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, Cotempla XR-ODT, Jornay PM, Adhansia XR
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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)
  • 25mg (Adhansia XR)
  • 30mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 35mg (Adhansia XR)
  • 40mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 45mg (Adhansia XR)
  • 50mg (Aptensio XR, Metadate CD)
  • 55mg (Adhansia XR)
  • 60mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 70mg (Adhansia XR)
  • 85mg (Adhansia XR)

capsule, extended release/delayed release: Schedule II

  • 20mg (Jornay PM)
  • 40mg (Jornay PM)
  • 60mg (Jornay PM)
  • 80mg (Jornay PM)
  • 100mg (Jornay PM)

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

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

Jornay PM: Initial, 20 mg PO qDay in the evening; may titrate weekly in increments of 20 mg; not to exceed 100 mg/day; initiate dosing at 8:00 p.m.; adjust timing of administration between 6:30 pm and 9:30 pm to optimize tolerability and efficacy the next morning and throughout the day

Adhansia XR: 25 mg PO qAM initially; may titrate upward in increments of 10-15 mg at intervals of at least 5 days; dosages >85 mg/day associated with increased incidence of certain adverse reactions

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 Modifications

Dose reduction and discontinuation (Adhansia XR or Jornay PM)

  • If paradoxical aggravation of symptoms or other adverse reactions occur, reduce dosage, or, if necessary, discontinue drug
  • Periodically discontinue treatment to assess condition
  • If improvement is not observed after appropriate dosage adjustment over a one-month period, discontinue treatment

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)
  • 25mg (Adhansia XR)
  • 30mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 35mg (Adhansia XR)
  • 40mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 45mg (Adhansia XR)
  • 50mg (Aptensio XR, Metadate CD)
  • 55mg (Adhansia XR)
  • 60mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 70mg (Adhansia XR)
  • 85mg (Adhansia XR)

capsule, extended release/delayed release: Schedule II

  • 20mg (Jornay PM)
  • 40mg (Jornay PM)
  • 60mg (Jornay PM)
  • 80mg (Jornay PM)
  • 100mg (Jornay PM)

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)

extended-release tablet, oral disintegrating

  • Cotempla XR-ODT
  • 8.6mg
  • 17.3mg
  • 25.9mg

Attention Deficit Hyperactivity Disorder

<6 years: Safety and efficacy not established

≥6 years

  • Also see Administration
  • 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
  • Cotempla XR-ODT (oral disintegrating tablets): 17.3 mg PO qAM initially; may titrate upward weekly by 8.6-17.3 mg increments; not to exceed 51.8 mg/day
  • Adhansia XR: 25 mg PO qAM initially; may titrate up in increments of 10-15 mg at intervals of at least 5 days; dosages ≥70 mg/day associated with increased incidence of certain adverse reactions

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)

Jornay PM

  • Initial: 20 mg PO qDay in the evening; may titrate weekly in increments of 20 mg; not to exceed 100 mg/day
  • Initiate dosing at 8:00 p.m.; adjust timing of administration between 6:30 pm and 9:30 pm to optimize tolerability and efficacy the next morning and throughout the day

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 and 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
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Interactions

Interaction Checker

and methylphenidate

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      Serious - Use Alternative

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            Contraindicated (12)

            • benzphetamine

              benzphetamine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • diethylpropion

              diethylpropion increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • isocarboxazid

              isocarboxazid increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • linezolid

              linezolid increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phendimetrazine

              phendimetrazine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenelzine

              phenelzine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • phentermine

              phentermine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • rasagiline

              rasagiline increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • safinamide

              safinamide increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • selegiline

              selegiline increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • selegiline transdermal

              selegiline transdermal increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • tranylcypromine

              tranylcypromine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            Serious - Use Alternative (18)

            • cabergoline

              cabergoline, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • desflurane

              desflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • dihydroergotamine

              dihydroergotamine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • doxapram

              doxapram increases effects of methylphenidate by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

            • ergoloid mesylates

              ergoloid mesylates, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ergotamine

              ergotamine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ethanol

              ethanol increases levels of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Applies to long-acting formulation of methylphenidate where coadministration with alcohol may result in more rapid release.

