methylphenidate (Rx)

Brand and Other Names:Ritalin, Ritalin SR, more...Ritalin LA, Aptensio XR, Concerta, Metadate, Metadate CD, Metadate ER, Methylin, Quillivant XR, QuilliChew ER, Cotempla XR-ODT, Jornay PM, Adhansia XR, Relexxii
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet: Schedule II

  • Ritalin
  • 5mg
  • 10mg
  • 20mg

capsule, extended-release: Schedule II

  • 10mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 15mg (Aptensio XR)
  • 20mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 25mg (Adhansia XR)
  • 30mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 35mg (Adhansia XR)
  • 40mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 45mg (Adhansia XR)
  • 50mg (Aptensio XR, Metadate CD)
  • 55mg (Adhansia XR)
  • 60mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 70mg (Adhansia XR)
  • 85mg (Adhansia XR)

capsule, extended release/delayed release: Schedule II

  • 20mg (Jornay PM)
  • 40mg (Jornay PM)
  • 60mg (Jornay PM)
  • 80mg (Jornay PM)
  • 100mg (Jornay PM)

tablet, extended-release: Schedule II

  • 10mg (Methylin, generics)
  • 18mg (Concerta, Relexxii)
  • 20mg (Methylin, generics)
  • 27mg (Concerta, Relexxii)
  • 36mg (Concerta, Relexxii)
  • 45mg (Relexxii)
  • 54mg (Concerta, Relexxii)
  • 63mg (Relexxii)
  • 72mg (Relexxii)

extended-release tablet, chewable (scored): Schedule II

  • QuilliChew ER
  • 20mg
  • 30mg
  • 40mg

tablet, chewable: Schedule II

  • Methylin
  • 2.5mg
  • 5mg
  • 10mg

oral solution: Schedule II

  • Methylin
  • 5mg/5mL
  • 10mg/5mL

Attention Deficit Hyperactivity Disorder

Adhansia XR: 25 mg PO qAM initially; may titrate upward in increments of 10-15 mg at intervals of at least 5 days; dosages >85 mg/day associated with increased incidence of certain adverse reactions

Aptensio XR: 10 mg PO qDay in AM; may increase weekly by 10-mg increments; not to exceed 60 mg/day

Concerta: Initial for methylphenidate-naïve, 18-36 mg PO qDay; may increase by 18-mg increments at weekly intervals; maintenance dose is 18-72 mg/day

Metadate CD: Initial, 20 mg PO qAM before breakfast; may increase in 10- to 20-mg increments; not to exceed 60 mg/day

Methylin ER: Duration of action ~8 hr; may use in place of methylphenidate IR tablets when 8-hr dosage of methylphenidate ER corresponds to titrated 8-hr dosage of methylphenidate IR; not to exceed 60 mg/day

Ritalin (immediate-release tablets and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; may gradually increase dose at weekly intervals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate

QuilliChew ER (chewable extended-release tablets): 20 mg PO qAM initially; may titrate up or down weekly in increments of 10 mg, 15 mg, or 20 mg; not to exceed 60 mg/day

Jornay PM: Initial, 20 mg PO qDay in the evening; may titrate weekly in increments of 20 mg; not to exceed 100 mg/day; initiate dosing at 8:00 pm; adjust timing of administration between 6:30 pm and 9:30 pm to optimize tolerability and efficacy the next morning and throughout the day

Relexxii: Initial for methylphenidate-naïve, 18-36 mg PO qDay; may increase by 18-mg increments at weekly intervals; maintenance dose is 18-72 mg/day; not to exceed 72 mg/day

Ritalin LA: Initial, 20 mg PO qAM; may adjust dose in weekly 10-mg increments, not to exceed 60 mg/day (patients requiring a lower initial dose may begin with 10 mg)

Narcolepsy

Methylin, Ritalin (immediate-release tablets and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate

Methylin ER: Duration of action is approximately 8 hr; may use in place of methylphenidate IR tablets when 8-hr dosage of methylphenidate ER corresponds to the titrated 8-hr dosage of methylphenidate IR

Dosage Modifications

Dose reduction and discontinuation

  • If paradoxical aggravation of symptoms or other adverse reactions occur, reduce dosage, or, if necessary, discontinue drug
  • Periodically discontinue treatment to assess condition
  • If improvement not observed after appropriate dosage adjustment over a one-month period, discontinue treatment

Conversion from methylphenidate to Concerta or Relexxii

  • Currently on methylphenidate 5 mg BID or TID: Start Concerta or Relexxii at 18 mg qAM
  • Currently on methylphenidate 10 mg BID or TID: Start Concerta or Relexxii at 36 mg qAM
  • Currently on methylphenidate 15 mg BID or TID: Start Concerta or Relexxii at 54 mg qAM
  • Currently on methylphenidate 20 mg BID or TID: Start Concerta or Relexxii at 72 mg qAM

Renal impairment

  • Since renal clearance is not an important route of clearance, renal insufficiency is expected to have little effect on pharmacokinetics of methylphenidate ER tablets

Hepatic impairment

  • \No experience with use in patients with hepatic insufficiency

Dosing Considerations

Before initiating

  • Assess for presence of cardiac disease (eg, family history of sudden death or ventricular arrhythmia)
  • Assess risk of abuse before prescribing and monitor for signs of abuse and dependence during therapy
  • Maintain careful prescription records, educate patients about abuse, and periodically re-evaluate need for use

