Choosing ADHD Medication: A Guide for Adults and Children
How do you choose the best medication for attention-deficit hyperactivity disorder (ADHD)? Here’s what you need to know about ADHD medications, from how they work to the risks.
methylphenidate ER
Used for ADHD
Used for ADHD
Methylphenidate extended-release (ER) is a first-choice option for people with attention deficit-hyperactivity disorder (ADHD). This once-daily medication can start to work within 2 hours and can last throughout the day. Methylphenidate ER can cause difficulty sleeping and a loss of appetite. It also has a potential risk of misuse and dependency and is thus a controlled substance.
What is Methylphenidate ER?
What is Methylphenidate ER used for?
- Attention-deficit/hyperactivity disorder (ADHD)
How Methylphenidate ER works
Methylphenidate ER is a stimulant medication. It's not exactly known how methylphenidate ER helps to improve attention and focus. But it's thought to work by raising the levels of chemicals in your brain called norepinephrine and dopamine. It's also thought to boost the activity of serotonin in the brain.
When does Methylphenidate ER start working?Time passed since treatment started:
Drug facts
| Common Brands | Concerta, Adhansia XR, Aptensio XR, Jornay PM, QuilliChew ER, Quillivant XR, Ritalin LA, Relexxii |
|---|---|
| Drug Class | Stimulant |
| Controlled Substance Classification | Schedule II |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Risks and warnings for Methylphenidate ER
Methylphenidate ER can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Misuse and dependence
- Risk factors: History of substance or alcohol use disorder | Taking more methylphenidate ER than prescribed | Suddenly stopping methylphenidate ER
Methylphenidate ER has a risk of misuse and dependence. Misuse is when a medication is used differently than how it's prescribed. Misusing methylphenidate ER raises your risk for serious side effects such as fast heart rate, high blood pressure, aggressive behavior, and even thoughts of hurting yourself.
In addition, over time, you can become physically dependent on methylphenidate ER to function normally. This is usually related to having withdrawal symptoms like irritability, nightmares, and sleep problems if you take the medication for a long time and then suddenly stop. Take the medication exactly as prescribed to you. Don't change the dose or how often you take it without talking to your provider first.
Serious heart problems
- Risk factors: History of heart problems
There have been reports of sudden death, stroke, and heart attack in people who took methylphenidate ER at usual doses. Methylphenidate ER can also raise your blood pressure and heart rate. Tell your provider if you have a history of heart problems before starting methylphenidate ER to make sure it's safe for you to take. Your provider will check for heart problems before starting treatment with this medication. Contact your provider if you experience unexplained fainting, chest pain with physical activity, or irregular heartbeat while you're taking methylphenidate ER.
Changes in behavior or thoughts
- Risk factors: History of psychotic episodes, bipolar disorder, or other mental health or mood-related conditions | Depression
Taking a stimulant like methylphenidate ER can cause mental health problems such as hallucinations (seeing things that aren't really there), abnormal or unclear thinking, and mania. This medication can worsen mood-related problems that you already have. But these changes in mood or behavior can also happen even if you haven't had these problems before. If you develop these mood- and behavior-related symptoms while taking methylphenidate ER, talk to your healthcare provider right away because you might have to stop taking it.
Prolonged and painful erection
Although rare, some people taking methylphenidate ER experienced prolonged and painful erections. Sometimes, it might require surgery to treat. This was typically reported after the dose was raised, but could also happen when the medication was stopped. If you develop a painful erection that lasts longer than 4 hours, stop taking methylphenidate ER and get medical attention immediately.
Blood circulation problem (Raynaud's phenomenon)
Methylphenidate ER might be linked to poor blood circulation problems, such as Raynaud's phenomenon. People with Raynaud's phenomenon can experience episodes of poor blood flow to the fingers and toes, which can cause the skin to turn pale and to feel cold, numb, or painful. If this happens, symptoms are typically mild. But rarely, it can cause sores or ulcers in more serious cases. Let your healthcare provider know if you notice symptoms of circulation problems, such as bouts of numbness or pain in your fingers or toes. Your provider might need to lower your dose of methylphenidate ER or ask you to consider a different medication.