            • ether

              ether increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • iobenguane I 123

              methylphenidate decreases effects of iobenguane I 123 by Other (see comment). Avoid or Use Alternate Drug. Comment: Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose.

            • isoflurane

              isoflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • lofepramine

              lofepramine, methylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • maprotiline

              maprotiline, methylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • methoxyflurane

              methoxyflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • methylergonovine

              methylergonovine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ozanimod

              ozanimod increases toxicity of methylphenidate by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • sevoflurane

              sevoflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • yohimbe

              yohimbe, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            Monitor Closely (142)

            • albuterol

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

            • aluminum hydroxide

              aluminum hydroxide decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • amitriptyline

              amitriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amlodipine

              methylphenidate will decrease the level or effect of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • amoxapine

              amoxapine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • apomorphine

              apomorphine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • arformoterol

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

            • aripiprazole

              aripiprazole increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • armodafinil

              armodafinil increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • asenapine

              asenapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • atomoxetine

              methylphenidate will increase the level or effect of atomoxetine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • azilsartan

              methylphenidate will decrease the level or effect of azilsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • benazepril

              methylphenidate will decrease the level or effect of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, methylphenidate. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

            • bromocriptine

              bromocriptine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • caffeine

              caffeine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • calcium carbonate

              calcium carbonate decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • candesartan

              methylphenidate will decrease the level or effect of candesartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • captopril

              methylphenidate will decrease the level or effect of captopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • carbamazepine

              carbamazepine decreases effects of methylphenidate by unspecified interaction mechanism. Use Caution/Monitor. Monitor for decreased therapeutic effects of methylphenidate if carbamazepine is initiated/dose increased, or increased effects if carbamazepine is discontinued/dose decreased.

            • cariprazine

              cariprazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • chlorpromazine

              chlorpromazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • cimetidine

              cimetidine decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • clevidipine

              methylphenidate will decrease the level or effect of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • clomipramine

              clomipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • clozapine

              clozapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • cocaine

              cocaine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • desipramine

              desipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dexfenfluramine

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

            • dexlansoprazole

              dexlansoprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • dexmethylphenidate

              dexmethylphenidate increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • dextroamphetamine

              dextroamphetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • didanosine

              didanosine will decrease the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Interaction specifically associated with Ritalin LA.

            • diltiazem

              methylphenidate will decrease the level or effect of diltiazem by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • dobutamine

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

            • dopamine

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

            • dopexamine

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

            • doxepin

              doxepin, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dronabinol

              methylphenidate will increase the level or effect of dronabinol by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • enalapril

              methylphenidate will decrease the level or effect of enalapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • ephedrine

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

            • epinephrine

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

            • epinephrine inhaled

              methylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

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

            • eprosartan

              methylphenidate will decrease the level or effect of eprosartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • esketamine intranasal

              esketamine intranasal, methylphenidate. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .

            • esomeprazole

              esomeprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • famotidine

              famotidine will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies only to extended release formulation

              famotidine decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • felodipine

              methylphenidate will decrease the level or effect of felodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • fenfluramine

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

            • fluphenazine

              fluphenazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              fluphenazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • formoterol

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

            • fosinopril

              methylphenidate will decrease the level or effect of fosinopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • fosphenytoin

              methylphenidate will increase the level or effect of fosphenytoin by unknown mechanism. Use Caution/Monitor. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased.

            • green tea

              green tea, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Green tea may include caffeine. Caffeine is a CNS-stimulant and additive effects may be seen when coadministered with other CNS stimulants. Caffeine should be avoided or used cautiously.

