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 BRAND NAMES
 MECHANISM OF ACTION
In Attention Deficit Hyperactivity Disorder (ADHD), Methylphenidate is thought to to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space, enhancing activity in areas of the brain that control attention, the ability to focus, concentration and impulsive behaviours.
Methylphenidate is a racemic mixture comprised of the d- and l-threo enantiomers. The d-threo enantiomer is more pharmacologically active than the l-threo enantiomer.
- Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children 6 years of age and older, adolescents, and adults up to the age of 65. (FDA). ADHD is a condition in which children show a persistent inability to concentrate, hyperactivity and impulsive behaviour, and which can lead to psychological, emotional, social and educational problems.
- Normal Tablets (Ritalin):
- Children (6 years and over): Start with 5 mg twice daily ( preferably 30 to 45 minutes before meals) with gradual increments of 5 to 10 mg weekly. maximum daily dosage is 60 mg. Methylphenidate should be periodically discontinued to assess the child’s condition. Improvement may be sustained when the drug is either temporarily or permanently discontinued.
- Adults: Administer in divided doses 2 or 3 times daily, preferably 30 to 45 minutes before meals. Average dosage is 20 to 30 mg daily. Some patients may require 40 to 60 mg daily. In others, 10 to 15 mg daily will be adequate. Patients who are unable to sleep if medication is taken late in the day should take the last dose before 6 p.m
- Extended-release Tablets (Concerta, Ritalin LA):
- Children and adolescents: the recommended starting dosage is 18-20 mg once daily. Dosage may be increased by 10-18 mg/day at weekly intervals and should not exceed 54-60 mg/day. Tablets should be taken once daily in the morning and swallowed whole with the aid of liquids
- Adults: the recommended starting dose is 18 or 36 mg/day. Dosage may be increased by 18 mg/day at weekly intervals and should not exceed 72 mg/day for adults. Tablets should be taken once daily in the morning and swallowed whole with the aid of liquids
- Known hypersensitivity to Methylphenidate
- Marked anxiety, tension, or agitation (Methylphenidate may aggravate these symptoms)
- Tics or a family history or diagnosis of Tourette’s syndrome
- Patients currently using or within 2 weeks of using an MAO inhibitor (hypertensive crises may result)
 DOSAGE FORMS AND STRENGTHS
- Concerta: Tablets 18, 27, 36, and 54 mg
- Ritalin: Tablets 5, 10, 20 mg
- Ritalin LA: Capsules 10, 20, 30, 40 mg
- Ritalin SR: Tablets 20 mg
 WARNINGS AND PRECAUTIONS
- Serious Cardiovascular Events: Sudden death in patients who have heart problems or heart defects, stroke and heart attack in adults and increased blood pressure and heart rate have been reported with use of methylphenidate. Stimulant products generally should not be used in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious heart problems.
- Increase in Blood Pressure: Monitor patients for changes in blood pressure and use with caution in patients for whom an increase in blood pressure would be problematic.
- Psychiatric Adverse Events: Use of stimulants may cause treatment-emergent psychotic or manic symptoms in patients with no prior history, or exacerbation of symptoms in patients with preexisting psychiatric illness. Clinical evaluation for Bipolar Disorder is recommended prior to stimulant use. Monitor for aggressive behavior.
- Seizures (mainly in patients with a history of seizures): Stimulants may lower the convulsive threshold. Discontinue in the presence of seizures.
- Visual Disturbance: difficulties with accommodation and blurring of vision have been reported with stimulant treatment.
- Long-Term Suppression of Growth: slowing of growth (height and weight) in children. Monitor height and weight at appropriate intervals.
- Periodic CBC, differential, and platelet counts are advised during prolonged therapy
 PREGNANCY AND LACTATION
- Pregnancy Category C (US). Methylphenidate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- Nursing Mothers: It is not known whether methylphenidate is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if administered to a nursing woman.
 SIDE EFFECTS
Common adverse reaction include: Nervousness and insomnia (usually controlled by reducing dosage and omitting the drug in the afternoon or evening), abdominal pain, decreased appetite and weight loss, headache, dry mouth, nausea, anxiety, tachycardia, dizziness, weight decreased, irritability, and hyperhidrosis (increased sweating).
For serious side effects, see WARNINGS AND PRECAUTIONS