methylphenidate hydrochloride

(meth ill fen' i date)

Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, PMS-
Methylphenidate (CAN), Riphenidate (CAN), Ritalin, Ritalin LA, Ritalin SR

Pregnancy Category C
Controlled Substance C-II

Drug class
CNS stimulant

Therapeutic actions
Mild cortical stimulant with CNS actions similar to those of the amphetamines; efficacy
in hyperkinetic syndrome, attention-deficit disorders in children appears paradoxical and
is not understood

Indications
• Ritalin, Ritalin SR, Metadate ER: Narcolepsy
• Attention-deficit disorders, hyperkinetic syndrome, minimal brain dysfunction in
children or adults with a behavioral syndrome characterized by the following
symptoms: moderate to severe distractibility, short attention span, hyperactivity,
emotional lability, and impulsivity, not secondary to environmental factors or
psychiatric disorders
• Unlabeled use: Treatment of depression in the elderly, cancer and stroke patients;
alleviation of neurobehavioral symptoms after traumatic brain injury;
improvement in pain control and sedation in patients receiving opiates

Contraindications and cautions

• Contraindicated with hypersensitivity to methylphenidate; marked anxiety,
tension, and agitation; glaucoma; motor tics, family history or diagnosis of
Tourette syndrome; severe depression of endogenous or exogenous origin; normal
fatigue states.
• Use cautiously with seizure disorders; hypertension; drug dependence,
alcoholism; emotional instability; lactation, pregnancy.

Available forms
Tablets—5, 10, 20 mg; SR tablets—20 mg; ER tablets—10, 18, 20, 27, 36, 54 mg; ER
capsules—20 mg (Metadate CD); 20, 30, 40 mg (Ritalin); and 20, 30, 40 mg (Ritalin LA)

Dosages
ADULTS
Individualize dosage. Give orally in divided doses bid or tid, preferably 30–45 min before
meals; dosage ranges from 10–60 mg/day PO. If insomnia is a problem, drug should be
taken before 6 PM. Timed-release tablets have a duration of 8 hr and may be used when
timing and dosage are adjusted to the 8-hr daily regimen. ER tablets (Concerta): 18 mg
PO daily in the morning; may be increased by 18 mg/day at 1-wk intervals to a maximum
of 54 mg/day.
PEDIATRIC PATIENTS
< 6 yr: Not recommended.
> 6 yr: Start with small oral doses (5 mg PO before breakfast and lunch with gradual
increments of 5–10 mg weekly). Daily dosage > 60 mg not recommended. Discontinue
use after 1 mo if no improvement. Discontinue periodically to assess condition; usually
discontinued after puberty. ER tablets (Concerta): Use adult dosage.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 1–3 hr 4–6 hr

Metabolism: Hepatic; T1/2: 1–3 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Nervousness, insomnia, dizziness, headache, dyskinesia, chorea,
drowsiness, Tourette syndrome, toxic psychosis, blurred vision, accommodation
difficulties
• CV: Increased or decreased pulse and BP; tachycardia, angina, cardiac
arrhythmias, palpitations
• Dermatologic: Rash, urticaria, fever, arthralgia, exfoliative dermatitis, erythema
multiforme with necrotizing vasculitis and thrombocytopenic purpura, loss of
scalp hair
• GI: Anorexia, nausea, abdominal pain, weight loss
• Hematologic: Leukopenia, anemia
• Other: Tolerance, psychological dependence, abnormal behavior with abuse

Interactions
Drug-drug
• Decreased effects of guanethidine; avoid this combination
• Increased effects and toxicity of methylphenidate with MAOIs
• Increased serum levels of phenytoin, TCAs, oral anticoagulants, SSRIs with
methylphenidate; monitor for toxicity
Drug-lab test
• Methylphenidate may increase the urinary excretion of epinephrine

Nursing considerations
Assessment
• History: Hypersensitivity to methylphenidate; marked anxiety, tension, and
agitation; glaucoma; motor tics, Tourette syndrome; severe depression; normal
fatigue state; seizure disorders; hypertension; drug dependence, alcoholism,
emotional instability; pregnancy, lactation
 • Physical: Weight; T; skin color, lesions; orientation, affect, ophthalmologic exam
(tonometry); P, BP, auscultation; R, adventitious sounds; bowel sounds, normal
output; CBC with differential, platelet count, baseline ECG

Interventions
• Ensure proper diagnosis before administering to children for behavioral
syndromes; drug should not be used until other causes or concomitants of
abnormal behavior (learning disability, EEG abnormalities, neurologic deficits)
are ruled out.
• Interrupt drug dosage periodically in children to determine if symptoms warrant
continued drug therapy.
• Monitor growth of children on long-term methylphenidate therapy.
• Ensure that all timed-release tablets and capsules are swallowed whole, not
chewed or crushed.
• Dispense the least feasible dose to minimize risk of overdose.
• Give before 6 PM to prevent insomnia.
• Monitor CBC and platelet counts periodically in patients on long-term therapy.
• Monitor BP frequently early in treatment.

Teaching points
• Take this drug exactly as prescribed. Timed-release tablets and capsules must be
swallowed whole, not chewed or crushed. Metadate CD capsules may be opened
and entire contents sprinkled on soft food—do not chew or crush granules.
• Take drug before 6 PM to avoid nighttime sleep disturbance.
• Avoid alcohol and over-the-counter drugs, including nose drops, cold remedies;
some over-the-counter drugs could cause dangerous effects.
• These side effects may occur: Nervousness, restlessness, dizziness, insomnia,
impaired thinking (may lessen; avoid driving or engaging in activities that require
alertness); headache, loss of appetite, dry mouth.
• Report nervousness, insomnia, palpitations, vomiting, rash, fever.

Adverse effects in Italic are most common; those in Bold are life-threatening.