            • haloperidol

              haloperidol increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • hydralazine

              hydralazine, methylphenidate. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

            • hydrocodone

              hydrocodone, methylphenidate. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

            • ibuprofen/famotidine

              ibuprofen/famotidine will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies only to extended release formulation

            • iloperidone

              iloperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • imipramine

              imipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • iohexol

              methylphenidate decreases effects of iohexol by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS stimulant should be discontinued at least 48 hours before myelography, should not be used for the control of nausea or vomiting during or after myelography, and should not be resumed for at least 24 hours postprocedure.

            • iopamidol

              methylphenidate decreases effects of iopamidol by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS stimulant should be discontinued at least 48 hours before myelography, should not be used for the control of nausea or vomiting during or after myelography, and should not be resumed for at least 24 hours postprocedure.

            • irbesartan

              methylphenidate will decrease the level or effect of irbesartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • isoproterenol

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

            • isradipine

              methylphenidate will decrease the level or effect of isradipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • lansoprazole

              lansoprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • levalbuterol

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

            • levodopa

              levodopa, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • lisdexamfetamine

              lisdexamfetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • lisinopril

              methylphenidate will decrease the level or effect of lisinopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • losartan

              methylphenidate will decrease the level or effect of losartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • loxapine

              loxapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • loxapine inhaled

              loxapine inhaled increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • lurasidone

              lurasidone, methylphenidate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects.

              lurasidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • magnesium oxide

              magnesium oxide decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • metaproterenol

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

            • methamphetamine

              methamphetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • methyldopa

              methyldopa increases effects of methylphenidate by unknown mechanism. Use Caution/Monitor.

            • modafinil

              modafinil increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • moexipril

              methylphenidate will decrease the level or effect of moexipril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • molindone

              molindone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • nadolol

              methylphenidate will decrease the level or effect of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nicardipine

              methylphenidate will decrease the level or effect of nicardipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nifedipine

              methylphenidate will decrease the level or effect of nifedipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nimodipine

              methylphenidate will decrease the level or effect of nimodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nisoldipine

              methylphenidate will decrease the level or effect of nisoldipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nizatidine

              nizatidine will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Applies only to extended release formulation

              nizatidine decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • norepinephrine

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

            • nortriptyline

              nortriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • olanzapine

              olanzapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • olmesartan

              methylphenidate will decrease the level or effect of olmesartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • omeprazole

              omeprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • oxytocin

              oxytocin increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor.

            • paliperidone

              paliperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • pantoprazole

              pantoprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • penbutolol

              methylphenidate will decrease the level or effect of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • perindopril

              methylphenidate will decrease the level or effect of perindopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • perphenazine

              perphenazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              perphenazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • phenobarbital

              methylphenidate will increase the level or effect of phenobarbital by unknown mechanism. Use Caution/Monitor. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased.

            • phenoxybenzamine

              methylphenidate will decrease the level or effect of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • phentolamine

              methylphenidate will decrease the level or effect of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • phenytoin

              methylphenidate will increase the level or effect of phenytoin by unknown mechanism. Use Caution/Monitor. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased.

            • pimavanserin

              pimavanserin increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • pimozide

              pimozide increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • pirbuterol

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

            • pramipexole

              pramipexole, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • prazosin

              methylphenidate will decrease the level or effect of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • procarbazine

              procarbazine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • prochlorperazine

              prochlorperazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promazine

              promazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promethazine

              promethazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • propranolol

              methylphenidate will decrease the level or effect of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • protriptyline

              protriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • quetiapine

              quetiapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • quinapril

              methylphenidate will decrease the level or effect of quinapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • rabeprazole

              rabeprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • ramipril

              methylphenidate will decrease the level or effect of ramipril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • risperidone

              risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • ropinirole

              ropinirole, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • rotigotine

              rotigotine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • sacubitril/valsartan

              methylphenidate will decrease the level or effect of sacubitril/valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • salmeterol

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

            • sodium zirconium cyclosilicate

              sodium zirconium cyclosilicate will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.