Slowed growth in children
In studies, children taking stimulants like methylphenidate ER daily throughout the year had a temporary slowing of growth. On average, the children in these studies had 2 cm less growth in height and 6 pounds less growth in weight over 3 years. Your child's provider will track your child's growth progress closely. If they suspect slowed growth, they might pause or stop your child's methylphenidate ER treatment. Talk to your child's provider if you have concerns.
Serotonin syndrome
- Risk factors: Taking monoamine oxidase inhibitors (MAOI) 14 days before starting methylphenidate ER | Taking other medications that raise serotonin levels in your brain
Serotonin syndrome is a rare, but potentially life-threatening condition where there's too much serotonin in the brain. Serotonin is one of the chemicals in your brain responsible for your mood. Your risk for this condition goes up if you use methylphenidate ER with other medications that affect serotonin levels, such as antidepressants (e.g., sertraline (Zoloft), duloxetine (Cymbalta)), MAOIs (e.g., phenelzine (Nardil)), linezolid (Zyvox), and certain migraine medications (e.g., sumatriptan (Imitrex)). Let your provider know about all the medications you take or plan to take before starting methylphenidate ER. Be aware of symptoms of serotonin syndrome, which include fast heart rate, sweating, muscle stiffness or spasms, high fever, and confusion. Get medical help right away if you have any of these symptoms.
Drug interactions
Methylphenidate ER can interact with a lot of medications. Methylphenidate ER counteracts (works against) the effects of many blood pressure medications. This means your blood pressure medications might not work as well for you if you take them with methylphenidate ER. Additionally, avoid taking methylphenidate ER with monoamine oxidase inhibitors (MAOIs). This combination can raise your risk of severely high blood pressure. Discuss with your healthcare provider and pharmacist about all the medications you take (including over-the-counter medications and supplements) before and during treatment with methylphenidate ER.
Side effects of Methylphenidate ER
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Side effects might differ depending on the formulation and brand. In general:
- Headache
- Low appetite
- Stomach pain
- Trouble sleeping
Less Common Side Effects
- Dry mouth
- Nausea
- Vomiting
- Anxiety
- Irritability
- Dizziness
- Racing heart
- Sweating
Methylphenidate ER serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reactions: rash; hives; difficulty breathing; swelling of face, lips, tongue, or throat
- Heart problems: heart attack, fast heart rate, high blood pressure
- Brain-related problems: seizures, stroke
- Mental health-related problems: manic episodes, changes in thoughts or behavior, hallucinations
- Serotonin syndrome: fast heart rate, sweating, muscle stiffness or spasms, fever, confusion
When do Methylphenidate ER possible side effects begin and end?
Time passed since treatment started:
H
D
W
M
Headache
Low appetite
Stomach pain
Trouble sleeping
Changes in heart rhythm (e.g., fast heart rate)
If a line continues to the right, you'll likely keep experiencing this side effect once it starts.
The following Methylphenidate ER side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Fast heartbeat
Rare
Black, tarry stools
blood in the urine or stools
blurred vision or other changes in vision
crusting, dryness, or flaking of the skin
muscle cramps
pinpoint red spots on the skin
scaling, severe redness, soreness, or swelling of the skin
seizures
uncontrolled vocal outbursts or tics (uncontrolled and repeated body movements)
unusual bleeding or bruising
Incidence not known
Agitation
arm, back or jaw pain
bleeding gums
bloody nose
chest discomfort
chest tightness or heaviness
chills
confusion
dark urine
difficulty with speaking
difficulty with swallowing
discouragement
dizziness
double vision
drowsiness
fainting
fast, pounding, or irregular heartbeat or pulse
feeling like surroundings are not real
feeling sad or empty
feeling that others are watching you or controlling your behavior
feeling that others can hear your thoughts
feeling, seeing, or hearing things that are not there
headache
heavier menstrual periods
inability to move the arms, legs, or facial muscles
inability to speak
irritability
itching skin
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
loss of interest or pleasure
mood swings
muscle pain, stiffness, or spasms
nervousness
numbness of the hands
overactive reflexes
painful or difficult urination
pale skin
paleness or cold feeling in the fingertips and toes
poor coordination
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red, irritated eyes
red, swollen, or scaly skin
redness, soreness, or itching skin
restlessness
right upper quadrant tenderness
seeing, hearing, or feeling things that are not there
