Methylphenidate

FDA label

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Titration Peds: increase weekly (5–10 mg increments)

Renal Undefined

Hepatic Undefined

Instructions

• Take 30–45 min before meals (adults); peds doses before breakfast and lunch
• If insomnia, take last dose before 6 p.m.
• Reduce dose or discontinue if paradoxical worsening or adverse reactions
• Discontinue if no improvement after appropriate dose adjustment over 1 month
• Pretreatment: cardiac history/exam and screen for tics/Tourette's and family history

Contraindications

• Concomitant MAOI treatment, or within 14 days of stopping an MAOI (hypertensive crisis risk)

Cautions

• Avoid in serious cardiac disease (structural abnormality, cardiomyopathy, serious arrhythmia, CAD)
• Increases BP and heart rate — monitor
• Psychiatric adverse reactions: screen for mania risk; consider discontinuing if new psychosis/mania
• Priapism — immediate medical attention if sustained/frequent painful erections
• Peripheral vasculopathy incl. Raynaud's — observe digits
• Long-term growth suppression in peds — monitor height/weight; interrupt treatment if not growing as expected
• Acute angle-closure glaucoma risk; caution with increased IOP/open-angle glaucoma
• Emergence/worsening of motor and verbal tics and Tourette's — monitor

Adverse reactions

• Common: tachycardia, palpitations, headache, insomnia, anxiety, hyperhidrosis, weight loss, decreased appetite, dry mouth, nausea, abdominal pain
• Also: psychosis/hallucinations, growth suppression (peds), blurred vision, dyskinesia, seizures, hepatic injury, Raynaud's, rash/urticaria, leukopenia/thrombocytopenia, priapism

Pregnancy Published data have not identified drug-associated risk of major birth defects/miscarriage; possible CNS-stimulant fetal risks; pregnancy exposure registry available

Lactation Present in milk (infant dose 0.16–0.7% of maternal weight-adjusted dose); no adverse infant reports; monitor infant for agitation, insomnia, anorexia, reduced weight gain