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