Rit·a·lin (r t l-n) A trademark for the drug methylphenidate. |
Ritalin,
methylphenidate hydrochloride
Concerta, Daytrana, Equasym (UK), Metadate CD, Metadate ER, Methylin, Methylin ER, PHL-Methylphenidate (CA), PMS-Methylphenidate (CA), Riphenidate (CA), Ritalin, Ritalin LA, Ritalin-SR
Pharmacologic class: Piperidine derivative
Therapeutic class: CNS stimulant
Controlled substance schedule II
Pregnancy risk category C
FDA Boxed Warning
• Give cautiously to patients with history of drug dependence or alcoholism. Chronic abuse can cause marked tolerance and psychological dependence with abnormal behavior. Frank psychotic episodes may occur, especially with parenteral abuse. Supervise carefully during withdrawal from abusive use, as severe depression may occur. Withdrawal after prolonged therapeutic use may unmask symptoms of underlying disorder, possibly requiring follow-up.
Action
Increases release of norepinephrine, which stimulates impulse transmission in respiratory system and CNS. Net effect is increased mental alertness.
Availability
Capsules (extended-release): 10 mg, 20 mg, 30 mg, 40 mg
Tablets (chewable): 2.5 mg, 5 mg, 10 mg
Tablets (extended-release): 10 mg, 18 mg, 20 mg, 27 mg, 36 mg, 54 mg
Tablets (prompt-release): 5 mg, 10 mg, 20 mg
Tablets (sustained-release): 20 mg
Transdermal patch: 10 mg/9 hours, 15 mg/9 hours, 20 mg/9 hours, 30 mg/9 hours
⊘Indications and dosages
➣ Adjunctive treatment of attention deficit hyperactivity disorder (ADHD)
Adults: 5 to 20 mg P.O. (prompt-release tablets) two to three times daily. Once maintenance dosage is determined, may switch to extended-release.
Children older than age 6: Initially, 5 mg P.O. (prompt-release tablets) before breakfast and lunch; increase by 5 to 10 mg at weekly intervals, not to exceed 60 mg/day. Once maintenance dosage is determined, may switch to extended-release.
If previous methylphenidate dosage was 10 mg b.i.d. or 20 mg sustained-release, give Ritalin LA 20 mg P.O. once daily. If previous dosage was 15 mg b.i.d., give Ritalin LA 30 mg P.O. once daily. If previous dosage was 20 mg b.i.d. or 40 mg sustained-release, give Ritalin LA 40 mg P.O. once daily. If previous dosage was 30 mg b.i.d. or 60 mg sustained-release, give Ritalin LA 60 mg P.O. once daily.
In all patients, Ritalin-SR or Metadate ER may be prescribed instead of prompt-release tablets when 8-hour dosage of those forms corresponds to titrated 8-hour dosage of prompt-release tablets.
Concerta -
Children ages 6 and older who haven't used methylphenidate previously: Initially, 18 mg P.O. once daily in morning; may be titrated weekly up to 54 mg/day
Children ages 6 and older using other methylphenidate forms: 18 mg P.O. once daily in morning if previous dosage was 5 mg two to three times daily, or 20 mg P.O. daily (sustained-release); 36 mg once daily in morning if previous dosage was 10 mg two to three times daily or 40 mg daily (sustained-release); or 54 mg once daily in morning if previous dosage was 15 mg two to three times daily or 60 mg once daily (sustained-release)
Metadate CD -
Children ages 6 and older: Initially, 20 mg once daily; may adjust in weekly increments of 10 to 20 mg, to a maximum of 60 mg/day taken in morning
➣ Adjunctive treatment of attention deficit hyperactivity disorder (ADHD)
Daytrana -
Children ages 6 and older: Apply patch to hip area 2 hours before effect is needed; remove 9 hours after application; titrate dosages as needed.
➣ Narcolepsy
Adults: 10 mg P.O. (Ritalin, Ritalin SR, or Metadate ER) two to three times daily, 30 to 45 minutes before a meal. Some patients may require up to 60 mg daily.
Off-label uses
• Depression in ill, elderly patients (such as those with cerebrovascular accident)
• To enhance analgesia and sedation in patients receiving opioids
Contraindications
• Hypersensitivity to drug or its components
• Glaucoma
• Motor tics, Tourette syndrome (or family history of syndrome)
• Psychosis
• Suicidal or homicidal tendencies
• MAO inhibitor use within past 14 days
Precautions
Use cautiously in:
• hypertension, cardiovascular disease, diabetes mellitus, seizure disorders
• elderly or debilitated patients
• pregnant or breastfeeding patients.
Administration
• Don't crush extended-release tablets or extended-release trilayer core tablets (Concerta).
• Have patient swallow extended-release capsules (Metadate CD, Ritalin LA) intact; or, if desired, sprinkle entire contents onto small amount (1 tbsp) of applesauce immediately before administration. (However, don't sprinkle Ritalin LA onto warm applesauce because its release properties may be affected.) Give water after patient swallows dose.
• Don't give extended-release tablets to initiate therapy or for daily use until dosage has been titrated using conventional tablets.
