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Methylphenidate
Aka: Methylphenidate, Ritalin, Methylin, Concerta, Focalin, Metadate, Quillivant, Daytrana
- See Also
- Attention Deficit Disorder in Children
- School Problem Evaluation
- Attention Deficit Disorder in Adults
- ADHD Diagnosis
- ADHD Differential Diagnosis
- ADHD Comorbid Conditions
- ADHD Non-Pharmacologic Management
- ADHD Medications
- Dextroamphetamine (Dexedrine, Dextrostat, Adderall) or Lisdexamfetamine (Vyvanse)
- Atomoxetine (Strattera)
- Indications: Methylphenidate (Ritalin)
- Attention Deficit Hyperactivity Disorder (ADHD)
- Narcolepsy
- Depression in medically ill elderly patients
- Enhanced pain control in patients on Opiates
- Contraindications
- See Drug Interactions below
- Congenital Heart Defect (ask related PMH, Family History and screen on ADHD exam)
- Consider an EKG before prescribing
- Vetter (2008) Circulation 117(18):2407-23. [PubMed]
- Motor Tics or Tourette's Syndrome
- Glaucoma
- Seizure disorder
- Hypertension
- Pregnancy
- Precautions
- See ADHD Medication for overall approach and medication selection
- Maximum Dosing
- Adults and older adolescents (>50 kg) may in some cases need dosing in excess of listed maximum
- Exercise caution and Informed Consent as these doses are not FDA approved
- Exceed the manufacturers recommendation
- Absolute maximum doses
- Methylphenidate: 100 mg per day in divided doses
- Concerta 108 mg per day
- (2013) Presc Lett 20(9): 50-1
- Pharmacokinetics: Methylphenidate
- Immediate Release: Ritalin-IR, Methylin IR
- Onset of action: within 20 to 30 minutes of dose (up to 60 minutes)
- Peaks at 1.9 hours on average
- Duration: 3 to 6 hours
- Immediate Release: Focalin (Dexmethylphenidate)
- D-isomer of Ritalin (l-isomer is inactive)
- Prescribed at half dose of Ritalin
- Same pharmacokinetics as immediate release Methylphenidate
- Fewer Headaches but more Stomache pain than with Methylphenidate
- Long-Acting: Ritalin-LA
- Duration: 8 hours
- Biphasic release
- Immediate release: 50%
- Modified release beads: 50%
- Preferred over Ritalin SR
- Long-Acting: Ritalin-SR, Metadate ER, Methylin ER
- Onset of action: within 90 minutes of dose
- Peaks at 3 hours on average
- Duration: 5-8 hours (gradual decrease after 3 hours)
- Less effective than Ritalin IR twice daily
- Other sustained release forms are preferred
- Very-Long-Acting: Concerta
- Onset of action: within 60 to 120 minutes of dose
- Duration: 12 hours
- Comparable to Ritalin-IR three times daily
- Very-Long-Acting: Metadate-CD
- Flat concentration curve despite biphasic release
- Duration: 8-10 hours
- Biphasic peaks at 1.5 hours and again at 4.5 hours
- Immediate release beads: 30%
- Extended release beads: 70%
- Very-Long Acting: Quillivant XR
- Combination of Immediate release Methylphenidate (20%) and extended release Methylphenidate (80%)
- Peaks at 5 hours
- Duration: 12 hours
- Niche is that it is suspension (compounded by pharmacy) at 5 mg/ml
- Other stimulant capsules can be sprinkled on apple sauce (Focalin XR, Metadate CD, Ritalin LA, Adderall XR)
- References
- (2013) Presc Lett 20(2): 8-9
- Dosing: Children (over age 6 years)