Dosage Forms & Strengths

tablet: Schedule II

  • Ritalin
  • 5mg
  • 10mg
  • 20mg

capsule, extended-release: Schedule II

  • 10mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 15mg (Aptensio XR)
  • 20mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 25mg (Adhansia XR)
  • 30mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 35mg (Adhansia XR)
  • 40mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 45mg (Adhansia XR)
  • 50mg (Aptensio XR, Metadate CD)
  • 55mg (Adhansia XR)
  • 60mg (Aptensio XR, Ritalin LA, Metadate CD)
  • 70mg (Adhansia XR)
  • 85mg (Adhansia XR)

capsule, extended release/delayed release: Schedule II

  • 20mg (Jornay PM)
  • 40mg (Jornay PM)
  • 60mg (Jornay PM)
  • 80mg (Jornay PM)
  • 100mg (Jornay PM)

tablet, extended-release: Schedule II

  • 10mg (Methylin, generics)
  • 18mg (Concerta, Relexxii)
  • 20mg (Methylin, generics)
  • 27mg (Concerta, Relexxii)
  • 36mg (Concerta, Relexxii)
  • 45mg (Relexxii)
  • 54mg (Concerta, Relexxii)
  • 63mg (Relexxii)
  • 72mg (Relexxii)

extended-release tablet, chewable (scored): Schedule II

  • QuilliChew ER
  • 20mg
  • 30mg
  • 40mg

tablet, chewable: Schedule II

  • Methylin
  • 2.5mg
  • 5mg
  • 10mg

transdermal patch: Schedule II

  • Daytrana
  • 10mg
  • 15mg
  • 20mg
  • 30mg

oral solution: Schedule II

  • Methylin
  • 5mg/5mL
  • 10mg/5mL

oral suspension, extended-release: Schedule II

  • Quillivant XR
  • 25mg/5mL (following reconstitution)

extended-release tablet, oral disintegrating

  • Cotempla XR-ODT
  • 8.6mg
  • 17.3mg
  • 25.9mg

Attention Deficit Hyperactivity Disorder

<6 years: Safety and efficacy not established

≥6 years

  • Aptensio XR: 10 mg PO qDay in AM; may increase weekly by 10-mg increments; not to exceed 60 mg/day
  • Adhansia XR: 25 mg PO qAM initially; may titrate up in increments of 10-15 mg at intervals of at least 5 days; dosages ≥70 mg/day associated with increased incidence of certain adverse reactions
  • Cotempla XR-ODT (oral disintegrating tablets): 17.3 mg PO qAM initially; may titrate upward weekly by 8.6-17.3 mg increments; not to exceed 51.8 mg/day
  • Methylin, Ritalin (immediate-release tablets and oral solution): 5 mg PO BID 30-45 minutes before breakfast and lunch initially; may increase by 5-10 mg/day at weekly intervals; not to exceed 60 mg/day divided BID/TID
  • Methylin ER: May be given in place of immediate-release products once daily dose is titrated and the titrated 8-hr dosage corresponds to SR or ER tablet size; not to exceed 60 mg/day
  • Metadate CD, Ritalin LA: Initial, 20 mg PO qAM; may increase by 10 mg (Ritalin LA) or 10-20 mg (Metadate CD) qWeek to not to exceed 60 mg/day
  • Quillivant XR (6-12 years): 20 mg PO qAM initially; may titrate at weekly intervals by weekly 10- to 20-mg increments; not to exceed 60 mg/day
  • QuilliChew ER (chewable extended-release tablets): 20 mg PO qAM initially; may be titrated up or down weekly in increments of 10 mg, 15 mg, or 20 mg, not to exceed 60 mg/day
  • Immediate-release weight-based dosing
    • Initial: 0.3 mg/kg/dose PO before breakfast and lunch; may increase by 0.1 mg/kg/dose qWeek  
    • Maintenance: 0.3-1 mg/kg PO before breakfast and lunch; not to exceed 2 mg/kg/day PO divided q12hr
  • Concerta or Relexxii (methylphenidate-naïve)
    • Initial: 18 mg PO qDay; dosage may be increased by 18 mg/day at weekly intervals
    • Do not exceed 54 mg/day in children (6-12 years) and 72 mg/day in adolescents (13-17 years)
  • Jornay PM
    • Initial: 20 mg PO qDay in the evening; may titrate weekly in increments of 20 mg; not to exceed 100 mg/day
    • Initiate dosing at 8:00 p.m.; adjust timing of administration between 6:30 pm and 9:30 pm to optimize tolerability and efficacy the next morning and throughout the day

Narcolepsy

<6 years

  • Safety and efficacy not established

≥6 years

  • Methylin, Ritalin (immediate-release tablets and oral solution): 5 mg PO q12hr; may increase by 5-10 mg/day weekly; not to exceed 60 mg/day
  • Methylin ER,: May be given in place of immediate-release products once the daily dose is titrated and the titrated 8-hour dosage corresponds to ER tablet size; not to exceed 60 mg/day

Dosage Modifications

Dose reduction and discontinuation

  • If paradoxical aggravation of symptoms or other adverse reactions occur, reduce dosage, or, if necessary, discontinue drug
  • Periodically discontinue treatment to assess condition
  • If improvement not observed after appropriate dosage adjustment over a one-month period, discontinue treatment

Conversion from methylphenidate to Concerta or Relexxii

  • Currently on methylphenidate 5 mg BID or TID: Start Concerta or Relexxii at 18 mg qAM
  • Currently on methylphenidate 10 mg BID or TID: Start Concerta or Relexxii at 36 mg qAM
  • Currently on methylphenidate 15 mg BID or TID: Start Concerta or Relexxii at 54 mg qAM
  • Currently on methylphenidate 20 mg BID or TID: Start Concerta or Relexxii at 72 mg qAM

Renal impairment

  • Since renal clearance is not an important route of clearance, renal insufficiency is expected to have little effect on pharmacokinetics of methylphenidate ER tablets

Hepatic impairment

  • No experience with use in patients with hepatic insufficiency

Dosing Considerations

Before initiating

  • Assess for presence of cardiac disease (eg, family history of sudden death or ventricular arrhythmia)
  • Assess risk of abuse before prescribing and monitor for signs of abuse and dependence while on therapy
  • Maintain careful prescription records, educate patients about abuse, and periodically re-evaluate the need for use

Limitations of use (Aptensio XR)

  • Patients <6 years of age experienced higher plasma exposure than patients aged ≥6 at the same dose and high rates of adverse reactions, most notably weight loss
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Interactions

Interaction Checker

and methylphenidate

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (12)

            • benzphetamine

              benzphetamine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • diethylpropion

              diethylpropion increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • isocarboxazid

              isocarboxazid increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • linezolid

              linezolid increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phendimetrazine

              phendimetrazine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenelzine

              phenelzine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • phentermine

              phentermine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • rasagiline

              rasagiline increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • safinamide

              safinamide increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • selegiline

              selegiline increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • selegiline transdermal

              selegiline transdermal increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            • tranylcypromine

              tranylcypromine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.

