methylphenidate transdermal (Rx)

Brand and Other Names:Daytrana
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

transdermal patch: Schedule II

  • Daytrana
  • 10mg/9hr
  • 15mg/9hr
  • 20mg/9hr
  • 30mg/9hr

Attention Deficit Hyperactivity Disorder

Indicated for attention deficit hyperactivity disorder (ADHD)

Starting dose for patients new to or converting from another formulation of methylphenidate is 10 mg

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

Individualize dose titration, final dosage, and wear time according to patient needs and response

Titrate to effect for best results

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

Dosage Forms & Strengths

transdermal patch: Schedule II

  • Daytrana
  • 10mg/9hr
  • 15mg/9hr
  • 20mg/9hr
  • 30mg/9hr

Attention Deficit Hyperactivity Disorder

Indicated for attention deficit hyperactivity disorder (ADHD) in patients aged >6 years

<6 years: Safety and efficacy not established

≥6 years

  • Starting dose for patients new to or converting from another formulation of methylphenidate is 10 mg
  • Apply patch on hip 2 hr before desired onset; remove after 9 hr; alternate application site
  • Individualize dose titration, final dosage, and wear time according to patient needs and response
  • Titrate to effect for best results
    • 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
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Interactions

Interaction Checker

and methylphenidate transdermal

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            Contraindicated (7)

            • isocarboxazid

              methylphenidate transdermal and isocarboxazid both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.

            • phenelzine

              methylphenidate transdermal and phenelzine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.

            • rasagiline

              methylphenidate transdermal and rasagiline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.

            • safinamide

              methylphenidate transdermal and safinamide both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.

            • selegiline

              methylphenidate transdermal and selegiline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.

            • selegiline transdermal

              methylphenidate transdermal and selegiline transdermal both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.

            • tranylcypromine

              methylphenidate transdermal and tranylcypromine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.

            Serious - Use Alternative (0)

              Monitor Closely (91)

              • acebutolol

                methylphenidate transdermal decreases effects of acebutolol by anti-hypertensive channel blocking. Use Caution/Monitor.

              • acetazolamide

                methylphenidate transdermal will increase the level or effect of acetazolamide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • amiloride

                methylphenidate transdermal decreases effects of amiloride by anti-hypertensive channel blocking. Use Caution/Monitor.

              • amitriptyline

                methylphenidate transdermal will increase the level or effect of amitriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • amoxapine

                methylphenidate transdermal will increase the level or effect of amoxapine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • azilsartan

                methylphenidate transdermal decreases effects of azilsartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • benazepril

                methylphenidate transdermal decreases effects of benazepril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • candesartan

                methylphenidate transdermal decreases effects of candesartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • cannabidiol

                methylphenidate transdermal will increase the level or effect of cannabidiol by anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • captopril

                methylphenidate transdermal decreases effects of captopril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • carbamazepine

                methylphenidate transdermal will increase the level or effect of carbamazepine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • cenobamate

                methylphenidate transdermal will increase the level or effect of cenobamate by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • chlorothiazide

                methylphenidate transdermal decreases effects of chlorothiazide by anti-hypertensive channel blocking. Use Caution/Monitor.

              • chlorthalidone

                methylphenidate transdermal decreases effects of chlorthalidone by anti-hypertensive channel blocking. Use Caution/Monitor.

              • citalopram

                methylphenidate transdermal will increase the level or effect of citalopram by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • clobazam

                methylphenidate transdermal will increase the level or effect of clobazam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • clomipramine

                methylphenidate transdermal will increase the level or effect of clomipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • clonazepam

                methylphenidate transdermal will increase the level or effect of clonazepam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • clorazepate

                methylphenidate transdermal will increase the level or effect of clorazepate by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • conivaptan

                methylphenidate transdermal and conivaptan both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • desipramine

                methylphenidate transdermal will increase the level or effect of desipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • desmopressin

                methylphenidate transdermal and desmopressin both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • diazepam

                methylphenidate transdermal will increase the level or effect of diazepam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • diazepam buccal

                methylphenidate transdermal will increase the level or effect of diazepam buccal by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • diazepam intranasal

                methylphenidate transdermal will increase the level or effect of diazepam intranasal by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • divalproex sodium

                methylphenidate transdermal will increase the level or effect of divalproex sodium by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • doxepin

                methylphenidate transdermal will increase the level or effect of doxepin by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • enalapril

                methylphenidate transdermal decreases effects of enalapril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • eprosartan

                methylphenidate transdermal decreases effects of eprosartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • escitalopram

                methylphenidate transdermal will increase the level or effect of escitalopram by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • eslicarbazepine acetate

                methylphenidate transdermal will increase the level or effect of eslicarbazepine acetate by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • esmolol

                methylphenidate transdermal decreases effects of esmolol by anti-hypertensive channel blocking. Use Caution/Monitor.

