Detailed Drug Information:

DRUG CLASS AND MECHANISM: Methylphenidate is a medication thatstimulates the central nervous system (brain) in a manner that is similarto the amphetamines; however, its actions are milder than those of theamphetamines. An additional difference is that methylphenidate producesmore noticeable effects on mental activities than on motor activities.Methylphenidate and amphetamines both have abuse potential. In treatingchildren with attention-deficit hyperactivity disorder (ADHD),methylphenidate produces a calming effect. This results in a reduction inhyperactivity and an improvement in attention span. Methylphenidate wasapproved by the FDA in 1955.

PREPARATIONS: Tablets (round): 5, 10, and 20 mg.Also available are sustained-release tablets of 20 mg (Ritalin SR) as well as long acting tablets of 20, 30, and 40 mg (Ritalin LA).

STORAGE: Tablets should be kept at room temperature, 15-30°C(59-86°F).

PRESCRIBED FOR: Methylphenidate is used in the treatment ofnarcolepsy (uncontrollable sleepiness) and in the treatment of childrenwith ADHD.

DOSING: The dose of methylphenidate is adjusted based onpatients' responses. It may be given once, twice, or three timesdaily. Ritalin LA is given once daily.

DRUG INTERACTIONS: The CNS stimulation effects ofmethylphenidate can be additive when used with other chemicals andmedications that stimulate the CNS, such as caffeine (in coffee, tea, orcola drinks), and pseudoephedrine or phenylpropanolamine (in manycough-and-cold preparations). The combination of methylphenidate andmonoamine oxidase inhibitors, for example, isocarboxazid (Marplan),phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine(Matulane), should be avoided since a hypertensive crisis (severely highblood pressure) may occur. Therefore, methylphenidate should not be givento any patient within 14 days of receiving such an inhibitor. The bloodpressure lowering effects of medications used to treat hypertension may bereduced by methylphenidate. As a result, blood pressure needs to bemonitored when starting or stopping methylphenidate in patients who arereceiving blood pressure medicines.

PREGNANCY: There are no adequate studies of methylphenidate inpregnant women.

NURSING MOTHERS: It is not known if methylphenidate is secreted in breast milk.

SIDE EFFECTS: The most common side effects with methylphenidateare nervousness, agitation, anxiety, and insomnia. Insomnia can be limitedby taking the drug before noon. For children taking methylphenidate forADHD, the most common side effects are loss of appetite, abdominal pain,weight loss, and sleep problems. The rate and severity of these sideeffects are less than that seen with dextroamphetamine (Dexedrine). Otherside effects include nausea, vomiting, dizziness, palpitations, headache,involuntary movements, chest pain, increased heart rate, increased bloodpressure, and psychosis.

There have been rare reports of Tourette's syndrome, a syndrome in whichthere are uncontrollable tics such as grimacing. Because of the potentialfor the side effects listed above, methylphenidate should be used withcaution by patients who have relatives with Tourette's syndrome orhave the syndrome themselves or who have severe anxiety, seizures,psychosis, emotional instability, major depression, glaucoma, or motortics. Sudden discontinuation of long-term methylphenidate therapy mayunmask depression. Gradual withdrawal, under supervision, is recommended.