Ritalin (Methylphenidate) - Oral

What Is Ritalin?

Ritalin (methylphenidate) is a controlled prescription medication commonly used to treat attention deficit hyperactivity disorder (ADHD). Ritalin is a brain stimulant. It's thought to work by influencing the amount of naturally occurring chemicals in your brain.

Ritalin is available in an immediate-release (IR) tablet dosage form. Methylphenidate also goes by many other brand names available in different dosage forms. Some of the other dosage forms are:

• IR chewable tablets
• IR solution (liquid)
• Patch
• Timed-release chewable tablets
• TImed-release orally disintegrating (easily dissolvable) tablets
• Timed-release suspension (liquid)
• Various versions of timed-release tablets
• Various versions of timed-release capsules

What Is Ritalin Used For?

Ritalin has been used to treat narcolepsy. It's also used for attention deficit hyperactivity disorder (ADHD) in people six years and older.

It's estimated that nearly 9% of children in the 4- to 17-year-old age group have ADHD in the United States. This condition also affects roughly 4% of adults between 18 and 44.

ADHD symptoms can be divided into three categories: inattention, hyperactivity, and impulsivity (trouble with impulse control). People with ADHD tend frequently show symptoms for longer than six months.

Symptoms of inattention may include being easily distracted or bored and having difficulty finishing one task. On the other hand, hyperactivity symptoms may consist of nonstop talking and restlessness. If you have trouble controlling your impulses, symptoms may include impatience and interrupting other people.

How to Take Ritalin

Take Ritalin by mouth two to three times daily before some food or a meal. If you have trouble sleeping with Ritalin, take the last dose of the day before 5 p.m.

Storage

After receiving Ritalin from the pharmacy, keep the medication at room temperature between 68 degrees to 77 degrees Fahrenheit—with a safe short-term storage range of 59 degrees to 86 degrees F.

Protect Ritalin from light. Keep your medications tightly closed and out of the reach of children and pets, ideally locked in a cabinet or closet.

Avoid pouring unused and expired drugs down the drain or in the toilet. Visit the FDA's website to know where and how to discard all unused and expired medications. You can also find disposal boxes in your area. Ask your pharmacist or healthcare provider if you have any questions about the best ways to dispose of your medications.

If you plan to travel with your Ritalin, get familiar with your final destination's regulations. Checking with the U.S. embassy or consulate might be a helpful resource. In general, however, make a copy of your Ritalin prescription. It's also a good idea to keep your medication in its original container from your pharmacy with your name on the label. Since Ritalin is a controlled substance, you may also want to ask your healthcare provider for a document of medical necessity on a letter with an official letterhead. Ask your pharmacist or healthcare provider if you have any questions about traveling with your medicine.

Off-Label Uses

Healthcare providers may prescribe methylphenidate for the following off-label uses:

Severe fatigue in cancer or palliative care settings: Some small studies suggest that people with cancer or other terminal conditions might experience less fatigue (excessive tiredness) from methylphenidate. Experts also support using methylphenidate for severe fatigue in people with advanced cancer or those actively undergoing cancer treatments.

Depression in older adults: A 2012 study and healthcare provider experiences suggest that methylphenidate might improve depression symptoms for older adults in hospice with a terminal condition or receiving palliative care. A small 2015 study also indicates that adding methylphenidate to an antidepressant might quickly improve depression symptoms in older adults.

What Are the Side Effects of Ritalin?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Ritalin may include:

• Anxiety
• Appetite loss
• Dry mouth
• Excessive sweating
• Fast heart rate
• Headache
• Insomnia
• Nausea
• Stomach pain
• Weight loss
  

Severe Side Effects

Get medical help right away if you experience the following serious side effects:

Severe allergic reaction: If you have a severe allergic reaction to Ritalin, symptoms may include breathing difficulties, itchiness, and swelling.

Cardiovascular (CV) events: Ritalin might raise your risk of CV events, such as heart attacks and strokes. There have also been reports of death from sudden cardiac arrest (the heart suddenly stops beating) in children and adults.

CV events are more likely in people with heart-related conditions, such as abnormal heart rhythm and abnormal heart structure (e.g., problems with your heart valves). Other conditions include coronary artery disease (cholesterol build-up in oxygen-rich blood vessels of the heart) and cardiomyopathy (heart muscle disease that makes the heart work too hard).

Be on the lookout for symptoms of chest pain, dizziness or fainting spells, and abnormal heart rhythm.

Delayed growth: Ritalin may affect your child's growth and weight gain. Regularly monitor your child's height and weight.

High blood pressure and fast heart rate: Ritalin may increase your or your child's blood pressure and heart rate. Consider routinely monitoring your or your child's blood pressure and heart rate.

Mood-related effects: If you have a mental health condition, you might experience psychosis (e.g., hallucinations, delusions) with Ritalin. If you have inadequately treated bipolar, Ritalin might lead to mania symptoms. There's also a chance that psychosis and mania symptoms might happen in some people without a history of a mental health condition.