              • ethosuximide

                methylphenidate transdermal will increase the level or effect of ethosuximide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • ethotoin

                methylphenidate transdermal will increase the level or effect of ethotoin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • ezogabine

                methylphenidate transdermal will increase the level or effect of ezogabine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • felbamate

                methylphenidate transdermal will increase the level or effect of felbamate by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • fenfluramine

                methylphenidate transdermal will increase the level or effect of fenfluramine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • fluoxetine

                methylphenidate transdermal will increase the level or effect of fluoxetine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • fluvoxamine

                methylphenidate transdermal will increase the level or effect of fluvoxamine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • fosinopril

                methylphenidate transdermal decreases effects of fosinopril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • fosphenytoin

                methylphenidate transdermal will increase the level or effect of fosphenytoin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • hydrochlorothiazide

                methylphenidate transdermal decreases effects of hydrochlorothiazide by anti-hypertensive channel blocking. Use Caution/Monitor.

              • imipramine

                methylphenidate transdermal will increase the level or effect of imipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • indapamide

                methylphenidate transdermal decreases effects of indapamide by anti-hypertensive channel blocking. Use Caution/Monitor.

              • irbesartan

                methylphenidate transdermal decreases effects of irbesartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • lacosamide

                methylphenidate transdermal will increase the level or effect of lacosamide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • lamotrigine

                methylphenidate transdermal will increase the level or effect of lamotrigine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • lisinopril

                methylphenidate transdermal decreases effects of lisinopril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • lorazepam

                methylphenidate transdermal will increase the level or effect of lorazepam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • losartan

                methylphenidate transdermal decreases effects of losartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • methsuximide

                methylphenidate transdermal will increase the level or effect of methsuximide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • methyclothiazide

                methylphenidate transdermal decreases effects of methyclothiazide by anti-hypertensive channel blocking. Use Caution/Monitor.

              • metolazone

                methylphenidate transdermal decreases effects of metolazone by anti-hypertensive channel blocking. Use Caution/Monitor.

              • midazolam

                methylphenidate transdermal will increase the level or effect of midazolam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • midazolam intranasal

                methylphenidate transdermal will increase the level or effect of midazolam intranasal by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • moexipril

                methylphenidate transdermal decreases effects of moexipril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • nortriptyline

                methylphenidate transdermal will increase the level or effect of nortriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • olmesartan

                methylphenidate transdermal decreases effects of olmesartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • oxcarbazepine

                methylphenidate transdermal will increase the level or effect of oxcarbazepine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • paroxetine

                methylphenidate transdermal will increase the level or effect of paroxetine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • perampanel

                methylphenidate transdermal will increase the level or effect of perampanel by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • perindopril

                methylphenidate transdermal decreases effects of perindopril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • phenobarbital

                methylphenidate transdermal will increase the level or effect of phenobarbital by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • phenytoin

                methylphenidate transdermal will increase the level or effect of phenytoin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • pregabalin

                methylphenidate transdermal will increase the level or effect of pregabalin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • primidone

                methylphenidate transdermal will increase the level or effect of primidone by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • propranolol

                methylphenidate transdermal decreases effects of propranolol by anti-hypertensive channel blocking. Use Caution/Monitor.

              • protriptyline

                methylphenidate transdermal will increase the level or effect of protriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • quinapril

                methylphenidate transdermal decreases effects of quinapril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • ramipril

                methylphenidate transdermal decreases effects of ramipril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • risperidone

                methylphenidate transdermal will increase the level or effect of risperidone by unspecified interaction mechanism. Use Caution/Monitor. When coadministered with methylphenidate, changes in dosage of either or both medications, may increase the risk of extrapyramidal symptoms (EPS). Monitor for signs of EPS.

