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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If you or someone in your family has attention deficit hyperactivity disorder (ADHD), you know it’s a behavioral condition that can make focusing on tasks very challenging.
Trouble concentrating, a short attention span, fidgeting, misplacing things, and impulsive behavior are just a few of the common struggles one has with ADHD. Fortunately, your healthcare provider is available to help, and their treatment plan may include medication like methylphenidate.
What is methylphenidate (Ritalin), and how does it work?
Methylphenidate hydrochloride (brand name: Ritalin) is a type of drug called a central nervous system (CNS) stimulant. It is a stimulant because it speeds up certain brain signals by increasing the availability of two neurotransmitters: norepinephrine and dopamine (Farzam, 2021).
Ritalin is an immediate-release oral tablet, which means it releases its active ingredient, methylphenidate, into your body all at once and is relatively short-acting. After taking a dose, Ritalin typically reaches its maximum effects in your body within 2.5–3 hours (within two hours for a child) before it starts wearing off (Novartis, 2021).
Several other products are available as extended-release formulations of the drug. Extended-release medications are designed to release the active ingredient gradually, and their effects last longer. This provides several advantages, including less frequent dosing and potentially fewer side effects. Some examples of other brands that contain methylphenidate as an extended-release formulation are (Drugs@FDA, n.d.):
- Concerta tablets
- Daytrana transdermal patches
- Journay PM capsules
- Metadate CD capsules
- Quillichew chewable tablet
- Quillivant XR liquid suspension
- Ritalin SR tablets
- Ritalin LA capsules
Do I have ADHD? Can you be diagnosed as an adult?
Methylphenidate (Ritalin) is approved by the Food and Drug Administration (FDA) to treat (Novartis, 2021):
- Attention deficit hyperactivity disorder (ADHD) in adults, adolescents, and children (ages six years and older). ADHD is a behavioral condition that makes focusing on tasks very challenging (American Psychological Association, n.d.).
- Narcolepsy in adults. Narcolepsy is a brain disorder that causes excessive daytime sleepiness and sudden “sleep attacks” during which the person cannot stay awake. Methylphenidate can help people with narcolepsy stay more alert during the day if other treatments aren’t effective (Novartis, 2021; Verghese, 2021).
Methylphenidate is also used “off-label” to treat other conditions besides those specifically approved by the FDA. A healthcare provider can prescribe medications for off-label use if they decide that it’s an appropriate treatment for their patient.
Some off-label uses for methylphenidate include (Verghese, 2021):
- Fatigue (feeling tired despite adequate sleep) due to cancer
- Refractory or treatment-resistant depression in older adults (ages 65 years and older)
- Apathy (defined as low motivation) related to Alzheimer’s disease, a progressive brain condition that affects memory and thinking abilities
If you’re wondering if methylphenidate would be an appropriate treatment for you, talk to your healthcare provider.
Methylphenidate (Ritalin) side effects
The most common side effects of methylphenidate are (Novartis, 2021):
- Increased heart rate
- Heart palpitations
- Insomnia (trouble sleeping)
- Increased sweating
- Weight loss
- Loss of appetite
- Dry mouth
- Abdominal pain
ADD vs. ADHD: what’s the difference?
Less frequently, some people may develop serious side effects of methylphenidate, such as heart problems like a heart attack or stroke. Changes in mood and behavior can also occur, such as psychosis or mania, especially in people who already have mental health conditions like bipolar disorder (Novartis, 2021).
Other less common side effects of methylphenidate (Novartis, 2021):
- Priapism (painful, prolonged erections)
- Circulation problems, such as Raynaud’s syndrome, in which you develop numbness or skin discoloration in your fingers and toes
In children taking methylphenidate long-term, growth suppression (not growing as expected for age) is possible. If your child takes methylphenidate, you’ll work with their pediatric healthcare provider to regularly monitor their height and weight (Novartis, 2021).
Methylphenidate (Ritalin) dosage
Methylphenidate (Ritalin) is a medication that you take by mouth. It comes in 5 milligrams (mg), 10 mg, and 20 mg tablets. The usual dosage is one tablet by mouth two or three times per day, 30 to 45 minutes before meals (Novartis, 2021).
Methylphenidate extended-release (such as Concerta, Ritalin LA, and others) is typically taken once per day in the morning.
Be sure to follow your healthcare provider’s instructions. They may increase or adjust your dosing based on how well the medication works for you, if you develop side effects, and if you’re taking other medications or have other medical conditions. You should not change your dose or stop taking methylphenidate without discussing it with your healthcare provider.