            Serious - Use Alternative (18)

            • cabergoline

              cabergoline, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • desflurane

              desflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • dihydroergotamine

              dihydroergotamine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • doxapram

              doxapram increases effects of methylphenidate by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

            • ergoloid mesylates

              ergoloid mesylates, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ergotamine

              ergotamine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ethanol

              ethanol increases levels of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Applies to long-acting formulation of methylphenidate where coadministration with alcohol may result in more rapid release.

            • ether

              ether increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • iobenguane I 123

              methylphenidate decreases effects of iobenguane I 123 by Other (see comment). Avoid or Use Alternate Drug. Comment: Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose.

            • isoflurane

              isoflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • lofepramine

              lofepramine, methylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • maprotiline

              maprotiline, methylphenidate. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • methoxyflurane

              methoxyflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • methylergonovine

              methylergonovine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ozanimod

              ozanimod increases toxicity of methylphenidate by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • sevoflurane

              sevoflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • yohimbe

              yohimbe, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            Monitor Closely (143)

            • albuterol

              albuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aluminum hydroxide

              aluminum hydroxide decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • amitriptyline

              amitriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amlodipine

              methylphenidate will decrease the level or effect of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • amoxapine

              amoxapine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • apomorphine

              apomorphine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • arformoterol

              arformoterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aripiprazole

              aripiprazole increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • armodafinil

              armodafinil increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • asenapine

              asenapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • atomoxetine

              methylphenidate will increase the level or effect of atomoxetine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • azilsartan

              methylphenidate will decrease the level or effect of azilsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • benazepril

              methylphenidate will decrease the level or effect of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, methylphenidate. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

            • bromocriptine

              bromocriptine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • caffeine

              caffeine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • calcium carbonate

              calcium carbonate decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • candesartan

              methylphenidate will decrease the level or effect of candesartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • captopril

              methylphenidate will decrease the level or effect of captopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • carbamazepine

              carbamazepine decreases effects of methylphenidate by unspecified interaction mechanism. Use Caution/Monitor. Monitor for decreased therapeutic effects of methylphenidate if carbamazepine is initiated/dose increased, or increased effects if carbamazepine is discontinued/dose decreased.

            • cariprazine

              cariprazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • chlorpromazine

              chlorpromazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • cimetidine

              cimetidine decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • clevidipine

              methylphenidate will decrease the level or effect of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • clomipramine

              clomipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • clozapine

              clozapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • cocaine

              cocaine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • desipramine

              desipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dexfenfluramine

              dexfenfluramine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dexlansoprazole

              dexlansoprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • dexmethylphenidate

              dexmethylphenidate increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • dextroamphetamine

              dextroamphetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • didanosine

              didanosine will decrease the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Interaction specifically associated with Ritalin LA.

            • diltiazem

              methylphenidate will decrease the level or effect of diltiazem by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • dobutamine

              dobutamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopamine

              dopamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopexamine

              dopexamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • doxepin

              doxepin, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dronabinol

              methylphenidate will increase the level or effect of dronabinol by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • enalapril

              methylphenidate will decrease the level or effect of enalapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • ephedrine

              ephedrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine

              epinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine inhaled

              methylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

              epinephrine racemic and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • eprosartan

              methylphenidate will decrease the level or effect of eprosartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • esketamine intranasal

              esketamine intranasal, methylphenidate. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .

            • esomeprazole

              esomeprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • famotidine

              famotidine will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies only to extended release formulation

              famotidine decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • felodipine

              methylphenidate will decrease the level or effect of felodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • fenfluramine

              fenfluramine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • fluphenazine

              fluphenazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              fluphenazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • formoterol

              formoterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • fosinopril

              methylphenidate will decrease the level or effect of fosinopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • fosphenytoin

              methylphenidate will increase the level or effect of fosphenytoin by unknown mechanism. Use Caution/Monitor. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased.

            • green tea

              green tea, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Green tea may include caffeine. Caffeine is a CNS-stimulant and additive effects may be seen when coadministered with other CNS stimulants. Caffeine should be avoided or used cautiously.

            • haloperidol

              haloperidol increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • hydralazine

              hydralazine, methylphenidate. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

            • hydrocodone

              hydrocodone, methylphenidate. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

            • ibuprofen/famotidine

              ibuprofen/famotidine will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies only to extended release formulation

            • iloperidone

              iloperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • imipramine

              imipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • iohexol

              methylphenidate decreases effects of iohexol by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS stimulant should be discontinued at least 48 hours before myelography, should not be used for the control of nausea or vomiting during or after myelography, and should not be resumed for at least 24 hours postprocedure.

            • iopamidol

              methylphenidate decreases effects of iopamidol by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS stimulant should be discontinued at least 48 hours before myelography, should not be used for the control of nausea or vomiting during or after myelography, and should not be resumed for at least 24 hours postprocedure.