- Maximum total daily dose: 60 mg/day
- Immediate Release: Methylphenidate
- Usual Range: 0.5 - 1 mg/kg/day
- Start: 2.5 to 5 mg per dose, twice daily
- Initial Schedule (lasts 4 hours - dose up to 4 times daily)
- Morning: 2.5 to 5 mg PO 30 minutes before breakfast
- Noon: 2.5 to 5 mg PO 30 minutes before lunch
- Afternoon: 1.25 to 2.5 mg PO at 3-4 pm
- Titrate dose up weekly
- Increase dose by 0.1 mg/kg/dose (or 5-10 mg/day)
- Maximum dose: 2 mg/kg/day or 60 mg/day (some sources suggest maximum up to 90)
- Immediate Release: Focalin (Dexmethylphenidate)
- Start: 2.5 mg orally twice daily
- Usual Dose: 5-10 mg orally twice daily
- Maximum Dose: 20 mg orally daily
- Sustained Release
- Concerta 18 to 54 mg orally daily
- Start: 18 mg qAM
- May increase weekly by 18 mg/day
- Conversions
- Ritalin 5 mg or 20 mg SR: Concerta 18 mg
- Ritalin 10 mg or 40 mg SR: Concerta 36 mg
- Ritalin 15 mg or 60 mg SR: Concerta 54 mg
- Maximum: 72 mg/day
- Ritalin LA or Metadate CD
- Start: 20 mg orally daily
- May increase weekly by 10-20 mg/day
- Usual dose: 20-40 mg orally once daily
- Maximum: 60 mg/day
- Ritalin-SR (Other long-acting agents are preferred)
- Dose: 0.6 to 2 mg/kg up to 20-40 mg orally daily
- Dose is directly converted from Regular Ritalin
- Conversion to Ritalin SR (Metadate ER, Methylin ER)
- Administer cumulative 8 hour regular dose
- Example: Conversion
- Child takes Ritalin 10 mg, 5 mg, and 5 mg
- Ritalin SR dosing will be 20 mg qAM
- Example: Schedule
- Morning: 20-40 mg orally
- Early afternoon: 20 mg orally
- Daytrana (Methylphenidate patch)
- Start: 10 mg patch worn 9 hours daily
- Max: 30 mg patch worn 9 hours daily
- Skin irritation or rash may occur
- Dosing: Adults with ADHD or Narcolepsy
- Maximum total daily dose: 90 mg
- Regular Release: 5 to 20 mg PO bid to tid at meals
- Sustained Release: 20 mg PO up to q8 hours
- Dosing: Elderly with comorbid Depression
- Maximum total daily dose: 30 mg
- Regular Release: 5 to 10 mg bid to tid
- Management Difficulty Swallowing Medication - Long Acting Methylphenidate
- Generic
- Ritalin LA
- Metadate CD Sprinkle caps
- Trade Name - Expensive ($300/month)
- Aptensio XR spinkle caps (lasts 12 hours)
- QuilliChew ER chewable 20 and 40 mg tabs (lasts 8-13 hours)
- Quillavant XR Suspension 5 mg/ml (lasts 12 hours)
- Adhansia XR (lasts 13 hours)
- Jornay PM (taken at night and peaks 14 hours later, the next morning)
- Contempla XR 17.3 mg dissolving tablets (lasts 12 hours)
- Daytrana Transdermal Patch 10 mg (lasts 10-12 hours)
- References
- (2016) Presc Lett 23(3):16
-
Drug Interactions
- Avoid concurrent Decongestant use
- Avoid within 14 days of MAO inhibitor
- Monitoring: Each Visit
- Height
- Weight
- Blood Pressure
- Pulse
- Adverse Effects
- See ADHD Medication
- References
- (2002) Lexicomp Drug Database
- (1996) Pediatrics 98:301-4 [PubMed]
- Andesman (1999) Pediatr Clin North Am 46:945-63 [PubMed]
- Bennett (1999) Pediatr Clin North Am 46:929-44 [PubMed]
- Challman (2000) Mayo Clin Proc 75:711-21 [PubMed]
- Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
- Pliszka (2007) J Am Acad Child Adolesc Psychiatry 46(7):894-921 [PubMed]
- http://www.jaacap.com/article/S0890-8567(09)62182-1/fulltext