Methylphenidate

Aka: Methylphenidate, Ritalin, Methylin, Concerta, Focalin, Metadate, Quillivant, Daytrana

advertisement

II. Indications: Methylphenidate (Ritalin)

  1. Attention Deficit Hyperactivity Disorder (ADHD)
  2. Narcolepsy
  3. Depression in medically ill elderly patients
  4. Enhanced pain control in patients on Opiates

III. Contraindications

  1. See Drug Interactions below
  2. Congenital Heart Defect (ask related PMH, Family History and screen on ADHD exam)
    1. Consider an EKG before prescribing
    2. Vetter (2008) Circulation 117(18):2407-23. [PubMed]
  3. Motor Tics or Tourette's Syndrome
  4. Glaucoma
  5. Seizure Disorder
  6. Hypertension
  7. Pregnancy

IV. Mechanism

  1. See ADHD Medication
  2. As with other Amphetamine-like drugs, Methylphenidate triggers release of biogenic amines
    1. Norepinephrine, Dopamine and Serotonin are released from storage Vesicles
  3. Effects
    1. CNS Stimulation
      1. Inhibits fast-rate behavior in hyperkinetic, hyperactive children
      2. Speeds slow-rate behavior (e.g. improves memory and learning)
    2. Decreases appetite
    3. Ergogenic Aid in athletes (illicit use)

V. Precautions

  1. See ADHD Medication for overall approach and medication selection
  2. Maximum Dosing
    1. Adults and older adolescents (>50 kg) may in some cases need dosing in excess of listed maximum
    2. Exercise caution and Informed Consent as these doses are not FDA approved
      1. Exceed the manufacturers recommendation
    3. Absolute maximum doses
      1. Methylphenidate: 100 mg per day in divided doses
      2. Concerta 108 mg per day
    4. (2013) Presc Lett 20(9): 50-1

VI. Pharmacokinetics: Methylphenidate

  1. Immediate Release: Ritalin-IR, Methylin IR
    1. Onset of action: within 20 to 30 minutes of dose (up to 60 minutes)
    2. Peaks at 1.9 hours on average
    3. Duration: 3 to 6 hours
  2. Immediate Release: Focalin (Dexmethylphenidate)
    1. D-isomer of Ritalin (l-isomer is inactive)
    2. Prescribed at half dose of Ritalin
    3. Same Pharmacokinetics as immediate release Methylphenidate
    4. Fewer Headaches but more Stomache pain than with Methylphenidate
  3. Long-Acting: Ritalin-LA
    1. Duration: 8 hours
    2. Biphasic release
      1. Immediate release: 50%
      2. Modified release beads: 50%
    3. Preferred over Ritalin SR
  4. Long-Acting: Ritalin-SR, Metadate ER, Methylin ER
    1. Onset of action: within 90 minutes of dose
    2. Peaks at 3 hours on average
    3. Duration: 5-8 hours (gradual decrease after 3 hours)
    4. Less effective than Ritalin IR twice daily
    5. Other sustained release forms are preferred
  5. Very-Long-Acting: Concerta
    1. Onset of action: within 60 to 120 minutes of dose
    2. Duration: 12 hours
    3. Comparable to Ritalin-IR three times daily
  6. Very-Long-Acting: Metadate-CD
    1. Flat concentration curve despite biphasic release
    2. Duration: 8-10 hours
    3. Biphasic peaks at 1.5 hours and again at 4.5 hours
      1. Immediate release beads: 30%
      2. Extended release beads: 70%
  7. Very-Long Acting: Quillivant XR
    1. Combination of Immediate release Methylphenidate (20%) and extended release Methylphenidate (80%)
    2. Peaks at 5 hours
    3. Duration: 12 hours
    4. Niche is that it is suspension (compounded by pharmacy) at 5 mg/ml
      1. Other stimulant capsules can be sprinkled on apple sauce (Focalin XR, Metadate CD, Ritalin LA, Adderall XR)
    5. References
      1. (2013) Presc Lett 20(2): 8-9

