6 Methylphenidate Interactions You Should Know About

Methylphenidate is a first-choice medication to treat attention-deficit hyperactivity disorder (ADHD) for both children and adults. The immediate-release version of methylphenidate (Ritalin) is also approved to treat narcolepsy. 

As with all medications, there are a few things to consider before taking methylphenidate. One being the dosage forms it comes in. There’s a long-acting version, called methylphenidate extended-release (Concerta, Metadate CD, Ritalin LA). And there’s a patch called Daytrana. 

Another consideration is that methylphenidate is a controlled substance. This means it has the ability to cause dependence and addiction. And there are restrictions on how much you can refill and how often.

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But what we will focus on here are methylphenidate’s potential drug interactions. Some interactions may require you to stop taking methylphenidate (or the interacting medication). But others only need more monitoring. Below, we’ve detailed some of the methylphenidate interactions you should watch out for and how to manage them.

1. Vasopressors

Vasopressors are medications that increase your blood pressure. Two examples of vasopressors include norepinephrine (Levophed) and vasopressin. You may need vasopressors if your blood pressure is too low due to conditions such as septic shock or severe allergic reactions (anaphylaxis). If you experience septic shock, vasopressors are typically given into your vein in a hospital setting. And for anaphylaxis, the vasopressor epinephrine (EpiPen, Auvi-Q) can be life-saving.

Both methylphenidate and vasopressors can raise blood pressure. Combining the two medications can lead to dangerously high blood pressure, but it’s rare. And since vasopressors are often life-saving in certain scenarios, you may need one even if you take methylphenidate. If so, you’ll likely have your heart rate and blood pressure checked frequently.

2. Warfarin

Warfarin (Coumadin, Jantoven) is an anticoagulant (blood thinner). It's used to prevent and treat blood clots. Methylphenidate can stop warfarin from being metabolized (broken down). This can cause high levels of warfarin in the body and a higher chance of bleeding or bruising.

Signs of bleeding might be obvious (like a nosebleed). But serious bleeding can occur inside the body, so you might not notice it right away. To make sure you’re not experiencing abnormal bleeding, you’ll need regular blood tests if you take warfarin. These blood tests are to check a lab value called the international normalized ratio (INR). Your healthcare provider will adjust your warfarin dose based on your INR.

This interaction may not be an issue if you’ve been taking methylphenidate and warfarin together for a while. Your healthcare provider has likely adjusted your warfarin dose to make sure your INR isn’t too high. But if you plan to start or stop methylphenidate while taking warfarin, talk to your provider. Stopping methylphenidate could affect your INR. Your provider might need to change your warfarin dose.

3. Some seizure medications

Seizure medications are usually used to treat seizures. Methylphenidate blocks the metabolism of some seizure medications. These include phenobarbital, phenytoin (Dilantin, Phenytek), and primidone (Mysoline). This can cause higher levels of these medications and lead to a higher risk of side effects. Some potential side effects include dizziness, fatigue, and drowsiness.

If you’re starting methylphenidate, you may need a lower dose of your seizure medication. If you’re stopping methylphenidate, you may need a higher dose of your seizure medication. Your healthcare provider will make this decision. They also might check medication levels more often to make sure your dose isn’t too high or low.

4. Some antidepressants

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) treat conditions like depression and anxiety. Methylphenidate may block the metabolism of these antidepressants. This can lead to a higher risk of side effects, including sleep issues, anxiety, and nausea.

Like SSRIs and TCAs, methylphenidate also raises serotonin levels. This raises the risk of developing serotonin syndrome. Serotonin syndrome is a condition caused by high serotonin levels in the brain. Most cases are mild and resolve quickly. Mild symptoms include sweating, tremors, and fast heartbeat. But serotonin syndrome can be life-threatening in rare cases. People with severe serotonin syndrome might have confusion, agitation, and high fever.

If you're taking an SSRI or TCA, your healthcare provider may need to adjust your dose if you're starting or stopping methylphenidate. Don't make changes to your medications without talking to your provider first. They can help you decide whether you need to increase or decrease your dose.

5. Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) treat medical conditions like depression and Parkinson’s disease. Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam, Zelapar). But these medications aren't commonly used due to their side effects and drug interactions.

Methylphenidate can also interact with MAOIs. This is because both medications can raise blood pressure. When combined, the risk increases. In severe cases, very high blood pressure can occur. This requires emergency medical care. Other risks of combining MAOIs and methylphenidate include seizures and serotonin syndrome.

In most cases, you shouldn’t take MAOIs while taking methylphenidate. If you’re taking a MAOI, you should stop taking it at least 14 days (2 weeks) before starting methylphenidate.

6. Antipsychotics like risperidone

Risperidone (Risperdal) is an atypical antipsychotic medication. It treats conditions like bipolar disorder and schizophrenia. One of its potential side effects is movement-related symptoms called extrapyramidal symptoms (EPS). These include uncontrollable muscle movements, restlessness, and stiffness.

Methylphenidate may also cause movement-related problems. Taking methylphenidate and risperidone together may raise the risk of EPS. This is especially true when starting or stopping either medication. It's also more likely during dose changes.

This interaction is also possible with other atypical antipsychotics that can cause movement problems, like aripiprazole (Abilify). But it’s more likely with risperidone. Risperidone has the highest risk of EPS of all the atypical antipsychotics.

If you’re taking risperidone and methylphenidate, talk to your healthcare provider. They may adjust the dose of either medication. But don’t stop either medication, or change your doses, without talking to them first.

When should I contact my healthcare provider about a methylphenidate interaction?

If you have a prescription for methylphenidate, you can work with your healthcare provider and pharmacist to keep you safe. Give them an updated list of all the medications you take, including prescription medications, over-the-counter medications, and supplements. They can help check for any methylphenidate interactions.

Some possible interactions only need extra monitoring. But some interactions may be more serious. These may require dose changes or stopping one of your medications altogether.

How to save on methylphenidate

There are ways to save on methylphenidate, which is available as a generic- and brand-name medication. GoodRx can help you navigate between GoodRx coupons and copay savings cards to save money on your prescription.

• Save with GoodRx: Generic methylphenidate’s price at certain pharmacies is as low as $22.22 with a free GoodRx discount. A generic extended-release version may cost as little as $37.63.

• Use exclusive savings: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of brand-name Relexxii (methylphenidate ER) at an exclusive cash price as low as $88.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $0 for Relexxii, $4 for Concerta, or $12 for Daytrana using a savings card from the manufacturer. Copay savings cards for other brand-name methylphenidate products are also available.

Keep in mind that methylphenidate is a controlled substance. Not all pharmacies accept GoodRx coupons for controlled substances.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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