Methylphenidate

Boxed warning:

Methylphenidate can be habit-forming, and prescribers must consider the risk of abuse before prescribing methylphenidate. Once prescribed, they must monitor for signs of abuse or dependence and adjust the treatment plan as needed. The drug is classified as a controlled substance, meaning its manufacturing, handling, storage, and distribution are tightly controlled because of the potential for abuse and dependence. 

What is methylphenidate?

Methylphenidate belongs to a class of medications called central nervous system (CNS) stimulants. It works by inhibiting specific transporters in the brain, leading to increased dopamine and norepinephrine levels. Through its stimulatory influence on those two neurotransmitters, methylphenidate boosts focus and reduces a person’s susceptibility to distractions.¹ ²

Methylphenidate is the generic name of the drug. It’s also available under the brand names Concerta, Ritalin, and others. Generic forms are typically less costly than their branded counterparts.

There is a potential for abuse of this drug, and thus it is regulated by the US Drug Enforcement Administration (DEA) as a controlled schedule II substance.

What is methylphenidate used to treat?

Methylphenidate has been approved by the US Food and Drug Administration (FDA) for treating adults and children with attention-deficit/hyperactivity disorder (ADHD) and adults with narcolepsy.

What You Need To Know About Attention-Deficit Hyperactivity Disorder (ADHD)

Methylphenidate increases attention and reduces restlessness in patients who are overactive, can't concentrate for reasonably long periods, are easily distracted, and struggle with impulsiveness. This drug is used as part of a multifaceted treatment plan that also includes social, educational, and psychological therapy.

Sometimes, doctors prescribe methylphenidate for other conditions, such as fatigue in cancer patients and depression in older individuals, but these are considered off-label uses.³

How do you take methylphenidate?

How you take methylphenidate will depend on your age, the condition you’re being treated for, other medical conditions you have and medications you are taking, and the form of the drug you take. You should always take methylphenidate precisely as prescribed.

Strengths and forms⁴ ⁵

Methylphenidate is available in several forms, some of which are intended exclusively for children. The strengths vary by form and brand.

Immediate-release forms

Oral tablets

• Swallow each tablet whole with a full glass of water (do not chew, break, or crush the tablet).

• Generic, Ritalin: 5mg, 10mg, 20mg

Chewable oral tablets

• Chew the chewable tablet and follow with a full glass of water to prevent the tablet from getting stuck in your throat, where it can expand and potentially block airflow.

• Generic: 2.5mg, 5mg, 10mg

Liquid for oral use⁶

• Measure the appropriate dose with the supplied measuring device (household measuring spoons are not adequately precise for dosing medications).

• Generic, Methylin: 5mg/5mL, 10mg/5mL

Extended-release forms

Oral tablets

• Swallow whole with a glass of water (do not break, crush, or chew).

• Generic: 10mg, 20mg

• Concerta ER: 18mg, 27mg, 36mg, 54mg

• Relexxii: 18mg, 27mg, 36mg, 45mg, 54mg, 63mg, 72mg

Chewable oral tablets

• Chew the chewable tablet and follow with a full glass of water to prevent the tablet from getting stuck in your throat, where it can expand and potentially block airflow.

• Quillichew ER: 20mg, 30mg, 40mg

Capsules

• Capsules are typically taken whole without chewing, crushing, or breaking. However, if you struggle with swallowing pills, you can break one open and mix its contents into a tablespoon of applesauce or yogurt. Consume the entire mixture immediately without chewing.

• Ritalin LA: 10mg, 20mg, 30mg, 40mg

• Aptensio XR: 10mg, 15mg, 20mg, 30mg, 40mg, 50mg, 60mg

• Metadate CD: 10mg, 20mg, 30mg, 40mg, 50mg, 60mg

• Adhansia XR: 25mg, 35mg, 45mg, 55mg, 70mg, 85mg

• Jornay PM: 20mg, 40mg, 60mg, 80mg, 100mg (delayed-release taken in the evening)

Disintegrating tablets

• Indicated for pediatric patients aged six years and older.

• Using dry hands, remove the tablet from the foil packaging and place it in your mouth immediately, allowing it to dissolve on your tongue.

• Cotempla XR-ODT: 8.6mg, 17.3mg, 25.9mg

Transdermal patches⁷

• Indicated for pediatric patients aged six years and older.

