Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

methylphenidate (Rx)Brand and Other Names:Ritalin, Ritalin SR, more...Ritalin LA, Aptensio XR, Concerta, Daytrana, Metadate, Metadate CD, Metadate ER, Methylin, Quillivant XR, QuilliChew ER

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet: Schedule II

  • Ritalin
  • 5mg
  • 10mg
  • 20mg

capsule, extended-release: Schedule II

  • 10mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 15mg (Aptensio XR)
  • 20mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 30mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 40mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 50mg (Aptensio XR, Metadate CD)
  • 60mg (Aptensio XR, Ritalin LA, Metadate CD)

tablet, extended-release: Schedule II

  • 10mg (Methylin, generics)
  • 18mg (Concerta)
  • 20mg (Methylin, Ritalin SR, generics)
  • 27mg (Concerta)
  • 36mg (Concerta)
  • 54mg (Concerta)

extended-release tablet, chewable (scored): Schedule II

  • QuilliChew ER
  • 20mg
  • 30mg
  • 40mg

tablet, chewable: Schedule II

  • Methylin
  • 2.5mg
  • 5mg
  • 10mg

transdermal patch: Schedule II

  • Daytrana
  • 10mg
  • 15mg
  • 20mg
  • 30mg

oral solution: Schedule II

  • Methylin
  • 5mg/5mL
  • 10mg/5mL
more...

Attention Deficit Hyperactivity Disorder

Metadate CD: Initial, 20 mg PO qAM before breakfast; may increase in 10- to 20-mg increments, not to exceed 60 mg/day

Ritalin LA: Initial, 20 mg PO qAM; may adjust dose in weekly 10-mg increments, not to exceed 60 mg/day (patients requiring a lower initial dose may begin with 10 mg)

Concerta: Initial, 18-36 mg PO qDay; may increase by 18-mg increments at weekly intervals; maintenance dose is 18-72 mg/day

Metadate ER, Methylin ER, and Ritalin SR: Duration of action is approximately 8 hr; may use in place of methylphenidate IR tablets when 8-hr dosage of methylphenidate ER and SR tablets corresponds to the titrated 8-hour dosage of methylphenidate IR; not to exceed 60 mg/day

Methylin, Ritalin (immediate-release tablets, chewable tablets, and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; may gradually increase dose at weekly intervals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate

Aptensio XR: 10 mg PO qDay in AM; may increase weekly by 10-mg increments; not to exceed 60 mg/day

QuilliChew ER (chewable extended-release tablets): 20 mg PO qAM initially; may be titrated up or down weekly in increments of 10 mg, 15 mg or 20 mg, not to exceed 60 mg/day

Narcolepsy

Methylin, Ritalin (immediate-release tablets, chewable tablets, and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate

Metadate ER, Methylin ER, and Ritalin SR: Duration of action is approximately 8 hr; may use in place of methylphenidate IR tablets when 8-hr dosage of methylphenidate ER and SR tablets corresponds to the titrated 8-hr dosage of methylphenidate IR

Dosage Forms & Strengths

tablet: Schedule II

  • Ritalin
  • 5mg
  • 10mg
  • 20mg

capsule, extended-release: Schedule II

  • 10mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 15mg (Aptensio XR)
  • 20mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 30mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 40mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 50mg (Aptensio XR, Metadate CD)
  • 60mg (Aptensio XR, Ritalin LA, Metadate CD)

tablet, extended-release: Schedule II

  • 10mg (Methylin, generics)
  • 18mg (Concerta)
  • 20mg (Methylin, Ritalin SR, generics)
  • 27mg (Concerta)
  • 36mg (Concerta)
  • 54mg (Concerta)

extended-release tablet, chewable (scored): Schedule II

  • QuilliChew ER
  • 20mg
  • 30mg
  • 40mg

tablet, chewable: Schedule II

  • Methylin
  • 2.5mg
  • 5mg
  • 10mg

transdermal patch: Schedule II

  • Daytrana
  • 10mg
  • 15mg
  • 20mg
  • 30mg

oral solution: Schedule II

  • Methylin
  • 5mg/5mL
  • 10mg/5mL

oral suspension, extended-release: Schedule II

  • Quillivant XR
  • 25mg/5mL (following reconstitution)
more...