              • rufinamide

                methylphenidate transdermal will increase the level or effect of rufinamide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • sacubitril/valsartan

                methylphenidate transdermal decreases effects of sacubitril/valsartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • sertraline

                methylphenidate transdermal will increase the level or effect of sertraline by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • sotalol

                methylphenidate transdermal decreases effects of sotalol by anti-hypertensive channel blocking. Use Caution/Monitor.

              • spironolactone

                methylphenidate transdermal decreases effects of spironolactone by anti-hypertensive channel blocking. Use Caution/Monitor.

              • stiripentol

                methylphenidate transdermal will increase the level or effect of stiripentol by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • telmisartan

                methylphenidate transdermal decreases effects of telmisartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • terlipressin

                methylphenidate transdermal and terlipressin both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • tiagabine

                methylphenidate transdermal will increase the level or effect of tiagabine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • tolvaptan

                methylphenidate transdermal and tolvaptan both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • topiramate

                methylphenidate transdermal will increase the level or effect of topiramate by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • trandolapril

                methylphenidate transdermal decreases effects of trandolapril by anti-hypertensive channel blocking. Use Caution/Monitor.

              • triamterene

                methylphenidate transdermal decreases effects of triamterene by anti-hypertensive channel blocking. Use Caution/Monitor.

              • trimipramine

                methylphenidate transdermal will increase the level or effect of trimipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • valproic acid

                methylphenidate transdermal will increase the level or effect of valproic acid by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • valsartan

                methylphenidate transdermal decreases effects of valsartan by anti-hypertensive channel blocking. Use Caution/Monitor.

              • vasopressin

                methylphenidate transdermal and vasopressin both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • vigabatrin

                methylphenidate transdermal will increase the level or effect of vigabatrin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              • warfarin

                methylphenidate transdermal will increase the level or effect of warfarin by decreasing metabolism. Modify Therapy/Monitor Closely. Decreasing the dose of these drugs may be required when given coadministered with methylphenidate. Consider monitoring plasma drug concentrations (or INR with coumadin), when initiating or discontinuing methylphenidate.

              • zonisamide

                methylphenidate transdermal will increase the level or effect of zonisamide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

              Minor (0)

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                Adverse Effects

                >10%

                Children

                • Decreased appetite (25.5%)
                • Headache (15.3%)
                • Insomnia (13.3%)
                • Nausea (12.2%)
                • Vomiting (10.2%)

                Adolescents

                • Decreased appetite (25.5%)
                • Headache (12.4%)
                • Irritability (11%)

                1-10%

                Children

                • Weight decreased (9.2%)
                • Irritability (7.1%)
                • Tic (7.1%)
                • Abdominal pain (7.1%)
                • Affect lability (6.1%)
                • Anorexia (5.1%)
                • Tachycardia (1%)

                Adolescents

                • Nausea (9.7%)
                • Insomnia (6.2%)
                • Weight decreased (5.5%)
                • Dizziness (5.5%)
                • Abdominal pain (4.8%)
                • Anorexia (4.8%)
                • Vomiting (3.4%)

                <1%

                Adolescents

                • Tachycardia (0.7%)

                Postmarketing Reports

                Cardiac disorders: Palpitations

                Eye disorders: Visual disturbances, blurred vision, mydriasis, and accommodation disorder

                General disorders and administration site disorders: Fatigue, application site reactions such as bleeding, bruising, burn, burning, dermatitis, discharge, discoloration, discomfort, dryness, eczema, edema, erosion, erythema, excoriation, exfoliation, fissure, hyperpigmentation, hypopigmentation, induration, infection, inflammation, irritation, pain, papules, paresthesia, pruritus, rash, scab, swelling, ulcer, urticaria, vesicles, and warmth

                Immune system disorders: Hypersensitivity reactions including generalized erythematous and urticarial rashes, allergic contact dermatitis, angioedema, and anaphylaxis

                Investigations: BP increased

                Nervous system disorders: Convulsion, dyskinesia, lethargy, somnolence, serotonin syndrome in combination with serotonergic drugs, and extrapyramidal disorder

                Psychiatric disorders: Depression, hallucination, nervousness, and libido changes

                Skin and SC Tissue Disorders: Alopecia

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                Warnings

                Black Box Warnings

                Abuse and dependence

                • CNS stimulants, including methylphenidate-containing products, and amphetamines, have a high potential for abuse and dependence
                • Assess the risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy

                Contraindications

                Hypersensitivity to methylphenidate or other components of product

                Coadministration with monoamine oxidase inhibitors (MAOIs) and within 14 days following discontinuing MAOIs