• Carefully open the pouch. While holding the patch with the logo facing away from the skin, peel back half the backing without touching the sticky surface, and apply it to the hip. Peel the remaining liner and smooth and press the patch onto the skin for about 30 seconds.

• Daytrana: 10mg, 15mg, 20mg, 30mg

Suspension for oral use

• Indicated for pediatric patients aged six years and older.

• Shake the bottle for ten seconds. Attach the supplied bottle adapter, and insert the provided dosing dispenser into the adapter (with the plunger all the way down). Flip the bottle upside down, and pull back the plunger to fill the dispenser with the prescribed dose. Slowly squirt the medication into the child’s mouth.

• Quillivant XR: 25mg/5mL (following reconstitution)

Most forms of methylphenidate are taken by mouth. The regular tablets, chewable tablets, and liquid for oral use are usually taken 35–40 minutes before a meal. Most extended-release forms are taken in the morning with or without food, except for the capsules, which are taken just before breakfast. The extended-release suspension form works faster when taken with food. Finally, the brand Jornay PM, an extended-release capsule uniquely designed for nighttime use, is taken with or without food in the evening.⁸

Seeing results

How soon you see results will depend on which form of methylphenidate you take. For example, those taking immediate-release tablets will experience peak plasma concentrations at around 1.9 hours compared to 4.7 hours for extended-release tablets. While most people will notice some improvements within a few days of starting the drug, they may not see the full benefits for several weeks.⁹ ¹⁰

Between 70% and 80% of children with ADHD experience fewer symptoms while taking stimulant medications such as methylphenidate.¹¹

Who should not take methylphenidate?

Methylphenidate is typically well-tolerated, but it isn’t suitable for everyone. The drug is contraindicated for people with any of the following:¹² ¹³

• Severe anxiety, tension, or agitation

• Glaucoma

• Motor tics

• Tourette syndrome (or a family history of the condition)

• Hypersensitivity to any of the medication’s active or inactive ingredients 

• Cardiomyopathy

• Severe cardiac arrhythmia

• Severe high blood pressure

• Severe cardiovascular disease

• Structural heart disease

• Coronary artery disease

• Taking monoamine oxidase inhibitors (MAOIs) 

Additionally, methylphenidate should be prescribed cautiously in patients with the following:

• Arrhythmia (non-severe)

• Congestive heart failure

• Hypertension

• Hyperthyroidism

• Psychosis

• Bipolar disorder (or risk)

• A history of seizures (or risk)

• A history of substance abuse

Some forms of the medication contain sucrose, lactose, or phenylalanine. Let your doctor know if you have any of the following conditions so they can prescribe a type that’s appropriate for you.

• Phenylketonuria

• Severe gastrointestinal stricture (abnormal narrowing of the esophagus that can cause difficulty swallowing)

• Lapp lactase deficiency

• Hereditary fructose or galactose intolerance

• Sucrase or isomaltase insufficiency

• Glucose or galactose malabsorption

Additionally, certain drugs interact adversely with methylphenidate, and concurrent use must be avoided. People taking MAOIs, in particular, should not take methylphenidate within 14 days of their last dose.

Warnings and potential side effects of methylphenidate

In addition to the boxed warning outlined above, methylphenidate has several general warnings to be aware of before you start taking the medication. Most notably, using methylphenidate may increase the risk of the following effects and conditions:¹⁴

Blood pressure and heart rate increases

Methylphenidate increases blood pressure by an average of approximately 2–4mm Hg and heart rate by an average of roughly 3–6 beats per minute. Some people may experience more significant increases, and patients must be monitored for signs of hypertension and tachycardia.

Severe cardiovascular reactions

There have been instances in which people taking normal doses of CNS stimulants, such as methylphenidate, have experienced strokes, heart attacks, and sudden death. Fatalities have also been reported in pediatric patients with abnormalities in cardiac structure and other severe heart problems.

Priapism

Prolonged, painful erections have been reported in patients taking methylphenidate. In some cases, this condition requires surgical intervention. Priapism often follows a dosage increase, but it may also develop during a period of drug withdrawal.

Growth suppression

CNS stimulants may suppress growth and appetite and trigger weight loss in pediatric patients. Therefore, children taking methylphenidate should be routinely monitored to ensure adequate calorie intake and expected growth rates.

Peripheral vasculopathy

CNS stimulants are associated with peripheral vasculopathy, including Raynaud phenomenon. Symptoms are typically mild but can result in digital ulceration or soft tissue breakdown. Careful observation is essential.