VII. Dosing: Children (over age 6 years)

  1. Maximum total daily dose: 60 mg/day
  2. Immediate Release: Methylphenidate
    1. Usual Range: 0.5 - 1 mg/kg/day
    2. Start: 2.5 to 5 mg per dose, twice daily
    3. Initial Schedule (lasts 4 hours - dose up to 4 times daily)
      1. Morning: 2.5 to 5 mg PO 30 minutes before breakfast
      2. Noon: 2.5 to 5 mg PO 30 minutes before lunch
      3. Afternoon: 1.25 to 2.5 mg PO at 3-4 pm
    4. Titrate dose up weekly
      1. Increase dose by 0.1 mg/kg/dose (or 5-10 mg/day)
    5. Maximum dose: 2 mg/kg/day or 60 mg/day (some sources suggest maximum up to 90)
  3. Immediate Release: Focalin (Dexmethylphenidate)
    1. Start: 2.5 mg orally twice daily
    2. Usual Dose: 5-10 mg orally twice daily
    3. Maximum Dose: 20 mg orally daily
  4. Sustained Release
    1. Concerta 18 to 54 mg orally daily
      1. Start: 18 mg qAM
      2. May increase weekly by 18 mg/day
      3. Conversions
        1. Ritalin 5 mg or 20 mg SR: Concerta 18 mg
        2. Ritalin 10 mg or 40 mg SR: Concerta 36 mg
        3. Ritalin 15 mg or 60 mg SR: Concerta 54 mg
      4. Maximum: 72 mg/day
    2. Ritalin LA or Metadate CD
      1. Start: 20 mg orally daily
      2. May increase weekly by 10-20 mg/day
      3. Usual dose: 20-40 mg orally once daily
      4. Maximum: 60 mg/day
    3. Ritalin-SR (Other long-acting agents are preferred)
      1. Dose: 0.6 to 2 mg/kg up to 20-40 mg orally daily
      2. Dose is directly converted from Regular Ritalin
      3. Conversion to Ritalin SR (Metadate ER, Methylin ER)
      4. Administer cumulative 8 hour regular dose
      5. Example: Conversion
        1. Child takes Ritalin 10 mg, 5 mg, and 5 mg
        2. Ritalin SR dosing will be 20 mg qAM
      6. Example: Schedule
        1. Morning: 20-40 mg orally
        2. Early afternoon: 20 mg orally
    4. Daytrana (Methylphenidate patch)
      1. Start: 10 mg patch worn 9 hours daily
      2. Max: 30 mg patch worn 9 hours daily
      3. Skin irritation or rash may occur

VIII. Dosing: Adults with ADHD or Narcolepsy

  1. Maximum total daily dose: 90 mg
  2. Regular Release: 5 to 20 mg PO bid to tid at meals
  3. Sustained Release: 20 mg PO up to q8 hours

IX. Dosing: Elderly with comorbid Depression

  1. Maximum total daily dose: 30 mg
  2. Regular Release: 5 to 10 mg bid to tid

X. Management Difficulty Swallowing Medication - Long Acting Methylphenidate

  1. Generic
    1. Ritalin LA
    2. Metadate CD Sprinkle caps
  2. Trade Name - Expensive ($300/month)
    1. Aptensio XR spinkle caps (lasts 12 hours)
    2. QuilliChew ER chewable 20 and 40 mg tabs (lasts 8-13 hours)
    3. Quillavant XR Suspension 5 mg/ml (lasts 12 hours)
    4. Adhansia XR (lasts 13 hours)
    5. Jornay PM (taken at night and peaks 14 hours later, the next morning)
    6. Contempla XR 17.3 mg dissolving tablets (lasts 12 hours)
    7. Daytrana Transdermal Patch 10 mg (lasts 10-12 hours)
  3. References
    1. (2016) Presc Lett 23(3):16

XI. Drug Interactions

  1. Avoid concurrent Decongestant use
  2. Avoid within 14 days of MAO Inhibitor

XII. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

XIII. Monitoring: Each Visit

  1. Height
  2. Weight
  3. Blood Pressure
  4. Pulse

XIV. Adverse Effects

  1. See ADHD Medication

XV. References

  1. (2002) Lexicomp Drug Database
  2. (1996) Pediatrics 98:301-4 [PubMed]
  3. Andesman (1999) Pediatr Clin North Am 46:945-63 [PubMed]
  4. Bennett (1999) Pediatr Clin North Am 46:929-44 [PubMed]
  5. Challman (2000) Mayo Clin Proc 75:711-21 [PubMed]
  6. Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
  7. Pliszka (2007) J Am Acad Child Adolesc Psychiatry 46(7):894-921 [PubMed]
    1. http://www.jaacap.com/article/S0890-8567(09)62182-1/fulltext

