Methylphenidate

Methylphenidate Brand Names

Adhansia XR | Aptensio XR | Concerta | Cotempla XR | Daytrana | Jornay | Metadate CD | Metadate ER | Methylin | QuilliChew ER | Quillivant XR | RELEXXII | Ritalin | Ritalin LA | Ritalin SR

What is Methylphenidate

Methylphenidate is a central nervous system stimulant that is chemically similar to the amphetamines.

The peripheral pharmacologic actions of methylphenidate are milder than those of the amphetamines; it has more noticeable effects on central functioning than on motor activities.

Methylphenidate is indicated for use in attention-deficit hyperactivity disorder (ADHD) and narcolepsy. It is occasionally used off-label for post-stroke depression or other depressive disorders refractory to other treatments. Stimulants are considered first-line agents in the treatment of ADHD. Methylphenidate and other stimulants are highly effective for the treatment of ADHD, with few comparative differences in efficacy.

Two well-controlled trials demonstrate that roughly 70% to 80% of children treated with stimulants will have improvements such that at the end of the treatment phase the child no longer meets criteria for diagnosis of ADHD.

Methylphenidate has been shown to have a strong effect on measures of attention, distractibility, impulsivity, and social and classroom behavior. Modest effect sizes have been reported for academic achievement.

Lack of response to 1 stimulant does not predict a response to other stimulants, and a trial with a different agent (i.e., dexmethylphenidate, dextroamphetamine, mixed amphetamine salts) may be warranted if treatment fails with the initial stimulant.

The Preschool ADHD Treatment Study (PATS), funded by the National Institute of Mental Health, provides important clinical guidance for children 3 to 5 years of age with ADHD. Stimulants have been associated with sudden death in pediatric patients with structural cardiac abnormalities; patients with structural heart defects, cardiomyopathy, or heart-rhythm disturbances may be at risk for adverse cardiac events.

The American Heart Association recommends careful screening of all children and adolescents prior to initiating pharmacologic therapy for ADHD, including a detailed patient and family history and physical examination.

Indications

• attention-deficit hyperactivity disorder (ADHD)
• depression
• narcolepsy

For the treatment of attention-deficit hyperactivity disorder (ADHD)

Side Effects

1. abdominal pain
2. agitation
3. alopecia
4. anaphylactoid reactions
5. anemia
6. angina
7. angioedema
8. anorexia
9. anxiety
10. arrhythmia exacerbation
11. arthralgia
12. asthenia
13. atopic dermatitis
14. back pain
15. blurred vision
16. bradycardia
17. bullous rash
18. chemical leukoderma
19. chest pain (unspecified)
20. coma
21. confusion
22. constipation
23. contact dermatitis
24. cough
25. delirium
26. depression
27. diaphoresis
28. diarrhea
29. diplopia
30. dizziness
31. drowsiness
32. dyskinesia
33. dyspepsia
34. dyspnea
35. ecchymosis
36. elevated hepatic enzymes
37. emotional lability
38. erythema
39. erythema multiforme
40. euphoria
41. exfoliative dermatitis
42. fatigue
43. fever
44. growth inhibition
45. gynecomastia
46. hallucinations
47. headache
48. hepatic failure
49. hostility
50. hot flashes
51. hyperactivity
52. hyperbilirubinemia
53. hyperhidrosis
54. hypertension
55. hyperthermia
56. infection
57. insomnia
58. irritability
59. lethargy
60. leukopenia
61. libido decrease
62. mania
63. migraine
64. muscle cramps
65. myalgia
66. mydriasis
67. myocardial infarction
68. nausea
69. neuroleptic malignant syndrome
70. ocular hypertension
71. ocular pain
72. palpitations
73. pancytopenia
74. paranoia
75. paresthesias
76. peripheral vasoconstriction
77. pharyngitis
78. physiological dependence
79. priapism
80. pruritus
81. psychological dependence
82. psychosis
83. purpura
84. rash
85. restlessness
86. rhabdomyolysis
87. seizures
88. serotonin syndrome
89. sinus tachycardia
90. sinusitis
91. skin erosion
92. skin hyperpigmentation
93. skin hypopigmentation
94. skin irritation
95. skin ulcer
96. stroke
97. suicidal ideation
98. supranormalization
99. supraventricular tachycardia (SVT)
100. syncope
101. teeth grinding (bruxism)
102. thrombocytopenia
103. tolerance
104. tremor
105. urticaria
106. vasculitis
107. vertigo
108. visual impairment
109. vomiting
110. weight loss
111. withdrawal
112. xerosis
113. xerostomia