severe or sudden headache
shivering
slow speech
slowed growth in children
sores, ulcers, or white spots on the lips or in the mouth
stuffy or runny nose
sudden loss of coordination
sudden slurring of speech
sweating
swollen glands
talking or acting with excitement you cannot control
tingling or pain in the fingers or toes when exposed to cold temperatures
trembling or shaking
trouble concentrating
trouble sleeping
troubled breathing with exertion
twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
unusual behavior
unusual tiredness or weakness
yellow skin or eyes
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Agitation
bigger, dilated, or enlarged pupils of the eyes
confusion as to time, place, or person
dark urine
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
dry eyes, mouth, nose, or throat
false or unusual sense of well-being
fast, slow, irregular, pounding, or racing heartbeat or pulse
holding false beliefs that cannot be changed by fact
increased sensitivity of the eyes to light
loss of consciousness
muscle pain, stiffness, or twitching
nervousness
overactive reflexes
pounding in the ears
rapid, shallow breathing
sweating
unusual excitement, nervousness, or restlessness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Get your GoodRx coupon
$224.84
GoodRx discount
$25.31
Pros and cons of Methylphenidate ER
Pros
- First-choice medication for ADHD
- Taken only once per day
- Available in many different forms (e.g., pills, chewable tablet, liquid)
- Some brands available in lower-cost generic form
- Can be prescribed for children as young as 6 years old
Cons
- Has a risk of misuse and dependency
- A controlled medication, so there are special requirements for getting the prescription filled
- Dose needs to be raised and lowered slowly to avoid bothersome side effects like distress and trouble sleeping
- Not the best choice for pregnant or breastfeeding females or people with heart conditions
- Can interact with certain blood pressure medications and depression medications
Pharmacist tips for Methylphenidate ER
- Be sure you know which methylphenidate ER product you're using and how to take it according to its directions. Doing so will help make sure the medication works properly for you and help avoid an accidental overdose. Different formulations and brand names of methylphenidate ER can have different instructions on how much to take and how often to take it. In addition, they aren't equal to each other on a milligram-to-milligram basis. Ask your pharmacist if you're not sure which product you have or how to take it properly.
- Take methylphenidate ER once per day in the morning to avoid trouble sleeping at night.
- You can take methylphenidate ER with or without food, but make sure to take it in the same way each day. That way, the medication gets absorbed into your body consistently.
- It's recommended to avoid alcohol while taking methylphenidate ER because it can make your ADHD symptoms worse. This combination can also cause dangerous side effects, including alcohol poisoning and heart problems.
- Avoid driving the first few days after you start methylphenidate ER and after dose changes until you know how this medication affects you. This medication might cause blurry vision and affect how well you see.
- Take methylphenidate ER exactly as your provider instructed you to. Don't change your dose or suddenly stop taking the medication without talking to your provider first. Doing so can lead to bothersome withdrawal symptoms, such as tiredness, irritability, and trouble sleeping. If you want to stop methylphenidate ER, your provider will give you directions to lower your dose slowly over time before you can completely stop taking it.
- Accidentally taking too much methylphenidate ER can lead to an overdose. Symptoms of an overdose include rapid heart rate, restlessness, confusion, hallucinations (seeing things that aren't real), and fever. Be sure you and your loved ones know how to recognize an overdose and to call 911 if this happens so emergency help can come right away.
Tips for methylphenidate ER non-chewable pills
- Swallow the non-chewable tablets and capsules whole. Don't crush or chew them. If you're having trouble swallowing the non-chewable tablets, ask your provider if an alternative form of methylphenidate ER is right for you.
- If you're having trouble swallowing the capsules, you can open them and sprinkle the entire contents onto applesauce. After mixing with applesauce, eat it right away; don't store it for later use.
Tips for QuilliChew ER chewable tablets only
- Chew the QuilliChew ER tablets, and swallow. Don't swallow the chewable tablets whole.
Tips for Quillivant XR oral suspension only
- Read the instructions for use so you understand how to take Quillivant XR safely and properly. This helps avoid accidentally wasting the medication or taking the wrong dose. Contact your pharmacist if you have any questions.