            • solriamfetol

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

            • sotalol

              methylphenidate will decrease the level or effect of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • sufentanil SL

              sufentanil SL, methylphenidate. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

            • telmisartan

              methylphenidate will decrease the level or effect of telmisartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • terazosin

              methylphenidate will decrease the level or effect of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • terbutaline

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

            • thioridazine

              thioridazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • thiothixene

              thiothixene increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • timolol

              methylphenidate will decrease the level or effect of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • trandolapril

              methylphenidate will decrease the level or effect of trandolapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • trazodone

              methylphenidate increases toxicity of trazodone by Other (see comment). Modify Therapy/Monitor Closely. Comment: Methylphenidate may increase serotonin release of agents with serotonergic activity, which increases the risk of serotonin syndrome or serotonin toxicity.

            • trifluoperazine

              trifluoperazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              trifluoperazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • trimipramine

              trimipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • valsartan

              methylphenidate will decrease the level or effect of valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • verapamil

              methylphenidate will decrease the level or effect of verapamil by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • warfarin

              methylphenidate will increase the level or effect of warfarin by unknown mechanism. Use Caution/Monitor.

            • ziprasidone

              ziprasidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            Minor (5)

            • amantadine

              amantadine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Potential for additive CNS stimulation.

            • American ginseng

              American ginseng increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.

            • desmopressin

              desmopressin increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.

            • guarana

              guarana increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.

            • yerba mate

              yerba mate increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Insomnia

            Decreased appetite

            1-10%

            Affect lability/mood swings

            Nasopharyngitis

            Pharyngitis streptococcal

            Confusion

            Back pain

            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

            Blood and lymphatic system disorders: Pancytopenia, thrombocytopenia, thrombocytopenic purpura

            Cardiac disorders: Angina pectoris, bradycardia, extrasystole, supraventricular tachycardia, ventricular extrasystole, hypertension

            Eye disorders: Diplopia, mydriasis, visual impairment

            General Disorders: Chest pain, chest discomfort, hyperpyrexia, long-term growth suppression

            Hepatobiliary disorders: Hepatocellular injury, acute hepatic failure

            Immune system disorders: Hypersensitivity reactions such as angioedema, anaphylactic reactions, auricular swelling, bullous conditions, exfoliative conditions, urticaria, pruritus, rashes, eruptions, and exanthemas

            Investigations: Alkaline phosphatase increased, bilirubin increased, hepatic enzyme increased, platelet count decreased, white blood cell count abnormal, severe hepatic injury

            Musculoskeletal, connective tissue and bone disorders: Arthralgia, myalgia, muscle twitching, rhabdomyolysis

            Nervous system disorders: Convulsion, grand mal convulsion, dyskinesia, serotonin syndrome in combination with serotonergic drugs, lethargy, somnolence

            Psychiatric disorders: Disorientation, hallucination, hallucination auditory, hallucination visual, libido changes, mania, depression, drug dependence

            Urogenitial system: Priapism

            Vascular system: Peripheral vasculopathy, including Raynaud phenomenon

            Skin and subcutaneous tissue disorders: Alopecia, erythema

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            Warnings

            Black Box Warnings

            Assess risk of abuse prior to prescribing, and monitor for signs of abuse and dependence while on therapy

            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 (angioedema, anaphylactic reactions reported)

            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

            Stimulants used to treat ADHD are associated with peripheral vasculopathy, including Raynaud phenomenon; careful observation for digital changes is necessary during treatment with ADHD stimulants; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients; 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

            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 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

            CNS stimulants cause an increase in blood pressure (mean increase approximately 2 to 4 mmHg) and heart rate (mean increase approximately 3 to 6 bpm); individuals may have larger increases; 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 (eg, hallucinations, delusional thinking, or mania) 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; if psychotic or manic episodes occur, consider discontinuing treatment

