METHYLPHENIDATE

Central nervous system stimulant

Dosage Forms

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Tablet

5 mg

Uses

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  • Attention deficit hyperactivity disorder (ADHD)

Dose and Duration

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Attention deficit hyperactivity disorder

Adult: 5 mg every 8–12 hours, increased if necessary at weekly intervals according to response (max 100 mg daily in 2–3 divided doses

Child 6–18 years: initially 5 mg every 12–24 hours, increased if necessary at weekly intervals by 5–10 mg up to the usual maximum dose of 60 mg daily in 2–3 divided doses. Dose may be increased to 2.1 mg/kg daily in 2–3 divided doses (max 90 mg daily) under the direction of a specialist.
Discontinue if no response after 1 month

Child 4–6 years: 2.5 mg every 12 hours increased at weekly intervals by 2.5 mg to a maximum of 1.4 mg/kg daily in 2–3 divided doses.
Discontinue if there is no response after 1 month

Contraindications

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  • Glaucoma
  • Pheochromocytoma
  • Hyperthyroidism and thyrotoxicosis
  • Known sensitivity to methylphenidate
  • Severe depression, psychosis
  • Anorexia nervosa
  • Uncontrolled bipolar disorder
  • Cardiovascular disease
  • Structural cardiac abnormalities
  • Vasculitis
  • Cerebrovascular disorders

Side Effects

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  • Anorexia and decreased appetite
  • Insomnia, nervousness, anxiety, depression, abnormal behaviour, headache, dizziness
  • Dyskinesia, psychomotor hyperactivity, arthralgia
  • Arrhythmia, tachycardia, palpitations, hypertension
  • Cough
  • Pharyngolaryngeal pain
  • Gastrointestinal disturbances
  • Pyrexia
  • Growth retardation during prolonged use in children

Interactions

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  • Warfarin: (possibly enhanced anticoagulant effect)
  • Halothane, isoflurane, desflurane: (increased risk of hypertension)
  • MAOIs: (risk of hypertensive crisis)
  • Clonidine: (serious adverse events when used concomitantly with methylphenidate)

Pregnancy

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  • Do not use

Breast-feeding

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  • Do not use

⚠️ Caution

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  • Do not use during treatment with non-selective irreversible MAOIs, or within a minimum of 14 days of discontinuing those medicines, due to risk of hypertensive crisis
  • Discontinue if frequency of seizures increases in treatment of patients with epilepsy
  • Avoid abrupt withdrawal
  • If effect wears off in evening (with rebound hyperactivity), a dose at bedtime may be appropriate