Methylphenidate (Ritalin, Ritalin SR)

Category:

  • CNS Stimulant

Description:

  • Cerebral stimulant: DEA Schedule II

Indications:

  • Attention deficit disorders

  • Narcolepsy

  • Depression in elderly, cancer, and post-stroke victims (non FDA approved)

Contraindications:

  • Marked anxiety, tension and agitation

  • Glaucoma, Tourette’s syndrome or motor tics, prevention of normal fatigue

Precautions:

  • Pregnancy category C

  • Severe depression, seizure disorders, hypertension, history of drug abuse

  • Children <6 years, symptoms associated with acute stress reactions

Adverse Reactions (Side Effects):

  • CNS: akathisia, dizziness, dyskinesia, fever, headache, hyperactivity, insomnia, restlessness, talkativeness, Tourette’s syndrome (rare)

  • CV: angina, blood pressure changes, dysrhythmias, palpitations, tachycardia

  • GI: abdominal pain, anorexia, dry mouth, nausea, weight loss

  • GU: uremia

  • HEME: anemia, leukopenia

  • METAB: growth retardation

  • MS: arthralgia

  • SKIN: erythema-multiforme, exfoliative dermatitis, rash, scalp hair loss, urticaria

 

Dosage:

Administered orally

  • Adult:            

    • Narcolepsy: PO 10mg 2-3 times daily 30 to 45 minutes before meals; may increase up to 40-60mg daily

  • Child > or =6 years: 

    • Attention deficit disorder: PO 0.3 mg/kg/dose or 2.5-5 mg/dose given before breakfast and lunch; increase by 0.1 mg/kg/dose or 5-10mg daily at weekly intervals; usual dose 0.5-1 mg/kg/day, max 2 mg/kg/day or 60mg daily; sustained release may be used when the 8 hour dose of sustained release corresponds to the titrated 8 hour dose of immediate-release tablets

Drug interactions:

  • Labs: false positive urine amphetamine

  • MAOIs: hypertensive reactions

  • Guanethidine: inhibition of guanethidine antihypertensive effect

Special considerations:

  • Overdosage may cause vomiting, agitation, tremor, muscle twitching, seizures, confusion, tachycardia, hypertension, arrythmias

  • Take last daily dose prior to 1800 to avoid insomnia

  • Do not chew or crush sustained release formulation

    

 
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