            • irbesartan

              methylphenidate will decrease the level or effect of irbesartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • isoproterenol

              isoproterenol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • isradipine

              methylphenidate will decrease the level or effect of isradipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • lansoprazole

              lansoprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • levalbuterol

              levalbuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • levodopa

              levodopa, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • lisdexamfetamine

              lisdexamfetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • lisinopril

              methylphenidate will decrease the level or effect of lisinopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • losartan

              methylphenidate will decrease the level or effect of losartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • loxapine

              loxapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • loxapine inhaled

              loxapine inhaled increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • lurasidone

              lurasidone, methylphenidate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects.

              lurasidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • magnesium oxide

              magnesium oxide decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • metaproterenol

              metaproterenol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methamphetamine

              methamphetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • methyldopa

              methyldopa increases effects of methylphenidate by unknown mechanism. Use Caution/Monitor.

            • modafinil

              modafinil increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • moexipril

              methylphenidate will decrease the level or effect of moexipril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • molindone

              molindone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • nadolol

              methylphenidate will decrease the level or effect of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nicardipine

              methylphenidate will decrease the level or effect of nicardipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nifedipine

              methylphenidate will decrease the level or effect of nifedipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nimodipine

              methylphenidate will decrease the level or effect of nimodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nisoldipine

              methylphenidate will decrease the level or effect of nisoldipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • nizatidine

              nizatidine will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Applies only to extended release formulation

              nizatidine decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • norepinephrine

              norepinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • nortriptyline

              nortriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • olanzapine

              olanzapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • olmesartan

              methylphenidate will decrease the level or effect of olmesartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • omeprazole

              omeprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • oxytocin

              oxytocin increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor.

            • paliperidone

              paliperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • pantoprazole

              pantoprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • penbutolol

              methylphenidate will decrease the level or effect of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • perindopril

              methylphenidate will decrease the level or effect of perindopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • perphenazine

              perphenazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              perphenazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • phenobarbital

              methylphenidate will increase the level or effect of phenobarbital by unknown mechanism. Use Caution/Monitor. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased.

            • phenoxybenzamine

              methylphenidate will decrease the level or effect of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • phentolamine

              methylphenidate will decrease the level or effect of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • phenytoin

              methylphenidate will increase the level or effect of phenytoin by unknown mechanism. Use Caution/Monitor. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased.

            • pimavanserin

              pimavanserin increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • pimozide

              pimozide increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • pirbuterol

              pirbuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pramipexole

              pramipexole, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • prazosin

              methylphenidate will decrease the level or effect of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • procarbazine

              procarbazine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • prochlorperazine

              prochlorperazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promazine

              promazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promethazine

              promethazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • propranolol

              methylphenidate will decrease the level or effect of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • protriptyline

              protriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • quetiapine

              quetiapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • quinapril

              methylphenidate will decrease the level or effect of quinapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • rabeprazole

              rabeprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • ramipril

              methylphenidate will decrease the level or effect of ramipril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • risperidone

              risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • ropinirole

              ropinirole, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • rotigotine

              rotigotine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.

            • sacubitril/valsartan

              methylphenidate will decrease the level or effect of sacubitril/valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • salmeterol

              salmeterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • serdexmethylphenidate/dexmethylphenidate

              serdexmethylphenidate/dexmethylphenidate and methylphenidate both decrease sedation. Use Caution/Monitor.

              serdexmethylphenidate/dexmethylphenidate and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              serdexmethylphenidate/dexmethylphenidate increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • sodium zirconium cyclosilicate

              sodium zirconium cyclosilicate will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.

            • solriamfetol

              methylphenidate and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • sotalol

              methylphenidate will decrease the level or effect of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • sufentanil SL

              sufentanil SL, methylphenidate. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

            • telmisartan

              methylphenidate will decrease the level or effect of telmisartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • terazosin

              methylphenidate will decrease the level or effect of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • terbutaline

              terbutaline and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • thioridazine

              thioridazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • thiothixene

              thiothixene increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • timolol

              methylphenidate will decrease the level or effect of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • trandolapril

              methylphenidate will decrease the level or effect of trandolapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • trazodone

              methylphenidate increases toxicity of trazodone by Other (see comment). Modify Therapy/Monitor Closely. Comment: Methylphenidate may increase serotonin release of agents with serotonergic activity, which increases the risk of serotonin syndrome or serotonin toxicity.

            • trifluoperazine

              trifluoperazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              trifluoperazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • trimipramine

              trimipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • valsartan

              methylphenidate will decrease the level or effect of valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • verapamil

              methylphenidate will decrease the level or effect of verapamil by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • warfarin

              methylphenidate increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.

            • ziprasidone

              ziprasidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            Minor (5)

            • amantadine

              amantadine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Potential for additive CNS stimulation.

            • American ginseng

              American ginseng increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.

            • desmopressin

              desmopressin increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.

            • guarana

              guarana increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.

            • yerba mate

              yerba mate increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            ER capsules (adults)

            • Insomnia (16%)
            • Decreased appetite (11%)

            Adhansia XR (patients aged 6-12 years)

            • Decreased appetite (35%)
            • Upper abdominal pain (15%)
            • Affect lability (13%)
            • Nausea or vomiting (13%)
            • Decreased weight (12%)

            Adhansia XR (patients aged 12-17 years)

            • Decreased appetite (20%)

            Aptensio XR

            • Headache (10.9%)

            Concerta or Relexxii (adults)

            • Decreased appetite (25.3%)
            • Headache (22.2%)
            • Dry mouth (14%)
            • Nausea (12.8%)
            • Insomnia (12.3%)

            Jornay PM

            • Any insomnia (33%)
            • Decreased appetite (19%)

            Metadate CD

            • Headache (12%)

            1-10%

            Adhansia XR (adults)

            • Dry mouth (9%)
            • Initial insomnia (6%)
            • Nausea (6%)
            • Diarrhea (4%)
            • Feeling jittery (4%)
            • Decreased weight (4%)
            • Headache (4%)
            • Fatigue (3%)
            • Upper respiratory tract infection (2%)
            • Irritability (2%)
            • Nausea (2%)
            • Dysmenorrhea (2%)