Psychiatric reactions

Methylphenidate may:

• Induce a manic or mixed mood episode in patients with bipolar disorder

• Worsen symptoms of behavior disturbance and thought disorder in patients with psychotic conditions

• Trigger new psychotic or manic symptoms in patients with no history of psychiatric illnesses or mania

Side effects

For the most part, side effects associated with methylphenidate are mild and self-resolving. Among the more common side effects are the following:¹⁵

• Irritability, moodiness

• Nervousness

• Drowsiness, fatigue

• Restlessness, feeling jittery

• Difficulty falling or staying asleep 

• Nausea, vomiting

• Weight loss

• Diarrhea

• Heartburn

• Stomach pain

• Poor appetite

• Dry mouth

• Muscle tightness

• Headaches

• Back pain

• Decreased sexual desire

• Heavy sweating

• Uncontrollable movements of part of the body, tremor

• Teeth grinding

Other side effects that are less common and may indicate a severe adverse reaction (including those outlined above) requiring urgent medical care include the following:

• Fast, irregular, or pounding heartbeat

• Shortness of breath

• Chest pain

• Fainting

• Seizures

• Difficulty speaking, breathing, or swallowing

• Hoarseness

• Swelling of the face, eyes, lips, mouth, tongue, or throat

• Weakness or numbness of a limb

• Numbness, pain, or sensitivity in the fingers or toes, which may be accompanied by a change in skin color

• Unexplained wounds on the fingers or toes

• Blistering or peeling skin

• Visual disturbances, including blurred vision

• Hallucinations

• Depression

• Mood changes, including agitation or abnormal excitement

• Feeling suspicious of others or believing things that aren’t true

• Motor or verbal tics

• Frequent and painful erections that may last longer than four hours

• Fever

• Hives, rash, or itching

Missed doses

If you miss a dose, skip it and resume your usual dosing schedule with the next dose. Never double your dose to make up for a missed one. If you struggle with remembering to take your medications, try setting an alarm to remind you.

Overdoses

Overdose symptoms may be physical or psychological.¹⁶

Physical symptoms of a methylphenidate overdose include:

• Diarrhea

• Fever

• Headache

• Muscle weakness or fatigue

• Nausea, vomiting

• Blurred vision

• Dizziness

• Muscle twitching or uncontrollable shaking or tremors

• Rapid breathing

• Rapid or irregular heart rate

• Seizures

• Loss of consciousness

• Sweating

• Flushing

• Dilation of the pupils

• Dry mouth or nose

• Dark urine

Psychological symptoms may include any of the following:

• Anxiety, panic

• Restlessness, agitation, aggression

• Confusion, delirium

• Hallucinations

• Feeling happy in inappropriate situations

If you develop any of the above symptoms and think you may have overdosed, call 911 for immediate medical assistance.

Allergy information

A severe allergic reaction to methylphenidate is rare. However, you must seek immediate medical care if you experience signs of a drug allergy, which may include any of the following symptoms:

• Hives, skin rash, itching

• Difficulty breathing or swallowing

• Swelling of your face, tongue, lips, or throat

• Vomiting

• Loss of consciousness

Long-term use of methylphenidate

People with attention disorders may need pharmacological treatment for years. Those taking methylphenidate long-term will likely continue to see benefits but should undergo routine assessments to determine if the treatment is still helpful and necessary.¹⁷

Methylphenidate in pregnancy and breastfeeding

Methylphenidate is a pregnancy category C drug, according to the US FDA. There are no adequate studies in humans, but animal studies indicate that there may be a risk.¹⁸

Usually, methylphenidate is not recommended during pregnancy. If you feel you need to take the drug, consult your doctor about the benefits and risks.

It’s not known if methylphenidate can pass from mother to child through breast milk. Speak with your doctor about symptoms or side effects that may develop in your infant if they’re exposed, such as problems sleeping or irritability.

Interactions with other drugs

 Among the drugs that might interact with methylphenidate are the following:¹⁹ ²⁰

• MAOIs: Taking medicines like selegiline (Eldepryl, Zelapar), tranylcypromine (Parnate), and phenelzine (Nardil) with methylphenidate might increase the risk of hypertension, which could result in severe complications. Methylphenidate is contraindicated in people currently taking MAOIs and those who’ve taken them in the past 14 days.

