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