Monitoring Parameters

• blood pressure
• CBC with differential
• growth rate
• heart rate
• platelet count
• weight

Contraindications

• abrupt discontinuation
• acute myocardial infarction
• alcoholism
• angina
• anorexia nervosa
• anxiety
• aortic stenosis
• arteriosclerosis
• bipolar disorder
• breast-feeding
• bulimia nervosa
• cardiac arrhythmias
• cardiac disease
• cardiomyopathy
• cerebrovascular disease
• chemical leukoderma
• congenital heart disease
• coronary artery disease
• cystic fibrosis
• depression
• driving or operating machinery
• dysphagia
• esophageal stricture
• geriatric
• GI obstruction
• glaucoma
• growth inhibition
• heart failure
• heating pad
• hereditary fructose intolerance
• hypertension
• hyperthyroidism
• ileus
• mania
• MAOI therapy
• myocardial infarction
• neonates
• obesity treatment
• peripheral vascular disease
• peritonitis
• phenylketonuria
• pregnancy
• priapism
• prosthetic heart valves
• psychosis
• Raynaud’s phenomenon
• schizophrenia
• seizure disorder
• seizures
• skin hypopigmentation
• stroke
• substance abuse
• suicidal ideation
• surgery
• tachycardia
• tartrazine dye hypersensitivity
• thyrotoxicosis
• tics
• Tourette’s syndrome
• valvular heart disease
• ventricular arrhythmias
• ventricular dysfunction
• visual disturbance
• vitiligo

