Methylphenidate (Ritalin, Ritalin SR)

Category:

CNS Stimulant

Description:

Cerebral stimulant: DEA Schedule II

Indications:

Attention deficit disorders
Narcolepsy
Depression in elderly, cancer, and post-stroke victims (non FDA approved)

Contraindications:

Marked anxiety, tension and agitation
Glaucoma, Tourette’s syndrome or motor tics, prevention of normal fatigue

Precautions:

Pregnancy category C
Severe depression, seizure disorders, hypertension, history of drug abuse
Children <6 years, symptoms associated with acute stress reactions

Adverse Reactions (Side Effects):

CNS: akathisia, dizziness, dyskinesia, fever, headache, hyperactivity, insomnia, restlessness, talkativeness, Tourette’s syndrome (rare)
CV: angina, blood pressure changes, dysrhythmias, palpitations, tachycardia
GI: abdominal pain, anorexia, dry mouth, nausea, weight loss
GU: uremia
HEME: anemia, leukopenia
METAB: growth retardation
MS: arthralgia
SKIN: erythema-multiforme, exfoliative dermatitis, rash, scalp hair loss, urticaria

Dosage:

Administered orally

Adult:
- Narcolepsy: PO 10mg 2-3 times daily 30 to 45 minutes before meals; may increase up to 40-60mg daily
Child > or =6 years:
- Attention deficit disorder: PO 0.3 mg/kg/dose or 2.5-5 mg/dose given before breakfast and lunch; increase by 0.1 mg/kg/dose or 5-10mg daily at weekly intervals; usual dose 0.5-1 mg/kg/day, max 2 mg/kg/day or 60mg daily; sustained release may be used when the 8 hour dose of sustained release corresponds to the titrated 8 hour dose of immediate-release tablets

Drug interactions:

Labs: false positive urine amphetamine
MAOIs: hypertensive reactions
Guanethidine: inhibition of guanethidine antihypertensive effect

Special considerations:

Overdosage may cause vomiting, agitation, tremor, muscle twitching, seizures, confusion, tachycardia, hypertension, arrythmias
Take last daily dose prior to 1800 to avoid insomnia
Do not chew or crush sustained release formulation

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300