            Instances of abnormal liver function, ranging from transaminase elevation to severe hepatic injury reported

            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

            Cardiovascular reactions

            • 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
            • Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, and other serious heart problems; further evaluate patients who develop exertional chest pain, unexplained syncope, or arrhythmias during treatment

            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

            Drug interaction overview

            • Therapy may decrease effectiveness of drugs used to treat hypertension; monitor blood pressure and adjust dosage of the antihypertensive drug as needed
            • Combined use of methylphenidate with risperidone when there is a change, whether an increase or decrease, in dosage of either or both medications, may increase risk of extrapyramidal symptoms (EPS); monitor for signs of EPS
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            Pregnancy & Lactation

            Pregnancy

            A pregnancy exposure registry monitors pregnancy outcomes in women exposed to JORNAY PM during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Psychostimulants at 1-866-961-2388 or visit https://womensmentalhealth.org/adhd-medications/

            Published studies and postmarketing reports on methylphenidate use during pregnancy are insufficient to inform a drug-associated risk of adverse pregnancy-related outcomes; no teratogenic effects were observed in embryo-fetal development studies with oral administration of methylphenidate to pregnant rats and rabbits during organogenesis at doses up to 2 and 9 times 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 31 times the MRHD given to adolescents; a decrease in pup body weight was observed in a pre-and post-natal development study with oral administration of methylphenidate to rats throughout pregnancy and lactation at doses 3.5 times the MRHD given to adolescents

            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

            Lactation

            Limited published literature, based on breast milk sampling from five mothers, reports that methylphenidate is present in human milk, which resulted in infant doses of 0.16% to 0.7% of the maternal weight-adjusted dosage and a milk/plasma ratio ranging between 1.1 and 2.7

            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; consider developmental and health benefits of breastfeeding along with the mother's clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition

            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

            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%); 73.9% (Jornay PM)

            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); 14 hr (Jornay PM)

            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
            • Jornay PM: 5.9 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

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            Administration

            Oral Administration

            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

            Cotempla XR-ODT

            • Take consistently with or without food
            • Use dry hands when opening the blister pack
            • Do not remove the tablet from the blister pack until just prior to dosing
            • Remove tablet by peeling back foil on blister pack; do not push the tablet through the foil
            • Do not store tablet for future use
            • Administer immediately after opening by placing the tablet on the patient’s tongue and letting it dissolve; do not chew or crush
            • Tablet will disintegrate in saliva so that it can be swallowed; no liquid is needed to take the tablet

            Jornay PM

            • Not to be administered in the morning
            • Following determination of optimal administration time, advise patients to maintain a consistent dosing time
            • Advise patients to take the dose consistently either with or without food
            • May take capsule whole, or may be opened and the entire contents sprinkled onto applesauce; if patient is using the sprinkled administration method, the sprinkled applesauce should be consumed immediately and not stored and should be taken in its entirety without chewing; the dose of a single capsule should not be divided and should be taken at the same time
            • Periodically reevaluate longterm use and adjust dosage as needed
            • Missed dose
              • Take dose as soon as patient remembers that same evening; if patient remembers the missed dose the following morning, skip the missed dose and wait until next scheduled evening administration
            • Switching from other methylphenidate products
              • If switching from other methylphenidate products, discontinue that treatment, and titrate with Jornay PM using the titration schedule described above
              • Do not substitute for other methylphenidate products on an mg-per-mg basis, because of different methylphenidate base compositions and differing pharmacokinetic profiles

            Adhansia XR

            • Swallow whole or open capsule and sprinkle entire contents onto 1 tablespoon of applesauce or yogurt; consume entire mixture immediately or within 10 min
            • Take the entire contents of capsule sprinkled on the chosen food in its entirety, without chewing
            • Discard mixture if not consumed within 10 min; do not store
            • Do not divide capsules nor take <1 capsule/day
            • Missed dose
              • Do not administer later in the day
              • Do not administer additional medication to make up for missed
            • Switching from other methylphenidate products
              • Switching from other methylphenidate products: Discontinue current treatment and titrate with Adhansia XR using titration schedule
              • Do not substitute for other methylphenidate products on a milligram-per-milligram basis because of different methylphenidate base compositions and differing pharmacokinetic profiles

