Key takeaways:
Methylphenidate (Ritalin, Concerta, Daytrana) treats attention-deficit hyperactivity disorder (ADHD) and narcolepsy. It comes in many different dosage forms, such as pills, liquid, and a patch.
Methylphenidate can interact with many medications. Common methylphenidate interactions include blood pressure medications, antidepressants, and antipsychotics.
Some methylphenidate interactions cause high blood pressure. Others can raise the risk of bleeding, drowsiness, serotonin syndrome, or other issues.
Give your prescriber and pharmacist a list of medications and supplements you take. They can help you check for methylphenidate interactions.
Methylphenidate is a first-choice medication to treat attention-deficit hyperactivity disorder (ADHD) in 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 misuse. And there are restrictions on how much you can refill and how often.
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.
Methylphenidate interactions at a glance
While not a complete list, here’s a summary of possible methylphenidate interactions:
Blood pressure medications like lisinopril (Zestril, Qbrelis): Methylphenidate may cause blood pressure medications to not work as well.
Vasopressors like vasopressin: This combination can cause a significant spike in blood pressure.
Other ADHD stimulants: This combination can raise blood pressure and heart rate too high.
Decongestants like pseudoephedrine (Sudafed): This combination can raise blood pressure and heart rate too high.
Warfarin (Coumadin, Jantoven): Methylphenidate can increase warfarin levels and increase the risk of bleeding.
Monoamine oxidase inhibitors like isocarboxazid (Marplan): This combination can cause dangerously high blood pressure, among other risks.
Certain antidepressants: This combination can increase the risk of serotonin syndrome and other side effects.
Antipsychotics like risperidone (Risperdal): This combination can raise the risk of movement-related side effects, such as stiffness and restlessness.
Antiseizure medications like phenobarbital: Methylphenidate can increase the risk of side effects such as dizziness and fatigue.
Drugs that affect heart rhythm: Methylphenidate may increase the risk of palpitations or abnormal heart rhythms when paired with medications that affect your heart.
Caffeine and stimulant supplements: The combination can make symptoms such as jitteriness, insomnia, and changes in blood pressure more intense.
Below, we’ll review seven notable methylphenidate interactions you should know about and how to manage them.
Good to know: Make sure to give your prescriber and pharmacist a complete list of medications and supplements that you take. They can look at what you’re taking and help you avoid interactions in advance.
1. Blood pressure medications
Methylphenidate can raise your blood pressure and heart rate. That’s part of how it works as a stimulant. But if you already have high blood pressure or take medication to treat it, this effect can be a concern.
When these medications are taken together, methylphenidate can make your blood pressure medication not work as well. So it may be harder to keep your blood pressure within your target range.
Examples of blood pressure medications include:
Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Zestril, Qbrelis) and enalapril (Vasotec)
Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar) and valsartan (Diovan)
Calcium channel blockers, such as amlodipine (Norvasc) and diltiazem (Cardizem)
Beta blockers, such as metoprolol (Toprol XL, Lopressor) and propranolol (Inderal LA)
Diuretics (water pills), such as hydrochlorothiazide (Microzide) and furosemide (Lasix)
If you’re taking methylphenidate with one of these medications, your prescriber may:
Check your blood pressure and heart rate more often, especially when starting treatment or changing doses.
Adjust your blood pressure medication if your readings go up.
Ask you to check your blood pressure at home between visits.
Don’t stop taking any of your medications on your own. If you notice higher blood pressure readings, reach out to your healthcare team. They can help figure out whether you need a dose change or a different medication.
Get emergency medical help right away if you have symptoms such as chest pain, shortness of breath, or vision changes. These can be signs of dangerously high blood pressure.
2. Vasopressors
Vasopressors are medications that increase your blood pressure. Two examples of vasopressors are norepinephrine (Levophed) and vasopressin.
You may need vasopressors if your blood pressure is too low due to conditions such as septic shock or a severe allergic reaction (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.
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.
3. 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 increase the risk of bleeding or bruising.
Some signs and symptoms 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 check a lab value called the international normalized ratio (INR). Your prescriber should 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 prescriber 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 healthcare team. Stopping methylphenidate could affect your INR, and your prescriber might need to change your warfarin dose.
4. Some antiseizure medications
Antiseizure medications treat seizures and prevent them from happening. But methylphenidate blocks the metabolism of some antiseizure medications. These include phenobarbital, phenytoin (Dilantin, Phenytek), and primidone (Mysoline).
This interaction can cause these medications to build up in your body, which raises your risk of side effects. Dizziness, fatigue, and drowsiness are all potential issues.
If you’re starting methylphenidate, you may need a lower dose of your antiseizure medication. If you’re stopping methylphenidate, you may need a higher dose of your antiseizure medication. Your prescriber will make this decision. They also might check medication levels more often to make sure your dose isn’t too high or low.
5. Some antidepressants
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) treat conditions such as depression and anxiety. Sertraline (Zoloft) and fluoxetine (Prozac) are two common SSRIs, while amitriptyline and doxepin (Silenor) are common TCAs.
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 increases the risk of 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 prescriber may need to adjust your dose if you're starting or stopping methylphenidate. Don't make changes to your medications without talking to your prescriber first. They can help you decide whether you need to increase or decrease your dose.
6. Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAOIs) treat conditions such as depression and Parkinson’s disease. Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), and selegiline (Emsam, Zelapar). Methylene blue is considered a MAOI, too. But these medications aren't commonly used due to their side effects and drug interactions.
Methylphenidate can 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.
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.
7. Antipsychotics like risperidone
Risperidone (Risperdal) is an atypical antipsychotic. It treats conditions such as 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 adjustments.
This interaction is also possible with other atypical antipsychotics that cause movement problems, such as 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 prescriber. They may adjust the dose of either medication. But don’t stop either medication, or change your doses, without talking to them first.
The bottom line
Methylphenidate can interact with warfarin (Coumadin, Jantoven), selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft), and antipsychotics such as risperidone (Risperdal). Methylphenidate interactions with antiseizure medications such as phenobarbital and monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) are also possible.
Some methylphenidate interactions can raise your risk of side effects. These include bleeding, serotonin syndrome, or movement problems. Other potential interactions (like with vasopressors) can cause high blood pressure.
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