Low Appetite, Headache, and More: 10 Concerta (Methylphenidate ER) Side Effects You Should Know About

Stimulant medications help make life more manageable for many people living with attention-deficit hyperactivity disorder (ADHD). Concerta (methylphenidate extended-release) is one type of stimulant that’s FDA approved to treat ADHD in people age 6 to 65.

Concerta has been around for decades, but having questions and concerns about ADHD medications is common, especially regarding side effects. Below, we cover 10 of the most important Concerta side effects to know about.

Concerta side effects at a glance

Common Concerta side effects are usually mild. If you do experience side effects, they may go away on their own. But you may need a lower dose if they don’t improve. Of note, you may notice the empty tablet shell from your Concerta dose in your stool. This is normal and isn’t concerning.

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Mild Concerta side effects include:

• Headache

• Dizziness

• Nausea

• Stomach pain

• Loss of appetite

• Weight loss

• Trouble sleeping

• Dry mouth

• Increased sweating

• Feeling anxious

• Blurred vision

• Lower sex drive

• Faster heart beat

• Increased blood pressure

Possible serious Concerta side effects include:

• Long-lasting, painful erections

• Slowed growth in children or teens

• Worsening blood flow, which can lead to Raynaud’s phenomenon

• New or worsening tics

• Heart-related events, especially in people with heart problems

• Increased risk of glaucoma

• Seizures

• Extreme mood swings

This medication also has a boxed warning — the FDA’s strictest medication warning — for dependence and misuse. For this reason, Concerta is classified as a controlled substance with restrictions on how it’s prescribed and refilled.

1. Decreased appetite

A decreased appetite is one of the most commonly reported Concerta side effects. This can make it harder to get essential nutrients in your diet, such as iron and fiber. It can also cause weight loss. And in children and teens, a lower appetite may interfere with their growth.

Research from the 1990s found a link between children taking methylphenidate and slowed growth. Newer research also shows that long-term stimulant use in children and adolescents may lead to a small reduction in height and weight. But these reductions are likely to be minimal.

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Your child’s prescriber will monitor their growth while taking Concerta. Try to notice if your child is eating less than usual. The same goes for you if you’re taking Concerta. For both adults and children, consider these tips for maintaining appetite:

• Take Concerta after or with breakfast

• Consume high-calorie, nutritious foods in the evening if you’re less hungry during the day

• Allow for consistent meals and snacks during the day to make sure food intake occurs regularly

Tell your prescriber if you notice changes in your or your child’s appetite or weight while taking Concerta. They may recommend a lower dose, taking Concerta less often, or a different ADHD medication.

2. Headache

Headaches are common in kids and adults. But if you or your child takes Concerta, headaches may be more likely.

Over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may help for mild headaches. You may also be able to ward off headaches by staying hydrated, eating at regular times, and avoiding strain from “tech neck.” But if you develop strong or persistent headaches while taking Concerta, tell your prescriber. They can help you figure out the cause and how best to manage them.

3. Dry mouth

Some people have less saliva after starting Concerta. This can cause dry mouth, leading to increased thirst and bad breath. But dry mouth is usually a temporary Concerta side effect.

In the meantime, sipping a cold drink or ice chips, chewing sugar-free gum, or using OTC saliva substitutes may help. But tell your prescriber if your dry mouth issues continue. Long-term dry mouth can cause gum or dental problems. Your prescriber may suggest a dose change or specific ways to manage your symptoms.

4. Trouble sleeping

Stimulants like Concerta work by increasing two brain chemicals: dopamine and norepinephrine. This helps improve your focus and makes you feel more awake. But the effects might linger later in the day and cause sleep disruptions, including insomnia (trouble sleeping).

That’s why it’s best to take your Concerta dose in the morning. This gives it time to leave your body before you go to sleep, minimizing the chances of it keeping you up at night. Additionally, maintaining a consistent sleep schedule and giving yourself or your child some wind-down time before bed — away from screens and bright lights — may also help.

Tell your healthcare team if your sleep quality is worse after starting Concerta. Also, discuss other side effects that may add to your sleep issues, such as feeling more anxious or sweatier at night.