            Adhansia XR (patients aged 6-12 years)

            • Insomnia (10%)
            • Irritability (10%)
            • Headache (10%)
            • Heart rate increased (5%)

            Adhansia XR (patients aged 12-17 years)

            • Weight decreased (7%)
            • Insomnia (6%)
            • Nausea (6%)
            • Initial insomnia (5%)
            • Upper abdominal pain (4%)
            • Dizziness (3%)
            • Dry mouth (3%)
            • Vomiting (3%)

            Aptensio XR

            • Insomnia (9.8%)
            • Upper abdominal pain (8.2%)
            • Decreased appetite (4.9%)
            • Nausea or vomiting (3.8%)
            • Dizziness (2.2%)

            Concerta or Relexxii (pediatric patients)

            • Upper abdominal pain (6.2%)
            • Irritability (5.8%)
            • Vomiting (2.8%)
            • Nasopharyngitis (2.8%)
            • Insomnia (2.8%)
            • Pyrexia (2.2%)
            • Dyspepsia (2.2%)
            • Dizziness (1.9%)
            • Cough (1.9%)
            • Vomiting (1.7%)
            • Constipation (1.4%)
            • Oropharyngeal pain (1.2%)

            Concerta or Relexxii (adults)

            • Anxiety (8.2%)
            • Dizziness (6.7%)
            • Decreased weight (6.5%)
            • Hyperhidrosis (5.1%)
            • Tachycardia (4.8%)
            • Initial insomnia (4.3%)
            • Depressed mood (3.9%)
            • Palpitations (3.1%)
            • Nervousness (3.1%)
            • Restlessness (3.1%)
            • Tremor (2.7%)
            • Upper respiratory tract infection (2.2%)
            • Agitation (2.2%)
            • Muscle tightness (1.9%)
            • Vertigo (1.7%)
            • Vision blurred (1.7%)
            • Anorexia (1.7%)
            • Aggression (1.7%)
            • Bruxism (1.7%)
            • Depression (1.7%)
            • Libido decreased (1.7%)
            • Oropharyngeal pain (1.7%)
            • Affect liability (1.4%)
            • Paresthesia (1.2%)
            • Sedation (1.2%)
            • Tension headache (1.2%)
            • Confusional state (1.2%)
            • Tension (1.2%)

            Jornay PM

            • Headache (10%)
            • Vomiting (9%)
            • Blood pressure diastolic increased (7%)
            • Nausea (6%)
            • Psychomotor hyperactivity (5%)
            • Nasopharyngitis (3%)
            • Pharyngitis streptococcal (3%)
            • Contusion (3%)
            • Back pain (3%)
            • Rash (2%)

            Metadate CD

            • Anorexia (9%)
            • Abdominal pain (7%)
            • Insomnia (5%)

            Frequency Not Defined

            Headache

            Hypertension

            Nausea

            Nervousness

            Toxic psychosis

            Seizures

            Tachycardia

            Angina

            Cardiac arrhythmia

            Cerebral occlusion

            Increased/decreased pulse

            Cerebral arteritis

            Cerebral hemorrhage

            Raynaud's phenomenom

            Vasculitis

            Anxiety

            Anger

            Agitation

            Irritability

            Vertigo

            Fatigue

            Erythema multiform

            Hyperhidrosis

            Rash

            Urticaria

            Exfoliative dermatitis

            Dysmenorrhea

            Constipation

            Xerostomia

            Vomiting

            Weight loss

            Erectile dysfunction

            Muscle tightness

            Paresthesia

            Blurred vision

            Necrotizing vasculitis

            Increased cough

            Dyspnea

            Sinusitis

            Upper respiratory tract infection

            Postmarketing Reports

            Blood and lymphatic system disorders: Pancytopenia, thrombocytopenia, thrombocytopenic purpura

            Cardiac disorders: Angina pectoris, bradycardia, extrasystole, supraventricular tachycardia, ventricular extrasystole, hypertension

            Eye disorders: Diplopia, mydriasis, visual impairment

            General Disorders: Chest pain, chest discomfort, hyperpyrexia, long-term growth suppression

            Hepatobiliary disorders: Hepatocellular injury, acute hepatic failure

            Immune system disorders: Hypersensitivity reactions such as angioedema, anaphylactic reactions, auricular swelling, bullous conditions, exfoliative conditions, urticaria, pruritus, rashes, eruptions, and exanthemas

            Investigations: Alkaline phosphatase increased, bilirubin increased, hepatic enzyme increased, platelet count decreased, white blood cell count abnormal, severe hepatic injury

            Musculoskeletal, connective tissue and bone disorders: Arthralgia, myalgia, muscle twitching, rhabdomyolysis

            Nervous system disorders: Convulsion, grand mal convulsion, dyskinesia, serotonin syndrome in combination with serotonergic drugs, lethargy, somnolence

            Psychiatric disorders: Disorientation, hallucination, hallucination auditory, hallucination visual, libido changes, mania, depression, drug dependence

            Urogenitial system: Priapism

            Vascular system: Peripheral vasculopathy, including Raynaud phenomenon

            Skin and subcutaneous tissue disorders: Alopecia, erythema

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            Warnings

            Black Box Warnings

            Abuse and dependence

            • CNS stimulants, including methylphenidate-containing products, and amphetamines, have a high potential for abuse and dependence
            • Assess the risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy

            Contraindications

            Hypersensitivity to methylphenidate or other components of product

            Coadministration with monoamine oxidase inhibitors (MAOIs) or within 14 days after discontinuing MAOIs

            Concerta

            • Motor tics or family history or diagnosis of Tourette syndrome
            • Glaucoma
            • Patients with marked anxiety, tension, and agitation