                Motor tics or with a family history or diagnosis of Tourette syndrome

                Glaucoma

                Patients with marked anxiety, tension, and agitation

                Cautions

                Assess the risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy

                May cause an increase in blood pressure (BP) and heart rate (HR); monitor for hypertension and tachycardia

                Prolonged and painful erections, sometimes requiring surgical intervention, reported with methylphenidate products, including another formulation of methylphenidate hydrochloride extended-release tablets, in both pediatric and adult patients

                Priapism was not reported with drug initiation but developed during treatment, often after an increase in dose and during a period of drug withdrawal (drug holidays or during discontinuation); if such reaction occurs, seek immediate medical attention

                CNS stimulants are associated with peripheral vasculopathy, including Raynaud phenomenon; signs and symptoms are usually intermittent and generally improve after dose reduction or discontinuing treatment; monitor for digital changes is necessary during treatment; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients

                Closely monitor growth (weight and height) in pediatric patients treated with stimulants; patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted

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

                Difficulties with accommodation and blurry vision reported

                Periodic complete blood cell count, differential, and platelet counts are advised during prolonged therapy

                Use may result in a persistent loss of skin pigmentation at and around the application site; monitor for signs of skin depigmentation and advise patients to immediately inform healthcare provider if changes in skin pigmentation occur; discontinue use in patients with chemical leukoderma

                Use may lead to contact sensitization; discontinue if contact sensitization is suspected

                Avoid exposing site to direct external heat sources, such as hair dryers, heating pads, electric blankets, heated water beds, etc., while wearing the patch

                Psychiatric adverse reactions

                • CNS stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a preexisting psychotic disorder
                • CNS stimulants may also induce a manic or mixed episode in patients
                • Before initiating treatment, screen for risk factors for developing a manic episode (eg, history or family history of suicide, bipolar disorder, and depression)
                • CNS stimulants at recommended doses, may cause psychotic or manic symptoms (eg, hallucinations, delusional thinking, or mania) in patients without a prior history of psychotic illness or mania; consider discontinuing therapy if such symptom occur

                Serious cardiovascular reactions

                • Sudden death, stroke, and myocardial infarction report in adults
                • Sudden death reported in pediatric patients with structural cardiac abnormalities and other serious heart problems
                • Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, and other serious heart problems
                • Further evaluate for developing exertional chest pain, unexplained syncope, or arrhythmias during treatment

                Drug interaction overview

                • MAOIs
                  • Contraindicated
                  • Do administer during or within 14 days of discontinuing MAOI treatment
                  • Coadministration of MAOIs with CNS stimulants can cause hypertensive crisis, which increases the risk of death, stroke, myocardial infarction, aortic dissection, ophthalmological complications, eclampsia, pulmonary edema, and renal failure
                • Antihypertensive drugs
                  • Monitor BP and adjust dose of antihypertensive drugs accordingly
                  • Methylphenidate may decrease effectiveness of antihypertensive drugs
                • Risperidone
                  • Monitor for signs of extrapyramidal symptoms (EPS)
                  • Dose changes in either risperidone and/or methylphenidate may increase the risk of EPS
                • Vasopressor agents
                  • Use with caution
                  • Vasopressors may exacerbate the effects of methylphenidate on BP
                • Anticoagulants, antidepressants, and selective serotonin reuptake inhibitors
                  • Decrease adjustments of these drugs may be required when coadministered methylphenidate; monitor plasma drug concentrations (or, in the case of coumarin, coagulation times), when initiating or discontinuing methylphenidate
                  • Studies have shown that methylphenidate may inhibit the metabolism of coumarin anticoagulants, anticonvulsants (eg, phenobarbital, phenytoin, primidone), and some tricyclic drugs (eg, imipramine, clomipramine, desipramine) and selective serotonin reuptake inhibitors
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                Pregnancy & Lactation

                Pregnancy

                Published studies and postmarketing reports on use during pregnancy have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

                Animal data

                • No teratogenic effects were observed with oral administration of methylphenidate to pregnant rats and rabbits during organogenesis at doses up to 2x and 9x the maximum recommended human dose (MRHD) of 100 mg/day given to adolescents on a mg/m2 basis, respectively
                • However, spina bifida was observed in rabbits at a dose 31x the MRHD given to adolescents
                • Decrease in pup body weight was observed in a pre- and postnatal development study with oral administration of methylphenidate to rats throughout pregnancy and lactation at doses 3.5x the MRHD given to adolescents

