Select a medication above to begin.
Ritalin
methylphenidate
Black Box Warnings .
Abuse, Misuse, and Addiction
CNS stimulants have high potential for abuse and misuse, can lead to substance use disorder, including addiction; misuse and abuse can result in overdose and death, risk incr. with higher doses or unapproved administration methods; assess risk for abuse, misuse, and addiction before prescribing and throughout tx; educate patients and families about risks and proper drug storage and disposal; monitor frequently for signs/symptoms of abuse, misuse, and addiction during tx
Adult Dosing .
Dosage forms: TAB: 5 mg, 10 mg, 20 mg
Special Note
- [strength clarification]
- Info: all strengths expressed as methylphenidate hydrochloride
ADHD
- [10-60 mg/day PO divided bid-tid]
- Start: 5-10 mg PO bid, may incr. by 5-10 mg/day q7 days; Max: 60 mg/day; Info: duration 3-5h; give 30-45min before meals, last dose before 6pm
narcolepsy
- [10-60 mg/day PO divided bid-tid]
- Start: 5-10 mg PO bid, may incr. by 5-10 mg/day q7 days; Max: 60 mg/day; Info: give 30-45min before meals, last dose before 6pm
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: TAB: 5 mg, 10 mg, 20 mg
Special Note
- [strength clarification]
- Info: all strengths expressed as methylphenidate hydrochloride
ADHD
- [4-5 yo (off-label)]
- Dose: 2.5-7.5 mg PO tid; Start: 2.5 mg PO bid, may incr. to 7.5 mg PO tid over 7 days; Max: 30 mg/day; Info: give 30-45min before meals, last dose before 6pm
- [6 yo and older]
- Dose: 0.3-2 mg/kg/day PO divided bid-tid; Start: 0.3 mg/kg/dose PO bid or 2.5-5 mg PO bid, may incr. by 0.1 mg/kg/dose or 5-10 mg/day q7 days; Max: 2 mg/kg/day up to 60 mg/day; Info: duration 3-5h; give 30-45min before meals, last dose before 6pm
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- MAO inhibitor use within 14 days
- cardiac disease, severe
- cardiac abnormality, structural
- arrhythmia, severe
- cardiomyopathy
- CAD
- fructose intolerance, hereditary (30% IR/70% ER cap form)
- sucrase-isomaltase deficiency (30% IR/70% ER cap form)
- glucose-galactose malabsorption (30% IR/70% ER cap form)
- GI stricture, severe (qd ER tab form)
- dysphagia (IR chewable tab form)
- avoid: alcohol use (qd ER cap form)
- caution: hypersensitivity to tartrazine (some generic forms)
- caution: peds patients (ER form)
- caution: HTN
- caution: psychosis
- caution: bipolar disorder
- caution: bipolar disorder risk
- caution: Tourette syndrome
- caution: Tourette syndrome family history
- caution: tic disorder
- caution: tic disorder family history
- caution: glaucoma risk, angle-closure
- caution: glaucoma, open-angle
- caution: IOP incr.
- caution: substance abuse risk
- caution: PKU (phenylalanine-containing form)
Drug Interactions .