            Metadate CD

            • Contains sucrose; do not administer to patients with hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency

            Cautions

            Assess risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy

            May cause an increase in blood pressure (BP) and heart rate (HR); monitor for hypertension and tachycardia

            Prolonged and painful erections, sometimes requiring surgical intervention, reported with methylphenidate products, including another formulation of methylphenidate hydrochloride extended-release tablets, in both pediatric and adult patients

            Priapism was not reported with drug initiation but developed during treatment, often after an increase in dose and during a period of drug withdrawal (drug holidays or during discontinuation); if such reaction occurs, seek immediate medical attention

            CNS stimulants are associated with peripheral vasculopathy, including Raynaud phenomenon; signs and symptoms are usually intermittent and generally improve after dose reduction or discontinuing treatment; monitor for digital changes is necessary during treatment; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients

            Closely monitor growth (weight and height) in pediatric patients treated with stimulants; patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted

            Stimulants may lower the convulsive threshold in patients with a history of seizures, in patients with prior EEG abnormalities in absence of seizures, and, very rarely, in patients without a history of seizures and no prior EEG evidence of seizures; if seizures occur, discontinue drug

            Difficulties with accommodation and blurry vision reported

            Periodic complete blood cell count, differential, and platelet counts are advised during prolonged therapy

            Potential bowel obstruction

            • Concerta or Relexxii
            • Tablet formulation is nondeformable and does not appreciably change in shape in the GI tract
            • Do not administer to patients with pre-existing severe gastrointestinal narrowing conditions, including esophageal motility disorders,small bowel inflammatory disease, "short gut" syndrome due to adhesions or decreased transit time, cystic fibrosis, history of peritonitis, or chronic intestinal pseudo-obstruction, or Meckel diverticulum
            • Use only in patients who can swallow tablets whole

            Psychiatric adverse reactions

            • CNS stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a preexisting psychotic disorder
            • CNS stimulants may also induce a manic or mixed episode in patients
            • Before initiating treatment, screen for risk factors for developing a manic episode (eg, history or family history of suicide, bipolar disorder, and depression)
            • CNS stimulants at recommended doses, may cause psychotic or manic symptoms (eg, hallucinations, delusional thinking, or mania) in patients without a prior history of psychotic illness or mania; consider discontinuing therapy if such symptom occur

            Serious cardiovascular reactions

            • Sudden death, stroke, and myocardial infarction report in adults
            • Sudden death reported in pediatric patients with structural cardiac abnormalities and other serious heart problems
            • Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, and other serious heart problems
            • Further evaluate for developing exertional chest pain, unexplained syncope, or arrhythmias during treatment

            Adhansia XR only

            • 45-mg capsules contain FD&C yellow #5 (tartrazine) which may cause allergic-type reactions (including bronchial asthma) in certain susceptible persons

            Drug interaction overview

            • MAOIs
              • Contraindicated
              • Do administer during or within 14 days of discontinuing MAOI treatment
              • Coadministration of MAOIs with CNS stimulants can cause hypertensive crisis, which increases the risk of death, stroke, myocardial infarction, aortic dissection, ophthalmological complications, eclampsia, pulmonary edema, and renal failure
            • Antihypertensive drugs
              • Monitor BP and adjust dose of antihypertensive drugs accordingly
              • Methylphenidate may decrease effectiveness of antihypertensive drugs
            • Halogenated anesthetics
              • Avoid using methylphenidate on day of surgery
              • Methylphenidate concomitantly used halogenated anesthetics may potentiate the risk of sudden BP and HR increase during surgery
            • Risperidone
              • Monitor for signs of extrapyramidal symptoms (EPS)
              • Dose changes in either risperidone and/or methylphenidate may increase the risk of EPS
            • Gastric pH modulators (Adhansia XR, Cotempla XR-ODT only)
              • Monitor and use alternant based on clinical response
              • Gastric pH modulators (eg, proton pump inhibitors, H2-blockers) may change the release, pharmacokinetic profiles, and pharmacodynamics of Adhansia XR
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            Pregnancy & Lactation

            Pregnancy

            Published studies and postmarketing reports on use during pregnancy have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

            Animal data

            • No teratogenic effects were observed with oral administration of methylphenidate to pregnant rats and rabbits during organogenesis at doses up to 2x and 9x the maximum recommended human dose (MRHD) of 100 mg/day given to adolescents on a mg/m2 basis, respectively
            • However, spina bifida was observed in rabbits at a dose 31x the MRHD given to adolescents
            • Decrease in pup body weight was observed in a pre- and postnatal development study with oral administration of methylphenidate to rats throughout pregnancy and lactation at doses 3.5x the MRHD given to adolescents

            Clinical considerations

            • CNS stimulant medications can cause vasoconstriction and thereby decrease placental perfusion
            • No fetal and/or neonatal adverse reactions reported with use of therapeutic doses of methylphenidate during pregnancy; however, premature delivery and low birth weight infants have been reported in amphetamine-dependent mothers

            Pregnancy exposure registry

            • Monitors pregnancy outcomes in females exposed to ADHD medications
            • Encourage providers to register patients by calling the National Pregnancy Registry for ADHD Medications at 1-866-961-2388

            Lactation

            Limited published literature, based on breast milk sampling from five mothers, reports that methylphenidate is present in human milk, which resulted in infant doses of 0.16% to 0.7% of the maternal weight-adjusted dosage and a milk/plasma ratio ranging between 1.1 and 2.7

            There are no reports of adverse effects on breastfed infant and no effects on milk production; however, long-term neurodevelopmental effects on infants from CNS stimulant exposure are unknown

            Monitor breastfeeding infants for adverse reactions, such as agitation, insomnia, anorexia, and reduced weight gain

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Unknown; may block reuptake of norepinephrine and dopamine into presynaptic neurons; may stimulate CNS similar to amphetamines; may stimulate cerebral cortex and subcortical structures