Peripheral vasculopathy: Ritalin is linked to peripheral vasculopathy. This means that people taking Ritalin might experience blood vessel problems, such as Raynaud's syndrome. In Raynaud's, blood vessels in certain areas of your body tighten in response to triggers, such as cold weather or emotional stress. This results in less blood flow to those areas, such as your fingers or toes, making them appear blue. Once blood flow returns, your fingers and toes look very red.

Priapism is a prolonged and painful erection. This can happen in children or adults, especially during increases in your Ritalin dose.

Substance use disorder (SUD): Ritalin raises your risk for SUD. SUD-like symptoms may include abnormal mood or behavioral changes.

Call 911 if your symptoms feel life-threatening.

Long-Term Side Effects

Ritalin's long-term side effects are very similar to its severe side effects, which may include the following:

• Cardiovascular (CV) events, such as heart attacks and strokes
• Blood vessels problems—like Reynaud's syndrome—may happen at any time during your Ritalin treatment
• Delayed growth and weight gain effects that your child may or may not make back up
• Prolonged and painful erections that may occur after taking Ritalin for a while or after stopping the medication
• Substance use disorder (SUD)

Dosage: How Much Ritalin Should I Take?

Modifications

The following modifications (changes) should be kept in mind when using Ritalin (methylphenidate):

Severe allergic reaction: Avoid using Ritalin if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In animal studies, very high doses of methylphenidate in rabbits did result in spina bifida. Otherwise, high doses in rabbits and rats weren't linked to other adverse effects, except for low fetal and newborn body weight.

In humans, there haven't been reports of adverse effects with methylphenidate during pregnancy. However, pregnant people dependent on amphetamine (another brain stimulant—like Adderall for ADHD) might experience premature delivery. Their newborns might also have a low birth weight.

Discuss with your healthcare provider if you plan to become pregnant or are pregnant. They will help you weigh the benefits and risks of Ritalin during your pregnancy. They can also help you enroll through the National Pregnancy Registry for ADHD Medications website or by phone at 1-866-961-2388.

Breastfeeding: Methylphenidate is present in human breast milk but in low amounts. Data suggests that it's not detectable in the bloodstream of nursing babies. Based on currently available information, methylphenidate isn't linked to adverse effects on nursing infants, so there's usually no need to stop methylphenidate while breastfeeding.

To be safe, however, monitor your child for symptoms of agitation, sleeping problems, feeding problems, and slow weight gain. If you're experiencing issues with making breast milk, you're likely taking high doses of methylphenidate—especially when breastfeeding isn't well established with the nursing baby.

If you plan to breastfeed, talk with your healthcare provider to weigh the benefits and risks of methylphenidate while nursing. They can also discuss the different ways available to feed your baby.

Older adults over 65: There is not enough information about Ritalin in older adults to see whether they respond differently than younger adults. Older adults with several medical conditions or taking several medications should use caution. Older adults may be more sensitive to side effects from medications.

Children: The Food and Drug Administration (FDA) approved Ritalin for people six years and older. Since children might experience delayed growth from Ritalin, your child's healthcare provider will closely monitor their height and weight.There is also a risk of heart issues and an abnormal heartbeat from using Ritalin. Ask your child's healthcare provider also closely to monitor their heart health.

Mental health conditions: If you have a mental health condition, you might experience psychosis with Ritalin. If you have inadequately treated bipolar, Ritalin might also lead to mania symptoms, so your healthcare provider may closely monitor you for symptoms of psychosis and mania. They may also assess if you have bipolar. If you have bipolar, they may want to ensure that you're receiving adequate treatment before starting you on Ritalin.

Missed Dose

If you're taking Ritalin on a schedule, take this medication as your healthcare provider recommended. If you accidentally forgot your Ritalin dose, take it as soon as you remember. If it's already close to your next scheduled dose, skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

For a missed dose that's your last dose for the day, your healthcare provider might recommend skipping it if it's already after 5 p.m. to prevent sleeping problems. Then you can continue your regular dosing schedule the following day.

Find ways to help yourself remember to keep your appointments and take your medication routinely. If you miss too many doses, Ritalin might be less effective.

Overdose: What Happens If I Take Too Much Ritalin?

The symptoms of a suspected overdose of Ritalin include:

• Abnormal heart rhythm
• Blood pressure changes
• Coma that might happen after seizures
• Confusion
• Delirium
• Diarrhea
• Dry mucous membranes (e.g., mouth, nose)
• Fast heart rate
• Feeling high
• Flushing
• Hallucinations
• Headache
• High fever
• Large or wide pupils (part of your eye that lets light in)
• Mood changes
• Muscle spasms
• Nausea or vomiting
• Overreactive reflexes
• Rapid breathing
• Restlessness
• Severe muscle pain
• Tremors
  

If you think you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

Precautions

What Are Reasons I Shouldn’t Take Ritalin?