Attention Deficit Hyperactivity Disorder

<6 years: Safety and efficacy not established

≥6 years:

Methylin, Ritalin (immediate-release tablets, chewable tablets, and oral solution): 5 mg PO BID 30-45 minutes before breakfast and lunch initially; may increase by 5-10 mg/day at weekly intervals; not to exceed 60 mg/day divided BID/TID

Metadate ER, Methylin ER, and Ritalin SR: May be given in place of immediate-release products once the daily dose is titrated and the titrated 8-hour dosage corresponds to SR or ER tablet size; not to exceed 60 mg/day

Metadate CD, Ritalin LA: Initial, 20 mg PO qAM; may increase by 10 mg (Ritalin LA) or 10-20 mg (Metadate CD) qWeek to not to exceed 60 mg/day

Quillivant XR (6-12 years): 20 mg PO qAM initially; may titrate at weekly intervals by weekly 10- to 20-mg increments; not to exceed 60 mg/day

Aptensio XR: 10 mg PO qDay in AM; may increase weekly by 10-mg increments; not to exceed 60 mg/day

QuilliChew ER (chewable extended-release tablets): 20 mg PO qAM initially; may be titrated up or down weekly in increments of 10 mg, 15 mg or 20 mg, not to exceed 60 mg/day

Immediate-release weight-based dosing

  • Initial: 0.3 mg/kg/dose PO before breakfast and lunch; may increase by 0.1 mg/kg/dose qWeek 
  • Maintenance: 0.3-1 mg/kg PO before breakfast and lunch; not to exceed 2 mg/kg/day PO divided q12hr

Concerta (methylphenidate-naïve)

  • Trilayer core tablets; extended-release core with immediate release
  • Initial: 18 mg PO qDay; dosage may be increased by 18 mg/day at weekly intervals
  • Do not exceed 54 mg/day in children (6-12 years) and 72 mg/day in adolescents (13-17 years)

Concerta (patients taking methylphenidate)

  • 18 mg PO qAM (if switching from methylphenidate 5 mg PO q8-12hr)
  • 36 mg PO qAM (if switching from methylphenidate 10 mg q8-12hr)
  • 54 mg PO qAM (if switching from methylphenidate 15 mg PO q8-12hr)
  • 72 mg PO qAM (if switching from methylphenidate 20 mg PO q8-12hr)

Transdermal patch (Daytrana)

  • Indicated for children aged 6-12 years and adolescents aged 13-17 years
  • Recommended starting dose for patients new to or converting from another formulation of methylphenidate is 10 mg
  • Apply patch on hip 2 hours before desired onset; remove after 9 hours; alternate application site
  • Dose titration, final dosage, and wear time should be individualized according to the needs and response of the patient
  • Titrate to effect for best results, following are Manufacturer's recommendations
  • Week 1: 10 mg (12.5 cm² patch); releases 1.1 mg/hr
  • Week 2: 15 mg (18.75 cm² patch); releases 1.6 mg/hr
  • Week 3: 20 mg (25 cm² patch); releases 2.2 mg/hr
  • Week 4: 30 mg (37.5 cm² patch); releases 3.3 mg/hr

Narcolepsy

<6 years

  • Safety & efficacy not established

≥6 years

  • Methylin, Ritalin (immediate-release tablets, chewable tablets, and oral solution): 5 mg PO q12hr; may increase by 5-10 mg/day weekly; not to exceed 60 mg/day
  • Metadate ER, Methylin ER, and Ritalin SR: May be given in place of immediate-release products once the daily dose is titrated and the titrated 8-hour dosage corresponds to SR or ER tablet size; not to exceed 60 mg/day
Next

Interactions

Interaction Checker

methylphenidate and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            Frequency Not Defined