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Methylphenidate." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Cost: Medications

methylphenidate (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
METHYLPHENIDATE 10 MG CHEW TAB Generic $3.44 each
METHYLPHENIDATE 10 MG TABLET Generic $0.14 each
METHYLPHENIDATE 10 MG/5 ML SOL Generic $0.16 per ml
METHYLPHENIDATE 10 MG/9 HR PATCH Generic $10.85 each
METHYLPHENIDATE 15 MG/9 HR PATCH Generic $12.83 each
METHYLPHENIDATE 2.5 MG CHEW TB Generic $1.86 each
METHYLPHENIDATE 20 MG TABLET Generic $0.17 each
METHYLPHENIDATE 20 MG/9 HR PATCH Generic $11.51 each
METHYLPHENIDATE 30 MG/9 HR PATCH Generic $12.98 each
METHYLPHENIDATE 5 MG CHEW TAB Generic $2.39 each
METHYLPHENIDATE 5 MG TABLET Generic $0.09 each
METHYLPHENIDATE 5 MG/5 ML SOLN Generic $0.09 per ml
METHYLPHENIDATE CD 10 MG CAP Generic $1.49 each
METHYLPHENIDATE CD 20 MG CAP Generic $1.47 each
METHYLPHENIDATE CD 30 MG CAP Generic $1.22 each
METHYLPHENIDATE CD 40 MG CAP Generic $1.66 each
METHYLPHENIDATE CD 50 MG CAP Generic $1.40 each
METHYLPHENIDATE CD 60 MG CAP Generic $1.28 each
METHYLPHENIDATE ER 10 MG CAP Generic $4.97 each
METHYLPHENIDATE ER 10 MG TAB Generic $0.37 each
METHYLPHENIDATE ER 18 MG TAB Generic $0.60 each
METHYLPHENIDATE ER 20 MG TAB Generic $0.41 each
METHYLPHENIDATE ER 27 MG TAB Generic $0.71 each
METHYLPHENIDATE ER 30 MG CAP Generic $4.97 each
METHYLPHENIDATE ER 36 MG TAB Generic $1.10 each
METHYLPHENIDATE ER 54 MG TAB Generic $1.05 each
METHYLPHENIDATE ER 72 MG TAB Generic $14.13 each
METHYLPHENIDATE ER(CD) 10 MG CP Generic $1.49 each
METHYLPHENIDATE ER(CD) 20 MG CP Generic $1.47 each
METHYLPHENIDATE ER(CD) 30 MG CP Generic $1.22 each
METHYLPHENIDATE ER(CD) 40 MG CP Generic $1.66 each
METHYLPHENIDATE ER(CD) 50 MG CP Generic $1.40 each
METHYLPHENIDATE ER(CD) 60 MG CP Generic $1.28 each
METHYLPHENIDATE ER(LA) 10 MG CP Generic $3.32 each
METHYLPHENIDATE ER(LA) 20 MG CP Generic $1.15 each
METHYLPHENIDATE ER(LA) 30 MG CP Generic $1.60 each
METHYLPHENIDATE ER(LA) 40 MG CP Generic $1.94 each
METHYLPHENIDATE LA 10 MG CAP Generic $3.32 each
METHYLPHENIDATE LA 20 MG CAP Generic $1.15 each
METHYLPHENIDATE LA 30 MG CAP Generic $1.60 each
METHYLPHENIDATE LA 40 MG CAP Generic $1.94 each
METHYLPHENIDATE LA 60 MG CAP Generic $8.07 each
ritalin (on 7/19/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
RITALIN 10 MG TABLET Generic $0.14 each
RITALIN 20 MG TABLET Generic $0.17 each
RITALIN 5 MG TABLET Generic $0.11 each
methylin (on 10/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
METHYLIN 5 MG/5 ML SOLUTION Generic $0.09 per ml
concerta (on 1/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CONCERTA ER 18 MG TABLET Generic $0.60 each
CONCERTA ER 27 MG TABLET Generic $0.71 each
CONCERTA ER 36 MG TABLET Generic $1.10 each
CONCERTA ER 54 MG TABLET Generic $1.05 each
focalin (on 7/27/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
FOCALIN 10 MG TABLET Generic $0.24 each
FOCALIN 2.5 MG TABLET Generic $0.09 each
FOCALIN 5 MG TABLET Generic $0.17 each
FOCALIN XR 10 MG CAPSULE Generic $0.78 each
FOCALIN XR 15 MG CAPSULE Generic $0.90 each
FOCALIN XR 20 MG CAPSULE Generic $1.50 each
FOCALIN XR 25 MG CAPSULE Generic $2.10 each
FOCALIN XR 30 MG CAPSULE Generic $1.97 each
FOCALIN XR 35 MG CAPSULE Generic $1.14 each
FOCALIN XR 40 MG CAPSULE Generic $1.33 each
FOCALIN XR 5 MG CAPSULE Generic $0.84 each
quillivant (on 1/3/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
QUILLIVANT XR 25 MG/5 ML SUSP $5.42 per ml
daytrana (on 8/23/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
DAYTRANA 10 MG/9 HR PATCH $14.92 each
DAYTRANA 15 MG/9 HR PATCH Generic $11.02 each
DAYTRANA 20 MG/9 HOUR PATCH Generic $11.51 each
DAYTRANA 30 MG/9 HOUR PATCH $14.81 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

advertisement