclic antidepressants (TCA) and monoamine oxidase inhibitors can interact with these medications resulting in serious reactions, including high body temperature, high blood pressure, and seizures (convulsions). Tell your healthcare provider if you are beginning or have recently discontinued any of these medications.

MAOIs, including phenelzine (Nardil®), Tranylcypromine (Parnate®), and selegiline (Emsam®), should not be taken with or within 2 weeks of taking these medications. Using these medications together can be fatal.

Medications that may increase the effects and adverse effects of methylphenidate/dexmethylphenidate include:

  • Atomoxetine (Strattera®), phenylephrine, guarana, and caffeine.
  • Fluoxetine (Prozac®), paroxetine (Paxil®), bupropion (Wellbutrin®), venlafaxine (Effexor® ), duloxetine (Cymbalta®)
  • Modafinil (Provigil®), armodafinil (Nuvigil®)

These medications may increase the blood level of some seizure medications such as phenobarbital or phenytoin. If you are taking any of these medications, tell your healthcare provider.

These medications may decrease response to some blood pressure medications such as clonidine, guanfacine, guanethidine and guanadrel. Tell your healthcare provider if you are taking any of these medications.

Urinary alkalinizers (e.g. sodium bicarbonate) may increase the effects of these medications, while urinary acidifiers (citrus beverages) may decrease the effects.

How long does it take for Concerta®, Daytrana®, Focalin®, Metadate®, Ritalin®, Quillivant XR® to work?

Although you may experience beneficial effects from methylphenidate/dexmethylphenidate within a few days of starting the medication, it often takes several weeks to get the full effect of the medication. Your healthcare provider may also need to adjust gradually the dose to find the dose that works best for you.

Updated by

College of Psychiatric and Neurologic Pharmacists

March 2014

FDA ALERT [02/2006] Sudden Unexplained Death, Cardiac/Cardiovascular, and Psychiatric Adverse Events Associated with Stimulant Therapy for ADHD.

In February of 2006, FDA warned of serious cardiac and cardiovascular risks including sudden unexplained death (SUD) associated with the use of methylphenidate or dexmethylphenidate in children, adolescents and adults. Individuals with structural heart abnormalities are at a greater risk for these adverse cardiac/cardiovascular effects although those without structural cardiac abnormalities are also at risk. In addition, psychiatric adverse events including hallucinations, increased aggression, and mania have been reported in individuals taking methylphenidate or dexmethylphenidate. The risk of these effects is greater in those with existing psychiatric illness.

Rarely, sudden unexplained death has been associated with stimulant use. Tell your prescriber about any history of heart disease in yourself or family member as it could increase the risk. These drugs also increase blood pressure and heart rate. Stimulants have a high potential for abuse and long term use may lead to dependence. Use or misuse may cause sudden death and serious cardiovascular events or stroke.

Stimulant medications have been associated with serious psychiatric adverse reactions including worsening psychosis, mania, panic attacks and severe anxiety.

FDA ALERT (12/2013) Risk of Long-Lasting Erections with Methylphenidate ADHD Medications

In December of 2013, the FDA warned that methylphenidate-containing products may in rare instances cause prolonged and sometimes painful erections known as priapism. Priapism may occur in males of any age and happens when blood in the penis becomes trapped, leading to an abnormally long-lasting and sometimes painful erection.



Related Resources

Partnership for Prescription Assistance
A new toll-free number and Web site provide help to those who lack prescription coverage or cannot afford their medications.

Prescription Drug Patient Assistance Programs
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Related Links

Food and Drug Administration Label Insert for Ritalin

YourPharmacyBenefit.org
Information to help you make good use of the pharmacy benefits that are part of your health insurance.


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