II. Indications: Methylphenidate (Ritalin)
- Attention Deficit Hyperactivity Disorder (ADHD)
- Narcolepsy
- Depression in medically ill elderly patients
- Enhanced pain control in patients on Opiates
III. 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
IV. 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)
- 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 bid
- 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 tid
- 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
V. 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
- Concerta 18 to 54 mg orally daily
VI. 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
VII. Dosing: Elderly with comorbid Depression
- Maximum total daily dose: 30 mg
- Regular Release: 5 to 10 mg bid to tid
VIII. Precautions: 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 and 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
IX. Drug Interactions
- Avoid concurrent Decongestant use
- Avoid within 14 days of MAO inhibitor
X. Monitoring: Each Visit
- Height
- Weight
- Blood Pressure
- Pulse
XI. Adverse Effects
- See ADHD Medication
XII. 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]
- Pliszka (2007) J Am Acad Child Adolesc Psychiatry 46(7):894-921 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
methylphenidate (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
METHYLPHENIDATE 10 MG TABLET | Generic | $0.54 each |
METHYLPHENIDATE 10 MG/5 ML SOL | Generic | $0.91 per ml |
METHYLPHENIDATE 20 MG TABLET | Generic | $0.77 each |
METHYLPHENIDATE 5 MG TABLET | Generic | $0.42 each |
METHYLPHENIDATE 5 MG/5 ML SOLN | Generic | $0.66 per ml |
METHYLPHENIDATE CD 10 MG CAP | Generic | $2.96 each |
METHYLPHENIDATE CD 20 MG CAP | Generic | $3.30 each |
METHYLPHENIDATE CD 30 MG CAP | Generic | $3.16 each |
METHYLPHENIDATE CD 40 MG CAP | Generic | $4.20 each |
METHYLPHENIDATE CD 50 MG CAP | Generic | $4.67 each |
METHYLPHENIDATE CD 60 MG CAP | Generic | $5.36 each |
METHYLPHENIDATE ER 10 MG CAP | Generic | $2.96 each |
METHYLPHENIDATE ER 10 MG TAB | Generic | $4.48 each |
METHYLPHENIDATE ER 18 MG TAB | Generic | $6.91 each |
METHYLPHENIDATE ER 20 MG CAP | Generic | $4.38 each |
METHYLPHENIDATE ER 20 MG TAB | Generic | $3.71 each |
METHYLPHENIDATE ER 27 MG TAB | Generic | $3.92 each |
METHYLPHENIDATE ER 30 MG CAP | Generic | $4.12 each |
METHYLPHENIDATE ER 36 MG TAB | Generic | $7.37 each |
METHYLPHENIDATE ER 40 MG CAP | Generic | $4.30 each |
METHYLPHENIDATE ER 50 MG CAP | Generic | $4.67 each |
METHYLPHENIDATE ER 54 MG TAB | Generic | $4.29 each |
METHYLPHENIDATE ER 60 MG CAP | Generic | $5.36 each |
METHYLPHENIDATE LA 20 MG CAP | Generic | $4.38 each |
METHYLPHENIDATE LA 30 MG CAP | Generic | $4.12 each |
METHYLPHENIDATE LA 40 MG CAP | Generic | $4.30 each |
ritalin (on 1/4/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
RITALIN 10 MG TABLET | Generic | $0.54 each |
RITALIN 20 MG TABLET | Generic | $0.77 each |
RITALIN LA 10 MG CAPSULE | $8.78 each | |
RITALIN LA 20 MG CAPSULE | Generic | $4.38 each |
RITALIN LA 30 MG CAPSULE | Generic | $4.12 each |
RITALIN LA 40 MG CAPSULE | Generic | $4.30 each |
methylin (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
METHYLIN 5 MG/5 ML SOLUTION | Generic | $0.66 per ml |
concerta (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
CONCERTA ER 18 MG TABLET | $9.57 each | |
CONCERTA ER 27 MG TABLET | $9.82 each | |
CONCERTA ER 36 MG TABLET | $10.21 each | |
CONCERTA ER 54 MG TABLET | $10.97 each |
Ontology: Methylphenidate (C0025810)
Definition (CHV) | a drug that stimulates the brain |
Definition (MSH) | A central nervous system stimulant used most commonly in the treatment of ATTENTION DEFICIT DISORDER in children and for NARCOLEPSY. Its mechanisms appear to be similar to those of DEXTROAMPHETAMINE. The d-isomer of this drug is referred to as DEXMETHYLPHENIDATE. |
Definition (NCI) | A synthetic central nervous system stimulant. Methylphenidate appears to activate the brain stem arousal system and cortex to produce its stimulant effect and, in some clinical settings, may improve cognitive function. |
Definition (CSP) | central stimulant used in treatment of hyperkinetic children, various types of depression, and narcolepsy. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D008774 |
SnomedCT | 18548003, 373337007 |
LNC | LP16202-1, MTHU008754 |
English | Methylphenidate, 2-Piperidineacetic acid, alpha-phenyl-, methyl ester, alpha-Phenyl-2-piperidineacetic Acid Methyl Ester, methylphenidate, METHYLPHENIDATE, Methylphenidate [Chemical/Ingredient], Methylphenidate (product), Methylphenidate (substance), d-methylphenidate |
Swedish | Metylfenidat |
Czech | methylfenidát |
Finnish | Metyylifenidaatti |
Russian | METILFENIDAT, FENIDILAT, МЕТИЛФЕНИДАТ, ФЕНИДИЛАТ |
Japanese | フェニジレート, リタリン, 塩酸メチルフェニデート, メチルフェニデート |
Polish | Rytalin, Metylofenidat |
Spanish | Ritalin, metilfenidato (producto), metilfenidato (sustancia), metilfenidato, Metilfenidato |
Portuguese | Ritalin, Metilfenidato |
French | Méthylphénidate |
German | Methylphenidat |
Italian | Metilfenidato |
Ontology: Ritalin (C0728759)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D008774 |
German | Ritalin |
English | Ritalin, Cephalon Brand of Methylphenidate Hydrochloride, Novartis Brand 1 of Methylphenidate Hydrochloride, Ritaline |
Ontology: Methylin (C0876085)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D008774 |
English | methylin, Methylin, Mallinckrodt Brand of Methylphenidate Hydrochloride |
Ontology: Concerta (C0939301)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D008774 |
English | concerta, Concerta |