Interactions

• Acarbose
• Acebutolol
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Tramadol
• Albiglutide
• Alfentanil
• Alogliptin; Pioglitazone
• Alpha-blockers
• Alpha-glucosidase Inhibitors
• Aluminum Hydroxide
• Aluminum Hydroxide; Magnesium Carbonate
• Aluminum Hydroxide; Magnesium Hydroxide
• Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
• Aluminum Hydroxide; Magnesium Trisilicate
• Amantadine
• Ambrisentan
• Amifampridine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Angiotensin II receptor antagonists
• Angiotensin-converting enzyme inhibitors
• Antacids
• Apomorphine
• Aripiprazole
• Armodafinil
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Atenolol
• Atenolol; Chlorthalidone
• Atomoxetine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• atypical antipsychotic
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Bendroflumethiazide; Nadolol
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Beta-blockers
• Betaxolol
• Bethanechol
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bosentan
• Bretylium
• Brexpiprazole
• Brimonidine; Timolol
• Bromocriptine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Caffeine
• Caffeine; Ergotamine
• Calcium Carbonate
• Calcium Carbonate; Magnesium Hydroxide
• Calcium Carbonate; Risedronate
• Calcium Carbonate; Simethicone
• Calcium-channel blockers
• Canagliflozin
• Canagliflozin; Metformin
• Carbamazepine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Cardiac glycosides
• Cariprazine
• Carteolol
• Carvedilol
• Chlophedianol; Guaifenesin; Phenylephrine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpromazine
• Chlorthalidone; Clonidine
• Cimetidine
• Citalopram
• Clomipramine
• Clonidine
• Clozapine
• Cocaine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Colchicine
• Colchicine; Probenecid
• COMT inhibitors
• Dapagliflozin
• Dapagliflozin; Metformin
• Dapagliflozin; Saxagliptin
• Desflurane
• Desipramine
• Desvenlafaxine
• Dexlansoprazole
• Dexmethylphenidate
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Promethazine
• Digitoxin
• Digoxin
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dipeptidyl Peptidase-4 Inhibitors
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Phenylephrine
• Dopamine
• dopamine agonists
• Dorzolamide; Timolol
• Doxazosin
• Doxepin
• Dronabinol
• Droxidopa
• Dulaglutide
• Duloxetine
• Dyphylline
• Dyphylline; Guaifenesin
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Enflurane
• Entacapone
• Ephedrine
• Eplerenone
• Epoprostenol
• Ertugliflozin
• Ertugliflozin; Metformin
• Ertugliflozin; Sitagliptin
• Escitalopram
• Esketamine
• Esmolol
• Esomeprazole
• Esomeprazole; Naproxen
• Ethanol
• Ethotoin
• Exenatide
• Famotidine
• Famotidine; Ibuprofen
• Fenfluramine
• Fentanyl
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvoxamine
• Fosphenytoin
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Green Tea
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guanabenz
• Guanfacine
• H2-blockers
• Halogenated Anesthetics
• Haloperidol
• Halothane
• Homatropine; Hydrocodone
• Hydantoins
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Iloperidone
• Iloprost
• Imipramine
• Incretin Mimetics
• Indacaterol
• Indacaterol; Glycopyrrolate
• Indapamide
• Insulin Degludec; Liraglutide
• Insulin Glargine; Lixisenatide
• Insulins
• Iobenguane I 131
• Isocarboxazid
• Isoflurane
• Labetalol
• Lansoprazole
• Lansoprazole; Naproxen
• Lasmiditan
• Levobetaxolol
• Levobunolol
• Levodopa
• Levomilnacipran
• Levorphanol
• Levothyroxine
• Levothyroxine; Liothyronine (Porcine)
• Levothyroxine; Liothyronine (Synthetic)
• Linezolid
• Liothyronine
• Liraglutide
• Lithium
• Lixisenatide
• Loop diuretics
• Loxapine
• Lumateperone
• Lurasidone
• Macitentan
• Magnesium Hydroxide
• Maprotiline
• Mecamylamine
• Meglitinides
• Meperidine
• Meperidine; Promethazine
• Mephobarbital
• Mesoridazine
• Metformin; Pioglitazone
• Metformin; Rosiglitazone
• Methadone
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methyldopa
• Methylene Blue
• Metoclopramide
• Metoprolol
• Midodrine
• Miglitol
• Milnacipran
• Mirtazapine
• Modafinil
• Molindone
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Nabilone
• Nadolol
• Nalbuphine
• Nebivolol
• Nebivolol; Valsartan
• Nefazodone
• Nitrates
• Nizatidine
• Non-Ionic Contrast Media
• Norepinephrine
• Nortriptyline
• Olanzapine
• Omeprazole
• Omeprazole; Amoxicillin; Rifabutin
• Omeprazole; Sodium Bicarbonate
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Pantoprazole
• Paroxetine
• Penbutolol
• Pergolide
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Phenothiazines
• Phenoxybenzamine
• Phentolamine
• Phenylephrine
• Phenylephrine; Promethazine
• Phenytoin
• Pimozide
• Pindolol
• Pioglitazone
• Potassium-sparing diuretics
• Pramipexole
• Pramlintide
• Prazosin
• Primidone
• Procarbazine
• Prochlorperazine
• Promethazine
• Propranolol
• Proton pump inhibitors
• Protriptyline
• Quetiapine
• Rabeprazole
• Ranitidine
• Rasagiline
• Remifentanil
• Reserpine
• Riociguat
• Risperidone
• Ropinirole
• Rosiglitazone
• Safinamide
• Selective serotonin reuptake inhibitors
• Selegiline
• Selexipag
• Semaglutide
• Serotonin norepinephrine reuptake inhibitors
• Sertraline
• Sevoflurane
• SGLT2 Inhibitors
• Sibutramine
• Sodium Bicarbonate
• Sodium Oxybate
• Solriamfetol
• Sotalol
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Sufentanil
• Sulfonylureas
• Tapentadol
• Tedizolid
• Terazosin
• Theophylline, Aminophylline
• Thiazide diuretics
• Thiazolidinediones
• Thiethylperazine
• Thioridazine
• Thiothixene
• Thyroid hormones
• Timolol
• Tolcapone
• Tramadol
• Tranylcypromine
• Treprostinil
• Triamterene
• Tricyclic antidepressants
• Trifluoperazine
• Trimipramine
• Umeclidinium; Vilanterol
• Vasodilators
• Vasopressors
• Venlafaxine
• Vilazodone
• Vortioxetine
• Warfarin
• Ziprasidone