methylphenidate
Methylphenidate hydrochloride (Ritalin) is a stimulant medication that's used for treating attention deficit-hyperactivity disorder (ADHD) and narcolepsy (daytime sleepiness) in adults and children ages 6 years and older. It works by raising the levels of certain chemicals in your brain to keep you focused and awake. The dosage is typically 2 to 3 times per day because it's an immediate-release form of methylphenidate. Side effects of this medication include low appetite, nervousness, and trouble sleeping.
What is Methylphenidate (Ritalin)?
What is Methylphenidate (Ritalin) used for?
Attention deficit-hyperactivity disorder (ADHD)
Narcolepsy (daytime sleepiness)
How Methylphenidate (Ritalin) works
Methylphenidate (Ritalin) is a stimulant medication. It's not exactly known how methylphenidate (Ritalin) helps to improve attention, focus, and wakefulness. But it's thought to work by raising the levels of chemicals in your brain called norepinephrine, dopamine, and serotonin.
methylphenidate extended-release (Concerta, Ritalin LA) instead?
Drug Facts
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What are the risks and warnings for Methylphenidate (Ritalin)?
Methylphenidate (Ritalin) 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 (Ritalin) than prescribed | Suddenly stopping methylphenidate (Ritalin)
Methylphenidate (Ritalin) has a risk of misuse and dependence. Misuse is when a medication is used differently than how it's prescribed. Misusing methylphenidate (Ritalin) 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 (Ritalin) 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 (Ritalin) at usual doses. Methylphenidate (Ritalin) can also raise your blood pressure and heart rate. Tell your provider if you have a history of heart problems before starting methylphenidate (Ritalin) 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 (Ritalin).
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 (Ritalin) 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. Talk to your provider right away if you have these mood- and behavior-related symptoms while you're taking methylphenidate (Ritalin) because you might have to stop taking it.
Prolonged and painful erection
Although rare, some people taking methylphenidate (Ritalin) have had prolonged and painful erections. Sometimes, this problem might require surgery to treat. This problem was typically reported after the dose was raised, but could also happen when the medication was stopped. Stop taking methylphenidate (Ritalin) and get medical attention as soon as possible if you develop a painful erection that lasts longer than 4 hours.
Blood circulation problem (Raynaud's phenomenon)
Methylphenidate (Ritalin) 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 (Ritalin) or ask you to consider a different medication.
Slowed growth in children
In studies, children taking stimulants like methylphenidate (Ritalin) daily throughout the year had a temporary slowing of growth. On average, the children in these studies had about 2 cm less growth in height and about 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 (Ritalin) treatment. Talk to your child's provider if you have concerns.
Serotonin syndrome
Risk factors: Taking monoamine oxidase inhibitors (MAOIs) 14 days before starting methylphenidate (Ritalin) | Taking other medications that raise serotonin levels in your brain
Serotonin syndrome is a rare, but potentially life-threatening condition that happens when 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 (Ritalin) with other medications that affect serotonin levels, such as antidepressants, MAOIs (e.g., phenelzine (Nardil)), linezolid (Zyvox), and migraine medications like sumatriptan (Imitrex). Tell your provider about all the medications you take or plan to take before starting methylphenidate (Ritalin). Be aware of symptoms of serotonin syndrome, such as 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 (Ritalin) can interact with many medications. For example, methylphenidate (Ritalin) 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 (Ritalin). Additionally, avoid taking methylphenidate (Ritalin) 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 (Ritalin).
Caution use in people with phenylketonuria (PKU) - chewable tablets only
The methylphenidate (Ritalin) chewable tablets contain phenylalanine, a component of the artificial sweetener aspartame. If you have a genetic condition called phenylketonuria (PKU), taking the chewable tablets can be dangerous for you. Let your provider know if you have PKU so they can prescribe a different formulation of methylphenidate (Ritalin) that might be safer for you.
What are the side effects of Methylphenidate (Ritalin)?
Common Side Effects
- Headache
- Anxiety
- Trouble sleeping
- Low appetite
- Weight loss
Other Side Effects
- Dizziness
- Dry mouth
- Nausea
- Stomach pain
- Restlessness
- High blood pressure
- Fast heart rate
- Sweating more than usual
Serious Side Effects
- 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
Source:Â DailyMed
More on Methylphenidate (Ritalin) side effects
The following 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.
Pros and cons of Methylphenidate (Ritalin)
Pros
Available as a lower-cost generic medication
Available as an oral tablet, chewable tablet, and liquid
Cons
Is a controlled substance because it has a risk of misuse and dependence
Shouldn't stop taking this medication suddenly without talking to your provider first because of greater risk for mood changes
Can negatively affect growth in children
Pharmacist tips for Methylphenidate (Ritalin)
Take your first dose of methylphenidate (Ritalin) as soon as you wake up to avoid having trouble sleeping later at night.
Take methylphenidate (Ritalin) exactly as prescribed. Don't change your dose or stop taking the medication without talking to your provider first. Doing so can lead to bothersome withdrawal symptoms, such as daytime sleepiness, large appetite, trouble sleeping, irritation, and depression.
You can take methylphenidate (Ritalin) with or without food. But since stimulants like methylphenidate (Ritalin) tend to lower appetite (and potentially lead to weight loss), make sure to follow a healthy and balanced diet. Let a provider know if you or your child seems to have lost their appetite or have had concerning weight changes while taking methylphenidate (Ritalin).
Avoid driving during the first few days after you start methylphenidate (Ritalin) and after dose changes until you know how this medication affects you. Methylphenidate (Ritalin) might cause dizziness. It might also cause blurry vision, which can affect how well you see.