5. Nausea

Concerta might make you queasy when you start it. But your body usually adjusts to the medication, and this side effect improves on its own.

If you’re experiencing nausea, you can try taking Concerta with food. It’s not required, but having food in your stomach when you take your dose might help minimize nausea.

Other gastrointestinal side effects are less likely, but vomiting, constipation, and heartburn can also occur. Tell your healthcare team if you’re having any of these bothersome symptoms. They can help you determine if Concerta is the cause.

6. Increased sweating

Concerta increases dopamine and norepinephrine, which can lead to increased sweating. But many other conditions and medications can also cause excessive sweating (hyperhidrosis). Additionally, some people just sweat more than others.

Using a deodorant with antiperspirant and wearing clothing made from natural fibers (like wool), or moisture-wicking fabrics can help. But if your sweating feels unusually heavy, tell your prescriber. They can help you figure out if it’s medication related and suggest a change if needed.

7. Mood changes

Because Concerta affects brain chemicals, increased anxiety, nervousness, and depression are possible. But it’s common for people with ADHD to have other mood-related disorders. For example, 4 in 10 children with ADHD also have an anxiety disorder. And up to 90% of adults have another mental health condition as well. So talk to your prescriber if you feel more depressed or anxious than usual. They can help you figure out how to best manage these symptoms. This may include taking medications or therapy.

Though rare, it’s also possible for Concerta to cause extreme mood swings, especially in people with bipolar disorder. So pay close attention to unusual behavior shifts. If behavior seems severe or thoughts of self-harm occur, get emergency help right away.

8. Reduced blood flow

Concerta can cause blood vessels to narrow and lead to reduced blood flow.

This may cause or worsen Raynaud’s phenomenon, a condition in which there’s decreased blood flow to the fingers and toes. This can cause tingling, pain, or changes in skin color (fingers and toes may turn blue or white). Though Raynaud’s phenomenon is usually mild, it can lead to ulcers in the fingers and toes in severe cases. So tell your prescriber if you’re experiencing this condition.

Priapism (painful erections lasting 4 hours or more) is another condition caused by reduced blood flow. It’s been reported in adults and children taking Concerta, and it isn’t caused by having sex. Priapism requires emergency care, since permanent damage can occur if it’s not treated. Make sure your child knows about priapism so they know to tell a trusted adult if they’re experiencing it.

Although priapism isn’t related to sex, Concerta can cause some sexual side effects, such as erectile dysfunction or decreased desire for sex. But these side effects aren’t common.

9. Heart problems

Stimulant medications commonly cause small increases in heart rate or blood pressure. These changes are minor and usually don’t cause a problem. But rare reports of heart rhythm problems and sudden death have occurred in people taking Concerta. A recent observational study (a study that looks for correlations) suggests that heart risks are more likely when stimulants like Concerta are taken long term.

For people without existing heart conditions, Concerta is considered safe. If you have an existing heart condition, it may need to be avoided. Share your medical and family history of heart issues with your prescriber. They can help you weigh the risks and benefits of taking Concerta.

10. Misuse

Taking Concerta can lead to dependence (when you feel off if you don’t take it) and tolerance (when you need more of the medication to get the same effect). More seriously, Concerta can lead to misuse, which is defined as taking your medication differently from how it’s prescribed. Stimulant overdose is also a concern.

A stimulant use disorder is when misuse happens regularly. The best way to avoid this is to take your medication exactly as prescribed. Don’t make any changes to your dose without talking to your prescriber.

You should also supervise your child’s Concerta doses and watch for misuse signs. Possible signs in kids or teens include sudden changes in school participation or to their mood.

Good to know: It’s a common misconception that ADHD medications can lead to substance use disorder. Although people with ADHD have a higher risk of developing a substance use disorder, treating ADHD effectively reduces the risk of substance misuse later in life.

If you or someone you know struggles with substance use, help is available. Call the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-4357 to learn about resources in your area.

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Written by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit (NICU) at Hassenfeld Children’s Hospital in New York City. His favorite part of the job is working with preterm newborns because they are strong and mighty despite their size.

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