Methylphenidate (Ritalin) warnings
Having certain health conditions can raise your chance of developing serious side effects of methylphenidate (Ritalin). Before starting this medication, it is important to talk with your healthcare provider about your current and past health conditions. This will help guide them in prescribing a treatment option that’s best for you.
The FDA has issued boxed warnings for methylphenidate and all CNS stimulants. Boxed warnings are the strongest type of FDA warnings, and they alert healthcare professionals and patients about risks that they should know about before starting treatment. These boxed warnings for Ritalin include (Novartis, 2021):
- Methylphenidate (Ritalin) and all CNS stimulants are schedule II controlled substances. They have legitimate medical purposes but carry serious risks for potential abuse and addiction. If you’ve had a past problem with substance abuse, it’s a good idea to be open with your healthcare provider about it. They’ll consider these risks and work with you to develop a treatment plan that fits your needs (DEA, n.d.).
- Serious cardiovascular health problems are possible risks of taking CNS stimulants. Taking stimulants more than prescribed or for a non-legitimate purpose could result in dangerous effects, including sudden death due to heart attack or stroke.
ADHD medication: what you need to know
Because of these risks, your doctor will monitor you to check for any signs of heart problems, such as increased blood pressure. They’ll work with you to adjust your dosage and treatment until they find a plan that’s safe and effective for you.
Also, tell your healthcare provider if you have any of the following conditions before you take Ritalin (Novartis, 2021):
- Hypertension (high blood pressure)
- Coronary artery disease, heart disease, or any circulatory or blood vessel problems
- An eye condition called glaucoma
- Mental health conditions such as bipolar disorder
- Tics, Tourette’s syndrome, or a family history of Tourette’s
- Pregnancy, breastfeeding, or you’re planning to become pregnant or breastfeed
Methylphenidate (Ritalin) drug interactions
Several different types of medications can interact with methylphenidate, raising the risk of harmful, adverse effects. Some examples of drugs that can interact with methylphenidate (Ritalin) include (Novartis, 2021):
- MAOIs. People who take monoamine oxidase inhibitors (MAOIs), or took them in the last two weeks, should not take methylphenidate. The combination can interact and cause your blood pressure to become dangerously high. MAOIs are older drugs previously used as antidepressants. They are no longer popular for depression due to their risks. Now, MAOIs are mainly prescribed for other reasons. One example is selegiline, a treatment for Parkinson’s disease, a progressive nervous system disorder that can cause tremors and other symptoms.
- Blood pressure medications. Methylphenidate can reduce the effectiveness of antihypertensive drugs used to lower blood pressure and treat heart disease. If you take a blood pressure medication, taking methylphenidate can raise your risk for increased blood pressure or heart rate, possibly leading to heart attack or stroke. Before prescribing methylphenidate, your healthcare provider will check your blood pressure and heart. If they decide that it’s safe for you to try methylphenidate, they’ll monitor you carefully and likely recommend that you check your blood pressure regularly at home during treatment.
- Surgical anesthesia. Certain types of drugs called halogenated anesthesia can cause increased blood pressure when combined with methylphenidate. If you are having an upcoming operation or medical procedure, ask your healthcare provider if you should temporarily stop taking methylphenidate.
- Risperidone (Risperdal). Methylphenidate can interact with risperidone, an antipsychotic medication used to treat mental health conditions such as bipolar disorder. The interaction can increase the risk of movement-related side effects called extrapyramidal symptoms. Tell your healthcare provider if you develop fidgeting or other unusual movements that you can’t control while taking these medications together.
Other drug interactions are possible, so it’s always a good idea to consult with your pharmacist or healthcare provider before taking any medications or supplements along with methylphenidate.
If you feel that you or a loved one can benefit from methylphenidate, speak with a healthcare provider to determine the best treatment approach for your needs.
- American Psychological Association. (n.d.). ADHD. Retrieved from https://www.apa.org/topics/adhd
- Drug Enforcement Agency (DEA). (n.d.). Drug Scheduling. Retrieved from https://www.dea.gov/drug-information/drug-scheduling
- Drugs@FDA: FDA-Approved Drugs. (n.d.). Drugs@FDA. Retrieved Aug. 17, 2021 from https://www.accessdata.fda.gov/scripts/cder/daf/
- Farzam, K., Faizy, R. M., & Saadabadi, A. (2021). Stimulants. [Updated Aug 6, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539896/
- Novartis. (2021). Ritalin (methylphenidate hydrochloride) tablets, for oral use, CII. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/010187s093lbl.pdf
- Verghese, C. & Abdijadid, S. (2021). Methylphenidate. [Updated May 4, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482451/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.