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa), and sertraline (Zoloft)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine (Pristiq), venlafaxine (Effexor), levomilnacipran (Fetzima), and escitalopram (Lexapro)

• Tricyclic antidepressants, such as clomipramine (Anafranil), and imipramine (Tofranil)

• Heartburn or ulcer treatments, including esomeprazole (Nexium), omeprazole (Prilosec), and famotidine (Pepcid)

• Antibiotics, including linezolid (Zyvox) and isoniazid (INH)

• Seizure medications, such as phenytoin (Dilantin), primidone (Mysoline), and phenobarbital

• Drugs for high blood pressure, such as atenolol (Tenormin), amiloride (Midamor), chlorothiazide (Diuril), and diltiazem (Cardizem)

• Weight loss drugs, including phendimetrazine (Adipex-P, Lomaira)

• Decongestants, such as oxymetazoline (Afrin, Dristan, Vicks Sinex), phenylephrine (Sudafed PE), and pseudoephedrine (Sudafed)

• Warfarin (Coumadin)

• Anti-parkinsonian medications, including methyldopa (Aldomet), safinamide (Xadago), and transdermal selegiline (Emsam)

• Sodium bicarbonate (baking soda, soda mint)

Can I drink alcohol while taking methylphenidate?

Drinking alcohol is not recommended while taking the extended-release chewable tablet, the extended-release orally disintegrating tablet, or the extended-release capsule versions of methylphenidate. Tell your doctor if you drink (or used to drink) alcohol, as the risk of developing dependence may be higher.²¹ ²²

What to discuss with your doctor before starting methylphenidate

Before starting methylphenidate, review any medical conditions you have and let your doctor know if:²³

• You’re taking any other medications (both prescribed and over the counter), vitamins, or supplements, either regularly or occasionally

• You have allergies, especially to methylphenidate, aspirin, or tartrazine (yellow) dye

• You have (or have a family history of) Tourette syndrome, motor tics, or verbal tics

• You have (or have a family history of) a heart rhythm disturbance, or if anyone in your family had a sudden cardiac death

• You have glaucoma, hyperthyroidism, phenylketonuria, hypertension, heart or cardiovascular disease, a seizure disorder, or poor circulation in your fingers and toes 

• You have (or have a family member with) depression, mania, bipolar disorder, thoughts of suicide, or any mental illness

• You plan to have surgery, including dental procedures

• You have a blockage or narrowing within your gastrointestinal tract

• You are pregnant or planning to become pregnant

• You are breastfeeding or planning to breastfeed

• You consume alcohol regularly, take recreational drugs, or have a substance use disorder or history

• You have phenylketonuria

Stopping methylphenidate

You should not stop taking methylphenidate without consulting your doctor, especially if you have taken it long-term. You may experience severe depression, particularly if you have been taking too much of the drug.²⁴

Your doctor might decrease your dosage slowly over time. You will need close monitoring because your symptoms could get worse upon stopping the medication. 

Drug approval history

• 1955: Methylphenidate earned US FDA approval.²⁵

Tips and advice for taking methylphenidate

The following tips and advice can help you take methylphenidate safely:²⁶ ²⁷ ²⁸

• Methylphenidate is an effective treatment for narcolepsy, but it can affect your planned nighttime sleep. If you struggle with sleep duration or quality while taking this drug (for either condition), discuss your concerns with your doctor. In most cases, it helps to take the last dose earlier in the evening.

• If you take Jornay PM, you can take it with or without food, but be consistent. Food may affect your body’s uptake of the medication, so taking it either with or without food consistently will help keep your levels stable. 

• If your child uses the transdermal patch (Daytrana), it’s best to alternate hips for daily placement to reduce irritation.

• Medication is one part of an overall plan for treating ADD and ADHD. Other strategies, such as therapy, are also crucial to an effective treatment program.

Frequently asked questions

Is methylphenidate the same as Adderall?

No. The active ingredients in Adderall are amphetamine and dextroamphetamine. While the drugs belong to the same class and both treat ADHD, they are not the same.

Can methylphenidate cause forgetfulness?

Forgetfulness is not a known side effect of methylphenidate. However, everyone is different. If you become unusually forgetful while taking any type of medication, speak with your doctor.

Does methylphenidate make you hungry?

Hunger is not a known side effect of methylphenidate. In fact, loss of appetite is more common.