• Apply patch immediately after opening pouch to a clean, dry hip area and alternate hips daily.
☞ Don't give within 14 days of MAO inhibitor use.
• To help prevent insomnia, give last daily dose of conventional tablets several hours before bedtime.
• Discontinue drug periodically in children who have responded to therapy, to assess patient's condition. After withdrawal, improvement may be temporary or permanent.
• Be aware that therapy shouldn't continue indefinitely.
| Route | Onset | Peak | Duration |
| P.O. | Unknown | 1-3 hr | 4-6 hr |
| P.O. (extended) | Unknown | Unknown | Up to 8 hr |
| Transdermal | Unknown | Unknown | Unknown |
Adverse reactions
CNS: restlessness, tremor, dizziness, headache, irritability, hyperactivity, insomnia, akathisia, dyskinesia, toxic psychosis
CV: hypertension, hypotension, palpitations, tachycardia
EENT: blurred vision
GI: nausea, vomiting, diarrhea, constipation, cramps, dry mouth, anorexia
Skin: rash, contact sensitization
Other: metallic taste, fever, suppression of weight gain (in children), hypersensitivity reactions, physical or psychological drug dependence, drug tolerance
Interactions
Drug-drug. Anticonvulsants, selective serotonin reuptake inhibitors, tricyclic antidepressants, warfarin: inhibited metabolism and increased effects of these drugs
Guanethidine: antagonism of hypotensive effect
MAO inhibitors, vasopressors: hypertensive crisis
Drug-food. Caffeine-containing foods and beverages (such as coffee, cola, chocolate): increased CNS stimulation
Drug-herbs. Ephedra (ma huang), caffeine-containing herbs (such as cola nut, guarana, maté): increased CNS stimulation
Drug-behaviors. Alcohol use: additive hypotension
Patient monitoring
• Monitor patient periodically for drug tolerance and psychological dependence.
• Watch for adverse effects. Know that these usually can be controlled by adjusting schedule or dosage.
• Monitor for contact sensitization (erythema accompanied by edema, papules, vesicles) that does not significantly improve within 48 hours or spreads beyond the patch site. Discontinue drug if this occurs.
• Stay alert for tachycardia, abdominal pain, insomnia, anorexia, and weight loss (more common in children).
• Consider periodic hematologic and liver function tests, especially during prolonged therapy.
• Monitor blood pressure, especially in patients with history of hypertension.
• Evaluate child's weight and growth patterns.
• Assess child for tics, which may develop in 15% to 30% of children using drug.
Patient teaching
• Inform patient or parent that last daily dose should be taken several hours before bedtime to avoid insomnia.
• Make sure patient or parent understands how drug should be taken.
• Tell patient taking Concerta not to be concerned if tablet-like substance appears in stool.
• Teach caregiver how to use patch and to make sure that skin is clean, dry, and free of cuts or irritation.
• Tell caregiver not to allow child to use heat sources, such as heating pads or electric blankets, while wearing the patch.
• Instruct caregiver to report redness accompanied by swelling or solid bumps or blisters on the skin that do not significantly improve within 48 hours or spread beyond the patch site.
• Tell caregiver to replace the patch if it falls off, but total wear time for the day should remain 9 hours.
• Advise patient or parent to report insomnia, palpitations, vomiting, fever, or rash.
• Caution patient or parent that continual use may lead to psychological or physical dependence.
• Instruct patient to avoid driving and other hazardous tasks until drug effects are known.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.
Patient discussion about Ritalin.
Q. Can ADHD and ADD medication harm you? My son is diagnosed as an ADHD and the Dr. recommended taking Ritalin
Q. My child, who has dypraxia, passed both TOVA & BRC. Help, I don't want to put him on ritalin but feel pres Since age 4 my child has received OT, ST and Physiotherpy. He is now 81/2 and has difficulties at school. Last year, after years of therapy, we went to a private Neuro Developmental Physiotherapist and she diagnosed him with Dyspraxia. I thought that my son was good at sport, but when she asked him to do the simplest of task like stand on one leg, or walk one foot infront of the other, he had great difficulty. He has diffculty processing information or thoughts and turning them into actions. This is especially evident in copying from the blackboard. His handwriting is extremely poor, even after many years, at much expence, of intense OT. His attention span is very poor, he daydreams and shuts down in class. The slightest noise, knock on the door, ticking clock etc wil break his concentration. He has passed both TOVA and BRC test, yet I am still under pressure from the school to put him on ritalin. I feel his concentration & attention problems are due to his Dyspraxia. Help
I no an American lady who lived in the uk at the time and used ritalin the out come was that she regretted using it on her daughter as she had lost her real child due to the drug.
Our Children are a Gift, enjoy them and grow with them but most of all let them grow with you. Enjoy the gift you have before its the one thing that you get for life.
Being a Parent is the most Under payed job in the world but our richness is payed back to us in love. We Parents are richer then we could ever dream....
Q. What happen if you have ADHD and stop taking Ritalin? My niece was recently diagnosed as having ADHD. If her parents decide to give her Ritalin, will she be able to stop taking the medication after a while?
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