About Ritalin
Ritalin (methylphenidate) is stimulant prescribed for treatment
of attention deficit disorders, with or without hyperactivity, and
narcolepsy (uncontrollable
drowsiness). Its method of action is unclear, but it appears to
directly affect the central nervous system, as well as the availability
of dopamine to the brain.
In clinical practice, methylphenidate may also be used as a treatment
for depression in individuals who cannot take standard antidepressants,
or who are experiencing situational depression due to an illness.
Ritalin should not be used to treat severe or prolonged depression,
or in patients who also show signs of anxiety, tension, or another
primary psychiatric condition. This medication is not recommended
for normal fatigue caused by lifestyle factors.
Methylphenidate is only available by prescription. Do not use this
medication with caffeine, or any other prescription or over
the counter stimulants. Ritalin Side Effects
Common Ritalin Side Effects: Decreased appetite, excitement,
growth supression (children), insomnia,
mild headache, mild increase in heart rate, nervousness.
Adverse Side Effects: Abnormal behavior, allergy (bruising,
fever, hives, joint pain, rash), altered heartbeat (irregular, pounding,
racing), black or tarry stools, blood in urine, blurred or altered
vision, delusions, depersonalization, dizziness, hallucinations,
headache (severe), high blood pressure, involuntary speech, liver
toxicity, muscle damage, nausea, porphyria, red points on skin,
stomachache, stuttering, tics or uncontrolled movements, Tourette's
syndrome onset, unusual bleeding, weight loss.
The likelihood of adverse side effects ranges from possible (documented
for similar medications), to infrequent (below 10% of users), to
rare (below 2%). Any adverse side effect should be reported to your
doctor immediately if mild, and should receive immediate medical
attention if severe. Seek professional advice as soon as possible.
If you have an adverse reaction, stop taking the medication until,
or if, your doctor approves further use.
Overdose: An overdose of this medication is possible, seek
emergency medical attention if several of the following symptoms
occur at once or are particularly severe. Agitation, altered
heartbeat (fast, pounding, racing), dry mouth or mucous membranes,
false euphoria, fever, hallucination, heavy sweating, higher blood
pressure, large pupils, muscle twitches or tics, overactive reflexes,
seizures, severe confusion, severe headache.
Cautions: This medication may not be safe or suitable for
all individuals. In some cases, your doctor may prescribe treatment
even if you have a history of one of the listed conditions, but
may take extra precautions. Please be sure to discuss any history
of the following conditions with your doctor, to ensure a high quality
of treatment.
- Allergy: An allergic reaction to this medication in the
past is a contraindication for further use. Also inform your physician
if you have any other medication, food, or dye allergies.
- Alcohol or Substance Abuse: Individual may be at higher
risk of dependence.
- Cardiovascular Illness: Any illness of the cardiovascular
system may be worsened by treatment with the stimulant methylphenidate.
Take this medication only with the approval of a fully informed
physician and careful monitoring.
- Epilepsy or Seizure Disorder: Increased risk of convulsion,
be especially cautious if you take other medication which could
increase the likelihood of seizure.
- Glaucoma: May increase pressure in the eye for individuals
who have a history of this condition.
- High Blood Pressure: Increased blood pressure or rapid
heartbeat are common side effects of this medication, treatment
is inadvisable.
- Primary Psychiatric Disorder (Agitation, Anxiety, Major
Depression, Severe Tension): These conditions may be worsened
by treatment with methylphenidate.
- Psychosis: The condition may worsen, this treatment is
not recommended.
- Tourette's Syndrome (or family history): Methylphenidate
may increase the symptoms of this condition, or cause an onset
of the syndrome if a predisposition exists.
- Tics: May be worsened.
Ritalin Interactions
Ritalin may interact negatively with certain medications, or alter
their pattern of side effects or usefulness. Speak with your doctor
or pharmacist about the safety of combining any prescription, over
the counter, or herbal treatment with this medication. Avoid consuming
other substances that act to stimulate the nervous system, or give
you a sense of heightened alertness. Mixing stimulants can dangerously
overstimulate the body, leading to undesirable side effects like
insomnia, irregular heartbeat, irritability, nervousness, racing
heartbeat, or seizure.
- Amphetamines - The use of these stimulants in combination with
methylphenidate could be dangerous or life-threatening. Do not
combine.
- Antiseizure treatments - If methylphenidate is used with Dilantin
(phenytoin), Mysoline, or Phenobarbitol, it may change the pattern
of seizure significantly, requiring dosing changes.
- Asthma medication - Possible risk of severe interaction effects
including insomnia, irregular heartbeat, irritability, nervousness,
racing heartbeat, or seizure.
- Caffeine - Increased risk of racing heartbeat, nervousness,
or other undesirable side effects.
- Cesamet (nabilone)
- Cocaine - May dangerously overstimulate the nervous system,
do not combine. Avoid taking all street drugs while using methylphenidate,
as the results could be dangerous or life-threatening.
- Cold medication - Possible risk of severe interaction effects
including insomnia, irregular heartbeat, irritability, nervousness,
racing heartbeat, or seizure.
