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
Ritalin
LA® (methylphenidate) – long-acting
Metadate
CD® (methylphenidate) – controlled release
-
Capsules:
10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg
Concerta® (methylphenidate) – controlled release
Daytrana® (methylphenidate) patch
Focalin® (dexmethylphenidate) – immediate release
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
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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