            Absorption

            Bioavailability

            • Aptensio XR: 101-102%
            • Jornay PM: 73.9%

            Peak plasma concentration

            • ER tablets: 19.3-19.7 ng/mL(72-mg dose); 3.7 ng/mL (18 mg-dose)
            • Aptensio XR: 23.47 ng/mL (capsule); 21.78 ng/mL (sprinkle)

            Peak plasma time

            • ER tablets: 5.5 hr (72-mg dose); 6.8 hr (18-mg dose)
            • Adhansia XR: 1.5 hr (1st median range time); 12 hr (2nd median range time)
            • Aptensio XR: 2 hr
            • Jornay PM: 14 hr

            AUC

            • ER tablets: 200.9-206.1 ng⋅hr/mL (72-mg dose); 41.8 ng⋅hr/mL (18-mg dose)
            • Aptensio XR: 258.1-262.7 ng⋅hr/mL (capsule): 258-262.9 ng⋅hr/mL (sprinkle)

            Distribution

            Plasma methylphenidate concentrations in adults and pediatric patients 13-17 years decline biexponentially following oral administration

            Vd: 2.65 L/kg (d-methylphenidate); 1.8 L/kg ( l-methylphenidate)

            Metabolism

            Primarily metabolized by de-esterification to PPAA (little or no pharmacologic activity)

            Elimination

            Half-life

            • ER tablets: 3.5 hr (18-mg dose)
            • Aptensio XR: 5.09 hr (capsule); 5.43 hr (sprinkle)
            • Jornay PM: 5.9 hr
            • Metadate CD: 6.8 hr
            • Immediate-release tablets: 2.9 hr

            Excretion

            • Urine: 90% (80% main urinary metabolite PPAA)
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            Administration

            Oral Administration

            Do not substitute for other methylphenidate products on an mg-per-mg basis, because of different methylphenidate base compositions and differing pharmacokinetic profiles

            Concerta or Relexxii

            • Take orally in the morning with or without food
            • Swallow tablet whole with liquid; do not chew, divide, or crush

            QuilliChew ER

            • Extended-release chewable tablet
            • Take once in morning
            • May take with or without food
            • Switching from other methylphenidate products
              • If switching from other methylphenidate products, discontinue that treatment, and titrate with QuilliChew ER using the titration schedule (see Pediatric Dosing)

            Methylin ER tablet

            • Swallow whole; do not crush or chew
            • Take 30-45 minutes before meals

            Ritalin

            • Ritalin: Swallow whole, do not crush or chew
            • Ritalin LA capsule: Swallow whole, do not crush or chew; may open capsule and sprinkle contents on applesauce and consumed immediately
            • Take all formulations 30-45 minutes before meals

            Metadate

            • Metadate CD: Swallow whole, do not crush or chew; may open capsule and sprinkle contents on applesauce and consumed immediately; administer once daily in AM

            Quillivant XR

            • Oral extended-release suspension
            • Shake bottle vigorously for at least 10 seconds before measuring dose
            • May take with or without food

            Aptensio XR

            May take with or without food

            Advise patients to establish a routine pattern regarding meals

            Capsules may be swallowed whole or opened and the entire contents sprinkled onto applesauce and consume immediately

            Cotempla XR-ODT

            • Take consistently with or without food
            • Use dry hands when opening the blister pack
            • Do not remove the tablet from the blister pack until just before dosing
            • Remove tablet by peeling back foil on blister pack; do not push the tablet through the foil
            • Do not store tablet for future use
            • Administer immediately after opening by placing the tablet on patient’s tongue and letting it dissolve; do not chew or crush
            • Disintegrate in saliva so that it can be swallowed; no liquid is needed to take the tablet

            Jornay PM

            • Not to be administered in the morning
            • Following determination of optimal administration time, advise patients to maintain a consistent dosing time
            • Advise patients to take the dose consistently either with or without food
            • May take capsule whole, or may be opened and the entire contents sprinkled onto applesauce; if patient is using the sprinkled administration method, the sprinkled applesauce should be consumed immediately and not stored and should be taken in its entirety without chewing; the dose of a single capsule should not be divided and should be taken at the same time
            • Periodically reevaluate long term use and adjust dosage as needed
            • Missed dose
              • Take dose as soon possible that same evening; if patient remembers the missed dose the following morning, skip missed dose and wait until next scheduled evening administration
            • Switching from other methylphenidate products
              • If switching from other methylphenidate products, discontinue that treatment, and titrate with Jornay PM using the titration schedule described above

            Adhansia XR

            • Swallow whole or open capsule and sprinkle entire contents onto 1 tablespoon of applesauce or yogurt; consume entire mixture immediately or within 10 min
            • Take the entire contents of capsule sprinkled on chosen food in its entirety, without chewing
            • Discard mixture if not consumed within 10 min; do not store
            • Do not divide capsules nor take <1 capsule/day
            • Missed dose
              • Do not administer later in the day
              • Do not administer additional medication to make up for missed
            • Switching from other methylphenidate products
              • Switching from other methylphenidate products: Discontinue current treatment and titrate with Adhansia XR using titration schedule

            Storage

            Metadate CD: Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F); protect from light and moisture

            Concerta. Relexxii: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F); protect from humidity

            Adhansia XR: Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F); protect from light

            Extended-release chewable (QuilliChew ER): Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F)

            Extended-release orally disintegrating (Cotempla XR-ODT): Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F); store in reusable travel case

            Immediate-release (Ritalin): Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F); protect from light