            Storage

            Metadate ER: Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F); protect from light and moisture

            Concerta: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F); protect from humidity

            Adhansia XR: Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F); protect from light

            Extended-release chewable (QuilliChew ER): Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F)

            Extended-release orally disintegrating (Cotempla XR-ODT): Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F); store in reusable travel case

            Immediate-release (Ritalin): Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F); protect from light

            Immediate-release chewable (Methylin): Store at 20-25°C (68-77°F); protect from light and moisture

            Sustained-release (Ritalin-SR): Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F); protect from light and moisture

            Transdermal system (Daytrana): Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F); store in protective pouch; once tray is opened, use patches within 2 months; once an individual patch has been removed from the pouch,use immediately; do not refrigerate or freeze

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            QuilliChew ER oral
            -
            30 mg chewable tablet
            QuilliChew ER oral
            -
            20 mg chewable tablet
            QuilliChew ER oral
            -
            40 mg chewable tablet
            Ritalin oral
            -
            20 mg tablet
            Ritalin oral
            -
            10 mg tablet
            Ritalin oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            10 mg chewable tablet
            methylphenidate HCl oral
            -
            5 mg chewable tablet
            methylphenidate HCl oral
            -
            2.5 mg chewable tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            40 mg capsule
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            50 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            40 mg capsule
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            50 mg capsule
            methylphenidate HCl oral
            -
            40 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            60 mg capsule
            methylphenidate HCl oral
            -
            40 mg capsule
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            15 mg capsule
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            2.5 mg chewable tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            60 mg capsule
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            60 mg capsule
            methylphenidate HCl oral
            -
            40 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            5 mg/5 mL solution
            methylphenidate HCl oral
            -
            10 mg/5 mL solution
            methylphenidate HCl oral
            -
            40 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            60 mg capsule
            methylphenidate HCl oral
            -
            50 mg capsule
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            50 mg capsule
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            60 mg capsule
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            40 mg capsule
            methylphenidate HCl oral
            -
            50 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg chewable tablet
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            Ritalin LA oral
            -
            10 mg capsule
            Ritalin LA oral
            -
            40 mg capsule
            Ritalin LA oral
            -
            30 mg capsule
            Ritalin LA oral
            -
            20 mg capsule
            Aptensio XR oral
            -
            60 mg capsule
            Aptensio XR oral
            -
            20 mg capsule
            Aptensio XR oral
            -
            15 mg capsule
            Aptensio XR oral
            -
            10 mg capsule
            Aptensio XR oral
            -
            50 mg capsule
            Aptensio XR oral
            -
            30 mg capsule
            Aptensio XR oral
            -
            40 mg capsule
            Concerta oral
            -
            36 mg tablet
            Concerta oral
            -
            27 mg tablet
            Concerta oral
            -
            54 mg tablet
            Concerta oral
            -
            18 mg tablet
            Metadate ER oral
            -
            20 mg tablet
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Jornay PM oral
            -
            60 mg capsule
            Jornay PM oral
            -
            40 mg capsule
            Jornay PM oral
            -
            20 mg capsule
            Jornay PM oral
            -
            100 mg capsule
            Jornay PM oral
            -
            80 mg capsule
            Adhansia XR oral
            -
            70 mg capsule
            Adhansia XR oral
            -
            25 mg capsule
            Adhansia XR oral
            -
            55 mg capsule
            Adhansia XR oral
            -
            35 mg capsule
            Adhansia XR oral
            -
            85 mg capsule
            Adhansia XR oral
            -
            45 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

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            Formulary

            FormularyPatient Discounts

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            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.
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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.