            Headache

            Hypertension

            Nausea

            Nervousness

            Toxic psychosis

            Seizures

            Tachycardia

            Angina

            Cardiac arrhythmia

            Cerebral occlusion

            Increased/decreased pulse

            Cerebral arteritis

            Cerebral hemorrhage

            Raynaud's phenomenom

            Vasculitis

            Anxiety

            Anger

            Agitation

            Irritability

            Vertigo

            Fatigue

            Erythema multiform

            Hyperhidrosis

            Rash

            Urticaria

            Exfoliative dermatitis

            Dysmenorrhea

            Constipation

            Xerostomia

            Vomiting

            Weight loss

            Erectile dysfunction

            Muscle tightness

            Paresthesia

            Blurred vision

            Necrotizing vasculitis

            Increased cough

            Dyspnea

            Sinusitis

            Upper respiratory tract infection

            Postmarketing reports

            Musculoskeletal: Rhabdomyolysis

            Previous
            Next

            Warnings

            Black Box Warnings

            Chronic abuse can lead to a marked tolerance and psychological dependence, with varying degrees of abnormal behavior

            Frank psychotic episodes can occur, especially with parenteral abuse

            Withdrawal from abusive use may result in depression

            Give cautiously to patients with a history of drug dependence or alcoholism

            Potential for drug dependency; withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up

            Contraindications

            Hypersensitivity

            Glaucoma

            Family history of Tourette's syndrome, motor tics

            Marked anxiety, tension, agitation

            Within 2 weeks of taking MAOIs: Risk of severe hypertensive reaction

            Metadate CD and Metadate ER

            • Heart failure, severe hypertension, arrhythmia, hyperthyroidism, recent MI or angina concomitant use of halogenated anesthetics

            Cautions

            Use caution in hypertension

            Stimulants used to treat ADHD are associated with serious cardiovascular events including sudden death, stroke, and MI; avoid in patients with structural cardiac abnormalities or other serious heart problems

            Stimulants used to treat ADHD are associated with peripheral vasculopathy, including Raynaud phenomenon; may improve with dose reduction or discontinuation

            Difficulties with accommodation and blurring of vision have been reported with stimulant treatment

            Sudden deaths, stroke, and myocardial infarction reported in patients with structural cardiac abnormalities or other serious heart problems taking stimulants at usual doses

            Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation

            Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients

            Aggressive behavior or hostility is often observed in children and adolescents with ADHD; monitor for the appearance of or worsening of aggressive behavior or hostility

            Monitor growth during treatment of children with stimulants; may need to interrupt therapy in patients not growing or gaining weight as expected

            Stimulants may lower convulsive threshold in patients with prior history of seizure, patients with prior EEG abnormalities in absence of seizures, and very rarely, patients without a history of seizures and no prior EEG evidence of seizures; discontinue therapy in the presence of seizures

            Use with caution in patients who use other sympathomimetic drugs

            Amphetamines may exacerbate motor and phonic tics and Tourette’s syndrome; perform clinical evaluation for tics and Tourette’s syndrome in children and their families prior to treating with stimulant medications

            Rare instances of prolonged and sometimes painful erections (priapism), sometimes requiring surgical intervention, reported with methylphenidate products; typically not reported during initiation, but often subsequent to an increase in dose; seek immediate medical attention for abnormally sustained or frequent and painful erections

            Carefully supervise during withdrawal

            Possibility of tolerance, psychologic dependence, and strange behavior

            Monitor blood pressure and pulse; consider benefits and risks in patients for whom increase in blood pressure or heart rate would be problem

            CNS stimulants may cause psychotic or manic symptoms in patients with no prior history, or exacerbation of symptoms in patients with pre-existing psychiatric illness; evaluate for bipolar disorder prior to initiating therapy

            Do not use Concerta with pre-existing severe gastrointestinal narrowing conditions, including esophageal motility disorders, cystic fibrosis, history of peritonitis, small bowel disease, or chronic intestinal pseudo-obstruction, or Meckel's diverticulum