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Ritalin oral
            -
            20 mg tablet
            Ritalin oral
            -
            10 mg tablet
            Ritalin oral
            -
            5 mg tablet
            QuilliChew ER oral
            -
            30 mg chewable tablet
            QuilliChew ER oral
            -
            20 mg chewable tablet
            QuilliChew ER oral
            -
            40 mg chewable tablet
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            Quillivant XR oral
            -
            5 mg/mL (25 mg/5 mL) suspension
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            10 mg chewable tablet
            methylphenidate HCl oral
            -
            5 mg chewable tablet
            methylphenidate HCl oral
            -
            2.5 mg chewable tablet
            methylphenidate HCl oral
            -
            54 mg tablet
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            27 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            40 mg capsule
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            15 mg capsule
            methylphenidate HCl oral
            -
            50 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
            -
            10 mg tablet
            methylphenidate HCl oral
            -
            5 mg chewable tablet
            methylphenidate HCl oral
            -
            20 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
            -
            5 mg tablet
            methylphenidate HCl oral
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            20 mg capsule
            methylphenidate HCl oral
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            30 mg capsule
            methylphenidate HCl oral
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            2.5 mg chewable tablet
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            54 mg tablet
            methylphenidate HCl oral
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            36 mg tablet
            methylphenidate HCl oral
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            18 mg tablet
            methylphenidate HCl oral
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            60 mg capsule
            methylphenidate HCl oral
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            40 mg capsule
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
            -
            5 mg/5 mL solution
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            36 mg tablet
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            30 mg capsule
            methylphenidate HCl oral
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            20 mg capsule
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            54 mg tablet
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            20 mg capsule
            methylphenidate HCl oral
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            30 mg capsule
            methylphenidate HCl oral
            -
            36 mg tablet
            methylphenidate HCl oral
            -
            18 mg tablet
            methylphenidate HCl oral
            -
            20 mg capsule
            methylphenidate HCl oral
            -
            10 mg capsule
            methylphenidate HCl oral
            -
            30 mg capsule
            methylphenidate HCl oral
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            30 mg capsule
            methylphenidate HCl oral
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            40 mg capsule
            methylphenidate HCl oral
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            20 mg capsule
            methylphenidate HCl oral
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            60 mg capsule
            methylphenidate HCl oral
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            50 mg capsule
            methylphenidate HCl oral
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            60 mg capsule
            methylphenidate HCl oral
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            40 mg capsule
            methylphenidate HCl oral
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            30 mg capsule
            methylphenidate HCl oral
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            20 mg capsule
            methylphenidate HCl oral
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            10 mg capsule
            methylphenidate HCl oral
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            10 mg capsule
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            5 mg tablet
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            10 mg capsule
            methylphenidate HCl oral
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            5 mg tablet
            methylphenidate HCl oral
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            36 mg tablet
            methylphenidate HCl oral
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            27 mg tablet
            methylphenidate HCl oral
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            60 mg capsule
            methylphenidate HCl oral
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            27 mg tablet
            methylphenidate HCl oral
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            30 mg capsule
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            20 mg capsule
            methylphenidate HCl oral
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            54 mg tablet
            methylphenidate HCl oral
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            27 mg tablet
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            40 mg capsule
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            5 mg tablet
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            5 mg tablet
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            18 mg tablet
            methylphenidate HCl oral
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            27 mg tablet
            methylphenidate HCl oral
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            18 mg tablet
            methylphenidate HCl oral
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            27 mg tablet
            methylphenidate HCl oral
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            54 mg tablet
            methylphenidate HCl oral
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            36 mg tablet
            methylphenidate HCl oral
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            18 mg tablet
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            10 mg capsule
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            10 mg tablet
            methylphenidate HCl oral
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            20 mg tablet
            methylphenidate HCl oral
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            5 mg tablet
            methylphenidate HCl oral
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            40 mg capsule
            methylphenidate HCl oral
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            10 mg capsule
            methylphenidate HCl oral
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            50 mg capsule
            methylphenidate HCl oral
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            20 mg capsule
            methylphenidate HCl oral
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            10 mg capsule
            methylphenidate HCl oral
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            50 mg capsule
            methylphenidate HCl oral
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            54 mg tablet
            methylphenidate HCl oral
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            27 mg tablet
            methylphenidate HCl oral
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            30 mg capsule
            methylphenidate HCl oral
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            20 mg capsule
            methylphenidate HCl oral
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            10 mg capsule
            methylphenidate HCl oral
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            36 mg tablet
            methylphenidate HCl oral
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            40 mg capsule
            methylphenidate HCl oral
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            27 mg tablet
            methylphenidate HCl oral
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            18 mg tablet
            methylphenidate HCl oral
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            50 mg capsule
            Metadate ER oral
            -
            20 mg tablet
            Aptensio XR oral
            -
            50 mg capsule
            Aptensio XR oral
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            15 mg capsule
            Aptensio XR oral
            -
            10 mg capsule
            Aptensio XR oral
            -
            30 mg capsule
            Aptensio XR oral
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            40 mg capsule
            Aptensio XR oral
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            60 mg capsule
            Aptensio XR oral
            -
            20 mg capsule
            Concerta oral
            -
            36 mg tablet
            Concerta oral
            -
            54 mg tablet
            Concerta oral
            -
            18 mg tablet
            Concerta oral
            -
            27 mg tablet
            Ritalin LA oral
            -
            10 mg capsule
            Ritalin LA oral
            -
            40 mg capsule
            Ritalin LA oral
            -
            30 mg capsule
            Ritalin LA oral
            -
            20 mg capsule
            Adhansia XR oral
            -
            70 mg capsule
            Adhansia XR oral
            -
            35 mg capsule
            Adhansia XR oral
            -
            25 mg capsule
            Adhansia XR oral
            -
            85 mg capsule
            Adhansia XR oral
            -
            55 mg capsule
            Adhansia XR oral
            -
            45 mg capsule
            Jornay PM oral
            -
            60 mg capsule
            Jornay PM oral
            -
            40 mg capsule
            Jornay PM oral
            -
            20 mg capsule
            Jornay PM oral
            -
            100 mg capsule
            Jornay PM oral
            -
            80 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Formulary

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.