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Methylphenidate/Dexmethylphenidate

Brand names:

Ritalin^®, Methylin^® (methylphenidate) – immediate release

• Tablets: 5 mg, 10 mg, 20 mg

• Chewable tablets: 2.5 mg, 5 mg, 10 mg

• Liquid: 5 mg/5mL and 10 mg/5 mL

Metadate ER^®, Ritalin SR^®, Methylin ER^® (methylphenidate) – extended release

• Tablets: 10 mg, 20 mg

Ritalin LA^® (methylphenidate) – long-acting

• Capsules: 10 mg, 20 mg, 30 mg, 40 mg

Metadate CD^® (methylphenidate) – controlled release

• Capsules: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

Concerta^® (methylphenidate) – controlled release

• Caplets: 18 mg, 27 mg, 36 mg, 54 mg

Daytrana^® (methylphenidate) patch

• Patch: 10 mg, 15 mg, 20 mg, 30 mg

Focalin^® (dexmethylphenidate) – immediate release

• Tablets: 2.5 mg, 5 mg, 10 mg

Focalin XR^® (dexmethylphenidate) – extended release

• Capsules: 2.5 mg, 10 mg, 15 mg, 20 mg, 30 mg

Generic name: methylphenidate (meth il FEN i date)

Medication class: central nervous system (CNS) stimulant

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

What are Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, and Focalin^® and what do they treat?

Methylphenidate and dexmethylphenidate are prescription medications that are used to treat individuals with attention-deficit hyperactivity disorder (ADHD). This sheet will use “methylphenidate� to refer to all products.

Symptoms of ADHD interfere with an individual’s ability to function at school or work or in social settings and include:

• Inattention (e.g., making careless mistakes, losing things necessary for tasks)

• Hyperactivity (e.g., inability to sit still)

• Impulsivity (e.g., interrupting or intruding on others)

Hyperactivity is less common in adults. A person may have severe inattention without hyperactivity or impulsivity.

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

What is the most important information I should know about Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^®?

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

Are there specific concerns about Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^® and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with ADHD who wish to become pregnant face important decisions. Abuse of products like methylphenidate (i.e., taking without a prescription or taking more than prescribed) has been associated with premature delivery, low birth weight, and neonatal withdrawal symptoms. Untreated ADHD may be associated with increased risk of substance use. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

Regarding breastfeeding, caution is advised since methylphenidate does pass into breast milk.

What should I discuss with my healthcare provider before taking Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^®?

• Symptoms of your condition that bother you the most

• If you have thoughts of suicide or harming yourself

• If you experience side effects from your medications, discuss them with your provider. Some side effects pass with time, but others may require changes in the medication.

• Any other psychiatric or medical problems you have, including heart disease

• All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have

• Other non-medication treatment you are receiving, such as 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 Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^®?

Methylphenidate is usually taken 1or 2 times per day with or without food.

• Immediate release tablets (Ritalin^®, Methylin^®, Focalin^®): Tablets may be swallowed whole or crushed.

• Extended-release tablets (Concerta^®, Ritalin SR^®, Methylin ER^®, Metadate ER^®): Swallow tablets whole. Do not crush or chew.

• Extended-release, controlled-release, or long-acting capsules (Ritalin LA^®, Metadate CD^®, Focalin XR^®): Swallow whole or sprinkle onto food, such as applesauce or pudding and eat immediately. Do not chew capsules or capsule contents.

• Liquid methylphenidate: Measure with a dosing spoon or oral syringe which you can get from your pharmacy.

• Patch: Apply once daily to the hip in the morning, 2 hours before effect is needed. Alternate hips each day. Do not cut patch. Remove patch no more than 9 hours after application. Fold the used patch in half and press it together firmly so the sticky side sticks to itself. Dispose of the patch in trash that is not accessible to pets or children.

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 Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^®?

If you miss a dose of methylphenidate, take it as soon as you remember, if it is still early in the day. Do not take a missed dose after 5:00 PM, as this may interfere with sleep. Do not take a missed dose of extended-release products after 2:00 PM, as this may interfere with sleep. Discuss missed doses with your healthcare provider. Do not double your next dose or take more than what is prescribed.

What should I avoid while taking Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^®?

Avoid drinking alcohol or using illegal drugs while you are taking this medication. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.

What happens if I overdose with Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^®?

If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of methylphenidate does not exist.

What are the possible side effects of Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^®?

Common Side Effects

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

Rare Side Effects

Contact your healthcare provider if any of the following occur while taking methylphenidate:

• Significant increases in blood pressure or heart rate, shortness of breath, fatigue

• Severe anxiety, panic attacks, mania, hallucinations, paranoia or delusions

• Rash with the patch form of methylphenidate

Serious Side Effects

Misuse of methylphenidate may cause serious cardiovascular adverse events and death. Methylphenidate should be avoided in individuals who have a heart defect (structural abnormality), uncontrolled high blood pressure, or other disorder of the heart or blood vessels.

Are there any risks for taking Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^® for long periods of time?

Methylphenidate is a Schedule II controlled substance. There is a risk of physical and/or emotional dependence (addiction) when it is taken for long periods of time.

Although treatment with methylphenidate can slow growth, many studies have shown that these changes are small, and children may catch-up with growth over time; therefore, it 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 Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, or Focalin^®

Medications used to treat depression can interact with methylphenidate 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.

Methylphenidate should not be taken with or within 2 weeks of monoamine oxidase inhibitor antidepressants (MAOIs), including phenelzine (Nardil^®), tranylcypromine (Parnate^®), selegiline (EMSAM^®), isocarboxazid (Marplan^®), and the antibiotic linezolid (Zyvox^®). Taking methylphenidate with or within 2 weeks of MAOIs can result in dangerously high blood pressure that can lead to death.

The following medications may increase the side effects of methylphenidate:

• Atomoxetine (Strattera^®), caffeine, phenylephrine, fluoxetine (Prozac^®), bupropion (Wellbutrin^®), venlafaxine (Effexor^®), duloxetine (Cymbalta^®), Modafinil (Provigil^®), and armodafinil (Nuvigil^®)

Methylphenidate may decrease the effects of blood pressure medications.

How long does it take for Ritalin^®, Methylin^®, Metadate^®, Concerta^®, Daytrana^®, and Focalin^®?

Although you may experience beneficial effects from methylphenidate 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 the dose gradually to find the dose that works best for you.

Provided by the College of Psychiatric and Neurologic Pharmacists

(January 2013)

Summary of Black Box Warnings

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. Psychotic episodes can occur, especially when injected. 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.

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