- Cylert (pemoline) - May overstimulate the nervous system.
- Diet pills - This drug combination could be dangerous, avoid
stimulant diet pills like Meridia
(sibutramine) while undergoing treatment with Methylphenidate.
Do not use herbal diet preparations, as they are likely to contain
one or more stimulants.
- Effexor (venlafaxine)
- Increased risk of side effects.
- Herbs - Avoid guarana, ma huang, kola nut, or St. John's wort
during treatment. Do not use herbal diet preparations, as they
are likely to contain one or more stimulants.
- Ismelin (guanethidine) - The usefulness of this medication may
be reduced by methylphenidate treatment.
- MAO inhibitors - Methylphenidate must never be mixed with MAO
(monoamine oxidase) inhibitors, a class of antidepressants and
antisenility drugs, such as Eldepryl (selegiline), Furoxone (furazolidone),
Nardil (phenelzine), Marplan (isocarboxazid), or Parnate (tranylcypromine).
Never use Methylphenidate within 2 weeks of starting or stopping
an MAO inhibitor. Side effects, such as increased blood pressure,
could be dangerous or life-threatening.
- Morphine - Methylphenidate may be very effective in countering
the drowsiness and lack of focus that can be experienced by individuals
who must use high doses of morphine.
- Orap (pimozide) - Should not be used to treat tics caused by
methylphenidate treatment.
- Provigil (modafinil) -
May increase CNS stimulation.
- Symmetrel (amantadine)
- Tricyclic antidepressants such as Elavil
(amitriptyline), Asendin (amoxapine), Anafranil (clomipramine),
Pertofrane or Norpramin (desipramine), Sinequan
(doxepin), Tofranil (imipramine), Aventyl or Pamelor (nortriptyline),
Vivactil (protriptyline), and Surmontil (trimipramine), may become
toxic when used with methylphenidate. Undesirable side effects,
such as increased blood pressure, could result.
- Ulone (chlophedianol) - May overstimulate the nervous system.
- Wellbutrin/Zyban (bupropion)
- May increase risk of serious side effects such as irregular
heartbeat or seizure.
Ritalin Dosages
The dosages here are general recommendations for individuals over
the age of 13. If your doctor should prescribe a different dosage
or schedule, follow it exactly. 60 mg is the generally recommended
daily maximum, though a starting dose will probably be around 15-20
mg daily.
For ADD/ADHD:
- Tablets: 5-20 mg 2 to 3 times daily
- Extended Release: 18-60 mg taken once daily in the morning
For Narcolepsy:
- Tablets: 5-20 mg 2 to 3 times daily
- Extended Release: As determined by your physician, taken once
daily in the morning
Ritalin Directions
Take this medication exactly as directed, preferably at least half
an hour before a meal. Ritalin SR and Concerta tablets must not
be broken or crushed, as this would release too much of the drug
into the system all at once. Do not take double doses of this medication.
If you miss a dose, take it as soon as possible. If it is almost
time for your next dose, resume your regular dosing schedule, skipping
the missed dose.
If insomnia results from taking this medication, avoid it
in the afternoon and evenings. Speak to your doctor about twice
daily dosing (once before breakfast and again before lunch), or
using one of the delayed release forms which can be taken once in
the morning and lasts for around 8 hours.
Store Ritalin away from direct light and heat. Store in a dry location;
avoid storing it in the bathroom, near sinks, or other areas where
it may become damp. Do not use after the expiration date.
Keep Ritalin away from children; both when storing it, and when
discarding any unused medication. If the prescription is for a child, carefully supervise its use.
Ritalin and Pregnancy
This medication has not been studied for safety during pregnancy, its use is not advised during this time. Discuss the possibility of use during breastfeeding with your doctor.
Ritalin and Children
This medication has not been studied for safety or effectiveness
in children under 6, though some physicians may determine that small
doses may be helpful.
Methylphenidate has been approved for use in children over 6 years
of age, though a doctor may prescribe small doses for younger children.
Manufacturer's guidelines recommend discontinuation if there is
no improvement after a month of treatment, and periodic drug holidays
to assess the continued need for medication. Dosage should not exceed
60 mg daily, and usually starts with 5 mg twice daily, increased
according to your doctor's instructions.
Side effects more likely to occur in children include abdominal
pain, decreased appetite, insomnia, racing heartbeat, and possible
weight loss with long term use. More significantly, however, growth
may be supressed. It is strongly recommended that the medication
be stopped during summer break to allow growth spurts to occur.
Ritalin and Seniors
Ritalin has not been specifically studied in seniors, and it is not known whether or not it affects them differently than the general adult population.
Ritalin and Ritalin SR are trademarks of Novartis
Concerta is a trademark of Alza and McNeil Consumer
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This document is provided for information only. It is not a substitute
for consultation with a physician, either to diagnose symptoms
or prescribe treatment. Any dosages mentioned are general
guidelines only, please follow the directions of your doctor
or pharmacist exactly when taking medication. We have made
every effort to ensure that this information is accurate,
but only your doctor can say if a medication, or drug combination,
is safe for you. Information intended for US residents only.
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