Methylphenidate

DEA Class; Rx

Common Brand Names; Ritalin, Ritalin SR, Ritalin LA, Aptensio XR, Concerta, Metadate, Metadate CD, Metadate ER, Methylin, Quillivant XR, QuilliChew ER, Cotempla XR-ODT, Jornay PM, Adhansia XR, Relexxii

CNS stimulant chemically similar to but with milder peripheral sympathomimetic actions than amphetamines
Used for attention-deficit hyperactivity disorder (ADHD) and narcolepsy
Pediatric patients with structural heart defects, cardiomyopathy, or heart-rhythm disturbances may be at risk for adverse cardiac events

Indicated for the treatment of attention-deficit hyperactivity disorder (ADHD).

Hypersensitivity to methylphenidate or other components of product

Coadministration with monoamine oxidase inhibitors (MAOIs) or within 14 days after discontinuing MAOIs

Concerta

• Motor tics or family history or diagnosis of Tourette syndrome
• Glaucoma
• Patients with marked anxiety, tension, and agitation

Metadate CD

• Contains sucrose; do not administer to patients with hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency

ER capsules (adults)

• Insomnia (16%)

• Decreased appetite (11%)

Adhansia XR (patients aged 6-12 years)

• Decreased appetite (35%)

• Upper abdominal pain (15%)

• Affect lability (13%)

• Nausea or vomiting (13%)

• Decreased weight (12%)

Adhansia XR (patients aged 12-17 years)

• Decreased appetite (20%)

Aptensio XR

• Headache (10.9%)

Concerta or Relexxii (adults)

• Decreased appetite (25.3%)

• Headache (22.2%)

• Dry mouth (14%)

• Nausea (12.8%)

• Insomnia (12.3%)

Jornay PM

• Any insomnia (33%)

• Decreased appetite (19%)

Metadate CD

• Headache (12%)

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

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

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

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

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

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

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

Difficulties with accommodation and blurry vision reported

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

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

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