• Severe allergic reaction: If you have a severe allergic reaction to Ritalin, then this medication isn't a viable option for you.
• Monoamine oxidase inhibitor (MAO-I) use: If you've taken an MAO-I, like selegiline for depression or Parkinson's disease (PD), in the last 14 days, avoid Ritalin. Combining these two medications raises your risk of excessively high blood pressure.
• Cardiovascular (CV) events: Ritalin might raise your or your child's risk of CV events, such as heart attacks and strokes. There were also reports of death from sudden cardiac arrest in children and adults. For this reason, people with severe heart-related conditions, such as abnormal heart rhythm, abnormal heart structure (e.g., valve problems), coronary artery disease, or cardiomyopathy (heart muscle disease), should avoid using Ritalin.
• Pregnancy: In humans, there haven't been reports of adverse effects with methylphenidate during pregnancy. However, pregnant people dependent on amphetamine (another brain stimulant—like Adderall for ADHD) might experience premature delivery. Their newborns might also have a low birth weight. Discuss with your healthcare provider the benefits and risks of Ritalin during pregnancy. They can also help you enroll through the National Pregnancy Registry for ADHD Medications website or by phone at 1-866-961-2388.
• Breastfeeding: Methylphenidate isn't detectable in the bloodstream of nursing babies. Based on currently available information, methylphenidate isn't linked to adverse effects on nursing infants, so there's usually no need to stop methylphenidate while breastfeeding. To be safe, however, monitor your child for symptoms of agitation, sleeping problems, feeding problems, and slow weight gain. If you're experiencing issues with making breast milk, reach out to your healthcare provider. They can also help you weigh the benefits and risks of methylphenidate while nursing.
• Older adults over 65: There is not enough information about Ritalin in older adults to see whether they respond differently from younger adults. In general, older adults should use caution.
• Children: The Food and Drug Administration (FDA) approved Ritalin for people six years and older. Since children might experience delayed growth from Ritalin, your child's healthcare provider will closely monitor their height and weight.
  

What Other Medications Interact With Ritalin?

Aside from monoamine oxidase inhibitors (MAO-I), use caution when taking Ritalin with the following medications:

• Blood pressure medications: Ritalin might work against your blood pressure medications. Therefore, your healthcare provider may want to monitor your blood pressure closely to adjust your medicines as needed. Examples of blood pressure medications may include lisinopril and hydrochlorothiazide (HCTZ).
• Halogenated anesthetics: In general, anesthesia helps you fall asleep or limits how much pain you feel during a medical procedure. There are different types of anesthetics. If halogenated anesthetics are used, you'll likely need to skip your Ritalin doses on the day of your procedure.
• Risperdal (risperidone): Risperidone is an antipsychotic. When combined with Ritalin, you're more likely to experience extrapyramidal symptoms (EPS), which are uncontrollable muscle movements.
  

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Ritalin.

And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

There are many brain stimulants used to treat ADHD. Ritalin is an immediate-release (IR) methylphenidate tablet.

Another IR methylphenidate prescription includes Methylin. Methylin is available in a solution (liquid) dosage form, which might be convenient for children.

There's also Focalin, which is IR dexmethylphenidate. Dexmethylphenidate is very similar to methylphenidate, except dexmethylphenidate might work for more extended periods of time.

Like Ritalin, Methylin and Focalin can be used in people six years or older. They're also available as generic products.

While all these medications are brain stimulants, some people with ADHD might take multiple brain stimulants together. For example, they may take an extended-release form every morning and an immediate-release version in the afternoon as needed, based on activities. Since the best treatment plan varies person-to-person, talk with your healthcare provider to help you determine whether one or a combination of medications will be better for you.

How Can I Stay Healthy While Taking Ritalin?

Living with ADHD can sometimes be challenging. Consider working with your healthcare provider to find the best treatment plan for you or your child, and to make any necessary adjustments in strategies or medicines based on your symptoms and side effects. Reaching out to a counselor may help you or your child with coping strategies for ADHD symptoms.

If you or your child are coping with ADHD, additional ways to support your family include behavioral or occupational therapy for both you and your children, as well as organizational and social skills training. 

Studies have shown that biofeedback may be a viable therapy to help support the development of attention in adults and children.  This may be a useful additional tool for you or your child.

ADHD also may have roots in adverse childhood experiences. While it's not the root cause for everyone, addressing trauma with a licensed therapist may be a step in your healing process. Speak with your or your child's healthcare provider about different approaches and treatment options.

It's important to note that there are also several medical conditions that can be mistaken for ADHD, such as low iron levels (anemia) or thyroid issues like hypothyroidism. Studies also show that sleep disturbances over time may increase a child's odds of developing ADHD. Your healthcare provider can help you discuss sleep hygiene and also rule out or address any potential sleep disorders (e.g., sleep apnea, restless leg syndrome) in yourself or your child before starting the process of an ADHD diagnosis. 

Other disorders that need to be ruled out before making a clear ADHD diagnosis include anxiety, depression, learning disorders (ex., dyslexia), and vision or hearing problems. Work with your or your child's healthcare provider to help figure out and address the root cause of the issue.

Ensure that you or your child does not have a heart condition before starting stimulant medication, as this can make preexisting heart conditions worse. Ask your healthcare provider to monitor you or your child for any development of heart conditions while on this or other stimulant medications.