- Shake the bottle well for at least 10 seconds before taking a dose. This makes sure the suspension is mixed well and medication hasn't settled at the bottom.
- Only use the oral syringe that's included with the product packaging to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
- Store Quillivant XR suspension at room temperature in the original container it came in from the pharmacy to protect it from light.
Methylphenidate ER dosage
The average cost for 30 tablets of 36mg of Methylphenidate ER is $33.61 with a free GoodRx coupon. This is 90.09% off the average retail price of $339.08. 
Tablet
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 18mg | 30 tablets | $31.20 | $1.04 |
| 27mg | 30 tablets | $30.99 | $1.03 |
| 36mg | 30 tablets | $33.61 | $1.12 |
| 54mg | 30 tablets | $35.15 | $1.17 |
| 20mg | 30 tablets | $25.31 | $0.84 |
| 10mg | 30 tablets | $25.88 | $0.86 |
| 72mg | 30 tablets | $195.94 | $6.53 |
| 63mg | 30 tablets | $305.68 | $10.19 |
| 45mg | 30 tablets | $305.68 | $10.19 |
Typical dosage for Methylphenidate ER
There are several different formulations (e.g., tablet, capsule, liquid) and brand names of methylphenidate ER. The dose, frequency (how often you take the medication), and age cut-offs might differ between the formulations and brands. Make sure you know which methylphenidate ER product you're using and how to take it properly.
The typical dose is 1 pill by mouth once per day in the morning for adults and children age 6 years and up.
Methylphenidate ER reviews
GoodRx has partnered with to provide reviews on the different aspects of Methylphenidate ER.
Effectiveness
Learn more about the effectiveness of Methylphenidate ER based on real life experiences.
Overall Rating
Based on 280 people taking this medication
3.3
Effectiveness by condition:
attention deficit/hyperactivity disorder210 reviews
3.6
attention deficit disorder33 reviews
3.7
narcolepsy19 reviews
3.7
idiopathic hypersomnia12 reviews
3.0
multiple sclerosis6 reviews
2.5
Side effects
Learn more about the side effects others have reported while taking Methylphenidate ER.
Severity of side effects
Based on 409 people taking this medication
0%
50%
100%
Top side effects
Based on 409 people taking this medication
Decreased appetite
9%
Dry mouth
5%
Jittery feeling
5%
Irritability
4%
Insomnia
4%
Usage
Review why people stop taking this medication and how long they take it.
Reasons people stopped taking Methylphenidate ER
Based on 501 people who have taken this medication
Did not seem to work
31%
Side effects too severe
24%
Doctor's advice
19%
Other
17%
Personal research
4%
Course of treatment ended
4%
Expense
3%
Change in health plan coverage
2%
How long people take Methylphenidate ER
Based on 609 people who have taken this medication
0%
50%
100%
Powered by:
Interactions between Methylphenidate ER and other drugs
Methylphenidate ER may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Methylphenidate ER. Please note that only the generic name of each medication is listed below.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Methylene Blue
- Moclobemide
- Nialamide
- Phenelzine
- Procarbazine
- Rasagiline
- Safinamide
- Selegiline
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amifampridine
- Bupropion
- Desflurane
- Donepezil
- Enflurane
- Halothane
- Iobenguane I 131
- Isoflurane
- Risperidone
- Sevoflurane
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Methylphenidate ER cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Methylphenidate ER contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Methylphenidate ER will not be safe for you to take.
- Severe allergy to methylphenidate-containing products
- Currently take or have taken an MAOI in the last 14 days
- Inherited problems affecting the ability to digest certain sugars (e.g., fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency) - capsules that contain sucrose only
- Marked anxiety, tension, and distress - Relexxi brand only
- Glaucoma - Relexxi brand only
- Motor tics, or personal or family history of Tourette syndrome
What are alternatives to Methylphenidate ER?
There are a number of medications that your doctor can prescribe in place of Methylphenidate ER. Compare a few possible alternatives below.
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Adderall and Alcohol: Why You Should Avoid Taking ADHD Medications While Drinking
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Concerta vs. Ritalin: Differences in Dosing, Side Effects, and More
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Methylphenidate ER images