            Transdermal patch

            • Chemical leukoderma (permanent loss of skin pigmentation) may occur at and around application site; loss of pigmentation, in some cases, has been reported at other sites distant from the application site; patients or their caregivers should watch for new areas of lighter skin, especially under the drug patch, and immediately report these changes to their health care professional; discontinue therapy if it occurs
            • Acts faster on inflamed skin
            • Use of transdermal methylphenidate may lead to contact sensitization; discontinue treatment if contact sensitization is suspected; erythema is commonly seen with use of transdermal methylphenidate and is not by itself an indication of sensitization; suspect sensitization if erythema is accompanied by evidence of a more intense local reaction, like edema, papules, and vesicles and do not significantly improve within 48 hr or spreads beyond patch site
            • Avoid exposing application site to direct external heat sources; heat applied after patch application, increases both the rate and extent of absorption
            • Perform periodic CBC, differential, and platelet counts during prolonged therapy
            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown; avoid during breastfeeding; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Unknown; may block reuptake of norepinephrine and dopamine into presynaptic neurons; may stimulate CNS similar to amphetamines; may stimulate cerebral cortex and subcortical structures

            Absorption

            Bioavailability: ~30%; large individual differences (11-52%)

            Duration: 3-6 hr (IR); 3-8 hr (ER, SR); 8-12 hr (CD, LA, Concerta)

            Peak plasma time: 6-8 hr (PO); 7.5-10.5 hr; (patch)

            Peak plasma concentration: 3.7 ng/mL (PO); 0-114 ng/mL (patch)

            Onset of action

            • Immediate release: ~2hr
            • Sustained-release tablet: 4-7 hr
            • Extended-release tablet (Concerta): 1-2 hr
            • Transdermal: ~2 hr; applied heat may expedite onset

            Distribution

            Protein bound: 10-33%

            VD: d-Methylphenidate (2.65 L/kg); l-methylphenidate (1.80 L/kg)

            Metabolism

            Metabolized mostly to a-phenyl-2-piperidine acetic acid (PPAA)

            Elimination

            Excretion: Urine (90%), mainly as PPAA

            Half-life elimination

            • d-Methylphenidate: 3-4 hr
            • l-Methylphenidate: 1-3 hr

            Pharmacogenomics

            Preliminary (and sometimes conflicting) reports have investigated whether genotypes change pharmacologic response to methylphenidate

            Genes studied to determine their role in methylphenidate response include the following: SLC6A3/DAT1, DRD4, ADRA2A, and COMPT

            Previous
            Next

            Administration

            Instructions

            QuilliChew ER

            • Extended-release chewable tablet
            • Take once in morning
            • May take with or without food
            • Switching from other methylphenidate products
              • If switching from other methylphenidate products, discontinue that treatment, and titrate with QuilliChew ER using the titration schedule (see Pediatric Dosing)
              • Do not substitute for other methylphenidate products on an mg-per-mg basis, because of different methylphenidate base compositions and differing pharmacokinetic profiles

            Methylin

            • Chewable tablet: Take with at least 8 ounces (a full glass) of water or other fluid; taking without enough liquid may cause choking
            • Methylin ER tablet: Swallow whole; do not crush or chew
            • Take all formulations 30-45 minutes before meals

            Ritalin

            • Ritalin, Ritalin SR tablets: Swallow whole, do not crush or chew
            • Ritalin LA capsule: Swallow whole, do not crush or chew; may open capsule and sprinkle contents on applesauce and consumed immediately
            • Take all formulations 30-45 minutes before meals

            Metadate

            • Metadate ER: Swallow whole, do not crush or chew; administer twice daily before breakfast and lunch
            • Metadate CD: Swallow whole, do not crush or chew; may open capsule and sprinkle contents on applesauce and consumed immediately; administer once daily in AM

            Quillivant XR

            • Oral extended-release suspension
            • Shake bottle vigorously for at least 10 seconds before measuring dose
            • May take with or without food

            Aptensio XR

            • May take with or without food
            • Advise patients to establish a routine pattern with regard to meals
            • Capsules may be swallowed whole or opened and the entire contents sprinkled onto applesauce and consume immediately

            Daytrana

            • Apply patch on hip 2 hr before desired onset; remove after 9 hr; alternate application site
            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.