Overview
methylphenidate
CNS stimulant
- gastric pH sensitive
- hypertensive effects
- potential for modified drug release
- serotonergic effects
- tachycardia
- add MAO inhibitor to Interaction Check if recent (14 days) use
- avoid combo with beverages or products containing ethanol and some ER methylphenidate formulations (including capsule, chewable, oral suspension, ODT); combo may incr. methylphenidate release rate, levels, risk of adverse effects, decr. duration of efficacy
Contraindicated
- benzphetamine
- isocarboxazid
- linezolid
- methylene blue injection
- phendimetrazine
- phenelzine
- rasagiline
- safinamide
- selegiline
- selegiline transdermal
- tranylcypromine
- yohimbe
Avoid/Use Alternative
- albuterol
- alfentanil
- aluminum hydroxide
- amphetamine
- buprenorphine
- butorphanol
- calcium carbonate
- cimetidine
- citalopram
- clomipramine
- codeine
- cyclobenzaprine
- desipramine
- desvenlafaxine
- dexlansoprazole
- dexmethylphenidate
- dextroamphetamine
- dihydrocodeine
- dronabinol
- duloxetine
- ephedra
- epinephrine inhaled
- escitalopram
- esomeprazole
- ethanol (alcoholic beverage)
- ethanol (in some formulations)
- famotidine
- fentanyl
- fluoxetine
- fluvoxamine
- furosemide
- gepirone
- granisetron
- hydrocodone
- hydromorphone
- isoniazid
- landiolol
- lansoprazole
- levomilnacipran
- levorphanol
- lisdexamfetamine
- lithium
- magnesium carbonate
- magnesium hydroxide
- magnesium oxide
- meperidine
- metaxalone
- methadone
- methamphetamine
- methylene blue oral
- midodrine
- milnacipran
- mirtazapine
- morphine
- nalbuphine
- nizatidine
- nortriptyline
- oliceridine
- omeprazole
- ondansetron
- opium
- oxycodone
- oxymorphone
- pantoprazole
- paroxetine
- pentazocine
- procarbazine
- rabeprazole
- remifentanil
- sertraline
- sodium bicarbonate
- sodium citrate
- sodium zirconium cyclosilicate
- sufentanil
- tapentadol
- tedizolid
- tipranavir
- tramadol
- trimipramine
- venlafaxine
- vilazodone
- vonoprazan
- vortioxetine
- ziprasidone
Monitor/Modify Tx
- 5-HTP
- abiraterone acetate
- acebutolol
- albuterol inhaled
- aliskiren
- almotriptan
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- angiotensin II
- aprocitentan
- arformoterol inhaled
- armodafinil
- asciminib
- atenolol
- atogepant
- atropine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- benazepril
- benztropine
- betamethasone
- betaxolol
- bevacizumab
- bismuth subsalicylate
- bisoprolol
- black cohosh
- brigatinib
- bromocriptine
- budesonide
- bumetanide
- bupropion
- buspirone
- cabozantinib
- caffeine
- caffeine citrate
- candesartan cilexetil
- cannabis
- captopril
- carbamazepine
- carfilzomib
- carvedilol
- celecoxib
- chlorothiazide
- chlorthalidone
- clevidipine
- clonidine
- cocaine
- copanlisib
- corticotropin
- cortisone
- cyclosporine
- danazol
- darbepoetin alfa
- deflazacort
- desflurane
- desmopressin
- dexamethasone
- dextromethorphan
- diclofenac
- diclofenac topical
- dicyclomine
- diethylpropion
- diflunisal
- dihydroergotamine
- diltiazem
- dobutamine
- dopamine
- doxapram
- doxazosin
- doxepin
- doxepin topical
- droxidopa
- eletriptan
- enalapril
- enalaprilat
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ergotamine
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fingolimod
- fludrocortisone
- flurbiprofen
- formoterol inhaled
- fosinopril
- fosphenytoin
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galcanezumab
- glycopyrrolate
- guanfacine
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydroxocobalamin IV
- hyoscyamine
- ibrutinib
- ibuprofen
- imipramine
- indapamide
- indomethacin
- irbesartan
- isoflurane
- isoproterenol
- isradipine
- ketamine
- ketoprofen
- ketorolac
- labetalol
- lanreotide
- leflunomide
- lenvatinib
- levalbuterol inhaled
- levothyroxine
- licorice
- lifileucel
- liothyronine
- liraglutide
- lisinopril
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- lumateperone
- luspatercept
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- methoxy polyethylene glycol-epoetin beta
- methscopolamine
- methyldopa
- methylergonovine
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- metoprolol
- minoxidil
- mirabegron
- modafinil
