Methylphenidate

Last Reviewed: Nov 19, 2024

Warnings

Methylphenidate HCl Risks, Warnings, and Complications

Methylphenidate can cause or worsen health problems in some people. Talk to your doctor or pharmacist about other medications for attention deficit hyperactivity disorder or narcolepsy if you are at an increased risk of adverse reactions from this drug.

POTENTIAL FOR ABUSE AND ADDICTION: Methylphenidate is a central nervous system stimulant and controlled substance. It carries a high risk of abuse and addiction. Tell your doctor if you have a history of drug or alcohol abuse before starting methylphenidate treatment. Your provider will monitor you for signs of abuse and dependence while on this medicine.
SERIOUS CARDIOVASCULAR EFFECTS: There are reports of heart attack, stroke, and sudden death in people who took CNS stimulants even at the recommended doses. The risk of sudden death is higher in people with structural heart abnormalities and other serious heart problems such as cardiomyopathy, coronary artery disease, and heart rhythm abnormalities. Tell your doctor immediately or seek emergency medical attention if you develop chest pain after exercise, fainting, or fast or irregular heartbeat while on this medicine.
INCREASED BLOOD PRESSURE AND HEART RATE: Taking CNS stimulants including methylphenidate can lead to an increase in blood pressure and heart rate. Your doctor will monitor you during therapy.
ADVERSE PSYCHIATRIC EFFECTS: Methylphenidate can cause worsening of preexisting psychosis and behavior disturbances (hallucinations, delusions, paranoia). It can also induce a manic or mixed mood episode in people with bipolar disorder. Your doctor will screen you for a personal or family history of psychotic disorders, bipolar disorder, or depression before starting treatment.
PRIAPISM: Methylphenidate has been reported to cause prolonged or painful erections, sometimes requiring surgical intervention. The risk of this happening is highest after a dose escalation but can also occur when you are on a drug holiday (i.e., you have temporarily discontinued methylphenidate treatment). Priapism is a medical emergency and can lead to permanent damage to the penis. You should seek medical care immediately if you develop a painful erection or an erection that lasts more than 4 hours.
PERIPHERAL VASCULAR DISEASE AND RAYNAUD’S PHENOMENON: Methylphenidate and other CNS stimulants can cause peripheral vasculopathy including Raynaud’s phenomenon. The signs and symptoms of these conditions can be mild but they can cause serious damage including ulceration and breakdown of soft tissues. Seek immediate medical care if you develop pain, numbness, increased sensitivity, a cold feeling, skin color changes, or unexplained wounds in your fingers and toes
LONG-TERM GROWTH SUPPRESSION: Methylphenidate can lead to weight loss and slow growth rate in children. This medication is not used to treat children younger than 6 years. If it is prescribed to children older than 6 years, the child’s healthcare provider will monitor growth carefully during treatment. If your child is not growing or gaining height or weight as expected, their provider may discontinue treatment with methylphenidate.

Precautions Before Starting Methylphenidate HCl

Tell your doctor if you have ever had an allergic reaction to methylphenidate, any of the inactive ingredients in methylphenidate formulations, or any other medications. Your pharmacy can give you a list of ingredients. If you are taking Adhansia XR, tell your doctor if you have had an allergic reaction to aspirin or yellow tartrazine dye.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, nutritional supplements, and herbal products. This can help avoid possible drug interactions between methylphenidate and your other medicines.

Methylphenidate may not be safe for people with certain medical conditions. Tell your doctor if you have a personal or family medical history of Tourette’s syndrome (tics or involuntary movements), glaucoma, hyperthyroidism (overactive thyroid gland), mental illness or psychiatric disorders, suicide attempts, irregular heartbeat, sudden death in a family member, recent heart attack, heart defects, irregular heartbeat, high blood pressure, coronary artery disease, blood vessel disease, cardiomyopathy, other heart problems, seizures, or circulation problems. If you are taking Concerta tablets, tell your doctor if you have any digestive system blockage or narrowing.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant soon, or are breast-feeding.

Precautions During Use of Methylphenidate HCl

Keep all your medical and lab appointments while on methylphenidate. Your doctor will adjust your dose based on your response to the medicine.

Avoid drinking alcohol if you are taking Quillichew ER (long-acting chewable tablets), Cotempla XR-ODT (long-acting orally disintegrating tablets), or Adhansia XR or Jornay PM (long-acting extended-release capsules).

You should know that some dosage formulations of methylphenidate contain aspartame which is a form of phenylalanine. These dosage forms should not be taken by people with a condition called phenylketonuria (PKU).

Tell your doctor if you become pregnant while on methylphenidate. If you are nursing an infant with breast milk while on this medication, your doctor will tell you to observe your baby carefully for poor appetite, weight loss, sleep difficulties, or agitation.

If you are having surgery, including dental procedures, tell your doctor or dental professional you are taking methylphenidate.

Methylphenidate is used to treat ADHD as part of a comprehensive treatment plan that includes counseling, training, behavior therapies, and medications. Follow your doctor’s recommendations to get the maximum benefit.

Methylphenidate HCl Drug Interactions

Concomitant use of certain other drugs can affect how methylphenidate works. Possible interactions with other medicines can increase the risk of severe adverse events. The following medications can have drug interactions with methylphenidate HCl:

Current use or use within the past 2 weeks of medications called monoamine oxidase (MAO) inhibitors, for example, methylene blue, linezolid (Zyvos), selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate), and rasagiline (Azilect)

Anticoagulant or blood thinner such as warfarin (Coumadin, Jantoven)
Tricyclic antidepressants such as desipramine (Norpramin), clomipramine (Anafranil), and imipramine (Tofranil)
Antidepressants (selective serotonin reuptake inhibitors or SSRIs) such as fluoxetine (Prozac, in Symbyax, Sarafem, others), paroxetine (Brisdelle, Paxil, Pexeva), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), and sertraline (Zoloft)
Antidepressants (selective serotonin norepinephrine reuptake inhibitors or SNRIs) such as venlafaxine (Effexor)
Cough and cold medications (decongestants)
Medicines used to treat heartburn or stomach ulcers, including famotidine (Pepcid), omeprazole (Prilosec, in Zegerid), esomeprazole (Nexium, in Vimovo), and pantoprazole (Protonix)
Antihypertensives used to treat high blood pressure
Antiepileptic drugs prescribed for seizure disorders, such as phenytoin (Dilantin, Phenytek), phenobarbital, and primidone (Mysoline)
Parkinson’s disease medications such as methyldopa
Sodium bicarbonate

The above list may not include all the potential drug interactions of methylphenidate. Give your doctor or pharmacist a complete list of your medications including prescription drugs, nonprescription drugs, nutritional supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription medications.

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