                Clinical considerations

                • CNS stimulant medications can cause vasoconstriction and thereby decrease placental perfusion
                • No fetal and/or neonatal adverse reactions reported with use of therapeutic doses of methylphenidate during pregnancy; however, premature delivery and low birth weight infants have been reported in amphetamine-dependent mothers

                Pregnancy exposure registry

                • Monitors pregnancy outcomes in females exposed to ADHD medications
                • Encourage providers to register patients by calling the National Pregnancy Registry for ADHD Medications at 1-866-961-2388

                Lactation

                Limited published literature, based on breast milk sampling from five mothers, reports that methylphenidate is present in human milk

                There are no reports of adverse effects on breastfed infant and no effects on milk production; however, long-term neurodevelopmental effects on infants from CNS stimulant exposure are unknown

                Monitor breastfeeding infants for adverse reactions, such as agitation, insomnia, anorexia, and reduced weight gain

                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.

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                Pharmacology

                Mechanism of Action

                Mechanism of action is unknown

                May block reuptake of norepinephrine and dopamine into presynaptic neurons; may stimulate CNS like amphetamines; may stimulate cerebral cortex and subcortical structures

                Absorption

                Peak plasma concentration (steady-state)

                • Children: 15.7 ng/mL (12.5 cm2); 42.9 ng/mL (37.5 cm2)
                • Adolescents: 8.32 ng/mL (12.5 cm2); 16.5 ng/mL (37.5 cm2)

                Minimum plasma concentration (steady-state)

                • Children: 1.04 ng/mL (12.5 cm2); 1.96 ng/mL (37.5 cm2)
                • Peak: 0.544 ng/mL (12.5 cm2); 1.02 ng/mL (37.5 cm2)

                AUC (steady-state)

                • Children: 163 ng·hr/mL (12.5 cm2); 447 ng·hr/mL (37.5 cm2)
                • Adolescents: 85.7 ng·hr/mL (12.5 cm2); 167 ng·hr/mL (37.5 cm2)

                Heat exposure

                • When applied to inflamed skin both the rate and extent of absorption are increased as compared with intact skin
                • When applied to inflamed skin, lag time is no greater than 1 hr, peak plasma time is 4 hr, and both Cmax and AUC are approximately 3-fold higher

                Metabolism

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

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                Administration

                Topical Administration

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

                Place adhesive side on a clean, dry area of the hip; area should not be oily, damaged, or irritated; apply patch to hip area avoiding the waistline, since clothing may cause the patch to rub off

                If patients or caregivers experience difficulty separating patch from release liner or observe transfer of adhesive to liner, tearing and/or other damage to patch during removal from liner, discard patch and apply a new patch; patients or caregivers should inspect release liner to ensure that no adhesive containing medication has transferred to the liner

                If adhesive transfer has occurred, discard patch

                Apply intact patches only; press tpatch firmly in place with the palm of the hand for approximately 30 seconds, making sure that there is good contact of the patch with the skin, especially around edges; exposure to water during bathing, swimming, or showering can affect patch adherence; patches should not be applied or re-applied with dressings, tape, or other common adhesives

                Advise patients to avoid exposing application site to direct external heat sources (eg, hair dryers, heating pads, electric blankets, heated water beds) while wearing the patch

                When heat is applied to patch application, both rate and extent of absorption are significantly increased

                Removal of patch

                • Peel off slowly
                • If necessary, gently apply an oil-based product (eg, petroleum jelly, olive oil, mineral oil) to the patch edges, gently working the oil underneath the patch edges
                • If any adhesive remains on skin following patch removal, apply an oil-based product to patch sites and remove any residual adhesive that remains

                Storage

                Unopened patches: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F); store in protective pouch

                Opened patches: Use patches within 2 months; once an individual patch has been removed from the pouch, use immediately; do not refrigerate or freeze

                Disposal of patches: Fold patch so that adhesive side adheres to itself and should be flushed down the toilet or disposed of in an appropriate lidded container

                If patient stops using medication, remove each unused patch from its individual pouch, separated from the protective liner, folded onto itself, and disposed of in same manner as used patches

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                Images

                No images available for this drug.
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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

                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.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.