- moexipril
- nabumetone
- nadolol
- naproxen
- naratriptan
- naxitamab
- nebivolol
- nefazodone
- nicardipine
- nicotine
- nifedipine
- nimodipine
- niraparib
- nisoldipine
- norepinephrine
- obinutuzumab
- olmesartan medoxomil
- olodaterol inhaled
- orphenadrine
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- ozanimod
- palonosetron
- pazopanib
- perindopril
- pexidartinib
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- phenytoin
- pindolol
- piroxicam
- ponatinib
- ponesimod
- pralsetinib
- prazosin
- prednisolone
- prednisone
- propranolol
- protriptyline
- pseudoephedrine
- quetiapine
- quinapril
- ramipril
- ramucirumab
- regorafenib
- rimegepant
- ripretinib
- rizatriptan
- ropinirole
- rotigotine transdermal
- salmeterol inhaled
- salsalate
- SAMe
- selpercatinib
- sevoflurane
- siponimod
- solriamfetol
- sorafenib
- spironolactone
- St. John's wort
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tagraxofusp
- telmisartan
- terazosin
- terbutaline
- teriflunomide
- testosterone
- thyroid
- timolol
- tivozanib
- tolmetin
- torsemide
- trametinib
- trandolapril
- trazodone
- triamcinolone
- triamterene
- trospium
- ubrogepant
- vadadustat
- valsartan
- vamorolone
- vandetanib
- vasopressin
- verapamil
- vilanterol inhaled
- viloxazine
- voclosporin
- zavegepant
- ziv-aflibercept
- zolmitriptan
Caution Advised
- ginseng, Asian
- risperidone
Adverse Reactions .
Serious Reactions
- dependency
- abuse
- psychosis
- mania
- aggressive behavior
- HTN
- MI
- stroke
- arrhythmia
- sudden death (patients with severe cardiac disease)
- seizures
- hypersensitivity reaction
- angioedema
- anaphylaxis
- exfoliative dermatitis
- erythema multiforme
- thrombocytopenic purpura
- blood dyscrasia
- priapism
- peripheral vasculopathy
- Raynaud phenomenon
- growth suppression (long-term use in peds patients)
- weight loss (ER form use in peds patients)
- glaucoma
- rhabdomyolysis
- hepatotoxicity
- withdrawal symptoms if abrupt D/C (prolonged use)
Common Reactions
- anorexia
- headache
- xerostomia
- nausea
- insomnia
- anxiety
- abdominal pain
- dizziness
- weight loss
- irritability
- hyperhidrosis
- fever
- tachycardia
- vomiting
- nervousness
- palpitations
- restlessness
- URI
- tremor
- dyspepsia
- BP incr.
- HR incr.
- visual disturbance
- affect lability
- tics
Safety/Monitoring .
Monitoring Parameters
cardiac evaluation at baseline; BP, HR; height, weight in peds at baseline, then periodically; ophthalmic exam if glaucoma risk; consider CBC with diff, Plt if prolonged tx
Look/Sound-Alike Drug Names
Ritalin confused with: Ritalin SR
methylphenidate confused with: methadone; methamphetamine
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no known risk of teratogenicity based on limited human data; possible risk of vasoconstriction in pregnant patients and decr. placental perfusion based on drug's mechanism of action
Pregnancy Registry
encourage patients to enroll in National Pregnancy Registry for ADHD Medications at 1-866-961-2388 or www.womensmentalhealth.org/adhd-medications
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no known risk of infant harm based on limited human data; no human data available, though theoretical decr. milk production based on decr. prolactin levels
Pharmacology .
Metabolism: for methylphenidate: de-esterification primarily; CYP450: none
Excretion: for methylphenidate: urine 78-97% (<1% unchanged), feces 1-3%; Half-life: 3.5h (IR tabs, adults), 2.5h (IR tabs, peds), 2.7h (IR solution, adults), 2.4-6.8h (ER forms)
Subclass: Attention Deficit Hyperactivity Disorder (ADHD) ; Narcolepsy/Somnolence ; Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
Mechanism of Action
for methylphenidate: exact mechanism of action unknown; stimulates CNS activity; blocks reuptake and increases release of norepinephrine and dopamine in extraneuronal space (sympathomimetic)
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Novartis Pharmaceuticals Corp.
DEA/FDA: Schedule II
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
oral tablet:
- 5 mg (90 ea): $66.00
- 10 mg (90 ea): $92.00
- 20 mg (60 ea): $89.00
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.