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MethylphenidateAka: Ritalin, Methylin, Concerta

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  1. Indications for 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
  2. Contraindications
    1. See Drug interactions below
    2. Motor Tics or Tourette's Syndrome
    3. Glaucoma
    4. Seizure disorder
    5. Hypertension
    6. Pregnancy
  3. Pharmacokinetics: Methylphenidate
    1. Immediate Release: Ritalin-IR, Methylin IR
      1. Onset of action: within 20 to 60 minutes of dose
      2. Peaks at 1.9 hours on average
      3. Duration: 3 to 6 hours
      4. Focalin is d-isomer of Ritalin (l-isomer is inactive)
        1. Prescribe at half dose of Ritalin
    2. 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
    3. 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 bid
      5. Other sustained release forms are preferred
    4. Very-Long-Acting: Concerta
      1. Onset of action: within 60 to 120 minutes of dose
      2. Duration: 12 hours
      3. Comparable to Ritalin-IR tid
    5. 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%
  4. Dosing: Children (over age 6 years)
    1. Maximum total daily dose: 60 mg/day
    2. Immediate Release
      1. Usual Range: 0.5 - 1 mg/kg/day
      2. Start: 2.5 to 5 mg per dose
      3. Initial Schedule (lasts 4 hours - dose up to qid)
        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 90 mg/day
    3. Sustained Release
      1. Concerta 18 to 54 mg PO qd
        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
      2. Ritalin LA or Metadate CD
        1. Start: 20 mg PO qd
        2. May increase weekly by 10-20 mg/day
        3. 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 PO qd
        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
          1. Child takes Ritalin 10 mg, 5 mg, and 5 mg
          2. Ritalin SR dosing will be 20 mg qAM
  5. 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
  6. Dosing: Elderly with comorbid Depression
    1. Maximum total daily dose: 30 mg
    2. Regular Release: 5 to 10 mg bid to tid
  7. Drug Interactions
    1. Avoid concurrent Decongestant use
    2. Avoid within 14 days of MAO inhibitor
  8. Monitoring
    1. Height
    2. Weight
    3. Blood Pressure
    4. Pulse
  9. Adverse Effects
    1. Rebound ADHD behavior when medication level wanes
    2. Emotional lability, irritability or tearfulness
    3. Social withdrawal
    4. Flat affect
    5. Insomnia
    6. Poor appetite
    7. Stomach pain
    8. Unintentional Weight Loss
    9. Reduced growth velocity
    10. Headache
    11. Psychosis (at excessive doses)
  10. References
    1. (2002) Lexicomp Drug Database
    2. (1996) Pediatrics 98:301
    3. Andesman (1999) Pediatr Clin North Am 46:945
    4. Bennett (1999) Pediatr Clin North Am 46:929
    5. Challman (2000) Mayo Clin Proc 75:711

Methylphenidate (C0025810)

Definition (MSH)A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of DEXTROAMPHETAMINE.
Definition (CSP)central stimulant used in treatment of hyperkinetic children, various types of depression, and narcolepsy.
Definition (NCI)A drug that is a central nervous system stimulant.
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.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishMethylphenidate, METHYLPHENIDATE PREPARATION
Spanishmetilfenidato
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Ritalin (C0728759)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishCephalon Brand of Methylphenidate Hydrochloride, Novartis Brand 1 of Methylphenidate Hydrochloride, Ritalin, Ritaline
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Methylin (C0876085)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishMallinckrodt Brand of Methylphenidate Hydrochloride, Methylin
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Concerta (C0939301)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishConcerta
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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