Make sure your provider knows all the medications you're taking before starting methylphenidate (Ritalin). Don't start any new medications while taking methylphenidate (Ritalin) without talking to your provider or pharmacist first. Since there can be harmful drug interactions with methylphenidate (Ritalin), your providers can check that all your medications are safe for you to take.
Accidentally taking too much methylphenidate (Ritalin) can lead to an overdose. Symptoms of an methylphenidate (Ritalin) overdose include restlessness, quick breathing, fast heartbeat, irritability, aggression, and fever. It's important for you and your loved ones to know how to recognize an overdose so it can be treated right away. Call 911 if you think an overdose has happened.
For the oral tablet: Swallow the tablet whole. Don't crush or chew the tablet. Ask your provider about switching you to the chewable tablet or liquid if you're having trouble swallowing the tablet.
For the chewable tablet: Chew the tablet(s) well. Then, swallow with at least 8 ounces (a full glass) of water or other liquid to avoid choking. Don't swallow the chewable tablet whole.
More tips for methylphenidate (Ritalin) liquid
Methylphenidate (Ritalin) liquid comes in two different strengths or concentrations. Make sure you know your dose and the concentration you have to avoid taking the wrong dose.
Only use the oral syringe that's provided to you to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose. Ask your provider or pharmacist if you're not sure how to measure out the correct dose.
Store the liquid at room temperature in the original bottle it came in from the pharmacy.
Frequently asked questions about Methylphenidate (Ritalin)
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Methylphenidate (Ritalin) dosage forms
Typical dosing for Methylphenidate (Ritalin)
Methylphenidate (Ritalin) is available as an oral tablet and chewable tablet. Methylphenidate is also available as a liquid (Methylin brand name). The dosage is the same for all forms of immediate-release methylphenidate.
Children 6 years and older: The typical starting dose is 5 mg by mouth two times daily (before breakfast and lunch).
Adults: The typical dose is 20 mg to 30 mg by mouth per day, split into two or three smaller doses throughout the day. Each dose is taken about 30 to 45 minutes before a meal.
The maximum daily dose is 60 mg.
Your provider will adjust your dose based on how well methylphenidate (Ritalin) is working for you and whether you're having side effects.
Interactions between Methylphenidate (Ritalin) and other drugs
More on Methylphenidate (Ritalin) interactions
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 (Ritalin) cost?
Methylphenidate (Ritalin) contraindications
Severe allergy to methylphenidate-containing products
Currently take or have taken an MAOI in the last 14 days
What are alternatives to Methylphenidate (Ritalin)?
Attention deficit-hyperactivity disorder (ADHD)
Narcolepsy (daytime sleepiness)
Attention-deficit hyperactivity disorder (ADHD)
Excessive daytime sleepiness or cataplexy (sudden muscle weakness) in adults with narcolepsy
Excessive daytime sleepiness in children ages 6 and older with narcolepsy
What is the latest news about Methylphenidate (Ritalin)?
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References
Best studies we foundCortese, S., et al. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry.
Khajehpiri, Z., et al. (2014). Adverse reactions of methylphenidate in children with attention deficit-hyperactivity disorder: Report from a referral center. Journal of Research in Pharmacy Practice.
Kimko, H. C., et al. (1999). Pharmacokinetics and clinical effectiveness of methylphenidate. Clinical Pharmacokinetics.
Lerner, A., et al. (2019). Dependence, withdrawal and rebound of CNS drugs: An update and regulatory considerations for new drugs development. Brain Communications.
Lupin Pharmaceuticals, Inc. (2023). Methylphenidate hydrochloride - methylphenidate hydrochloride tablet, chewable [package insert]. DailyMed.
Martin, D., et al. (2023). Amphetamine. StatPearls.
McGough, J. J., et al. (2005). Long-term tolerability and effectiveness of once-daily mixed amphetamine salts (Adderall XR) in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry.
Nanda, A., et al. (2023). Adverse effects of stimulant interventions for attention deficit hyperactivity disorder (ADHD): A comprehensive systematic review. Cureus.
National Human Genome Research Institute. (2014). About phenylketonuria.
National Institute on Drug Abuse. (2020). Misuse of prescription drugs research report: Overview.
Novartis Pharmaceuticals Corporation. (2023). Ritalin- methylphenidate hydrochloride tablet [package insert]. DailyMed.
Post, R. E., et al. (2012). Diagnosis and management of attention-deficit/hyperactivity disorder in adults. American Family Physician.
ScienceDirect. (n.d.). Dexmethylphenidate.
Shin, J. Y., et al. (2016). Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): Nationwide self controlled case series study. British Medical Journal (Clinical Research Edition).
Shionogi Inc. (2023). Methylin- methylphenidate hydrochloride solution [package insert]. DailyMed.
Shoptaw, S. J., et al. (2009). Treatment for amphetamine withdrawal. The Cochrane Database of Systematic Reviews.
Steingard, R., et al. (2019). New formulations of stimulants: An update for clinicians. Journal of Child and Adolescent Psychopharmacology.
U.S. Food and Drug Administration. (2021). Some medicines and driving don’t mix.
Verghese, C., et al. (2023). Methylphenidate. StatPearls.
Wolraich, M. L., et al. (2004). Pharmacokinetic considerations in the treatment of attention-deficit hyperactivity disorder with methylphenidate. CNS Drugs.
Wolraich, M. L., et al. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics.
Zorn, S. Z. (2015). The safety of stimulant medication use in cardiovascular and arrhythmia patients. American College of Cardiology.
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