Ritalin/Ritalin LA

Methylphenidate HCl

ADHD. Ritalin Narcolepsy.

Ritalin ADHD Childn & adolescent ≥6 yr Initially 5 mg once daily or bd w/ 5 or 10 mg gradual wkly increments. Administer total daily dose in divided doses. Narcolepsy Adult 20-30 mg daily in 2-3 divided doses. Max: 60 mg daily. Ritalin LA ADHD Adult Adjust dose at wkly intervals in 20 mg increments. Max: 80 mg daily. New to methylphenidate: Initially 20 mg once daily. Currently using methylphenidate: Dose should be equal to the total daily dose of previous IR formulation. Childn & adolescent ≥6 yr Adjust dose at wkly intervals in 10 mg increments. Max: 60 mg daily. New to methylphenidate: Initially 20 mg once daily. May begin treatment w/ 10 mg if necessary. Currently using methylphenidate: Dose should be equal to the total daily dose of previous IR formulation.

May be taken with or without food: May be taken w/ meals to reduce GI discomfort. Ritalin LA: Swallow whole, do not chew/crush/divide. Alternatively, open cap & sprinkle contents in a small amount of soft food. The food should not be warm. Do not chew/crush the contents of the cap.

Hypersensitivity. Anxiety, tension states; agitation; family history or diagnosis of Tourette's syndrome; glaucoma; hyperthyroidism; pre-existing CV disorders including uncontrolled HTN, angina pectoris, arterial occlusive disease especially coronary arteries; heart failure, haemodynamically significant congenital heart disease, cardiomyopathies, MI, cardiac arrhythmia & channelopathies; treatment w/ MAOIs, & also w/in a min of 14 days following discontinuation of a MAOI; phaeochromocytoma; known drug dependence or alcohol abuse; severe depression, anorexia nervosa, psychotic symptoms or suicidal tendency.

Not indicated in all cases of ADHD. Consider treatment only after detailed history taking & patient evaluation. Not usually indicated when symptoms are associated w/ acute stress reactions. Do not use in patients w/ known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may increase the risk of sudden death; pre-existing CNS abnormalities (eg, cerebral aneurysm) &/or other vascular abnormalities (eg, vasculitis or pre-existing stroke). Should not be used to treat severe depression or for the prevention or treatment of normal fatigue states. Do not initiate in patients w/ acute psychosis, acute mania, or acute suicidality. Risk of increased heart rate & systolic & diastolic BP. Monitor BP at appropriate intervals, especially patients w/ HTN. May exacerbate symptoms of behaviour disturbance & thought disorder in psychotic patients. Possible induction of a mixed/manic episode in patients w/ comorbid bipolar disorder. Reports of psychotic symptoms, including visual & tactile hallucinations or mania; worsening of Tourette's syndrome; priapism. Associated w/ aggression; onset or exacerbation of motor & verbal tics; peripheral vasculopathy, including Raynaud's phenomenon. Consider treatment discontinuation if psychotic symptoms occur. Monitor for clinical worsening, suicidal behaviour or thoughts or unusual changes in behaviour. Monitor growth as clinically necessary during treatment & interrupt treatment in patients who are not growing or gaining height or wt. May lower the convulsion threshold, especially in patients w/ history of seizures, w/ prior EEG abnormalities in the absence of seizures. Caution in emotionally unstable patients eg, those w/ history of drug or alcohol dependence. Careful supervision during treatment w/drawal. Risk of haematological disorders; periodic CBC, differential & platelet counts are advisable during prolonged therapy. Not recommended w/ serotonergic drugs. Safe concomitant use w/ anticonvulsants has not been established. Abstain from alcohol during treatment. May induce false +ve lab tests, particularly w/ immunoassay screen test. Do not take on the day of a planned surgery. May impair ability to drive or operate machinery. Pregnancy & lactation. Do not use in childn <6 yr. Ritalin Not effective for loss of voluntary muscle tone. Ritalin LA Use in elderly >60 yr has not been studied.

Nasopharyngitis; decreased appetite; nervousness, insomnia, irritability; nausea, dry mouth. Anxiety, restlessness, sleep disorder, agitation, depression, aggression, bruxism; dyskinesia, tremor, headache, drowsiness, dizziness; tachycardia, palpitation, arrhythmias, changes in BP & heart rate (usually an increase); cough; abdominal pain, vomiting, dyspepsia, toothache; rash, pruritus, urticaria, fever, scalp hair loss, hyperhidrosis; arthralgia; feeling jittery; decreased wt; Raynaud's phenomenon, peripheral coldness.

Decreased effectiveness of antihypertensives. Risk of severe HTN w/ drugs that elevate BP. Possible hypertensive crisis w/ non-selective, irreversible MAOIs (current or w/in the preceding 2 wk). Risk of sudden increase in BP & heart rate w/ anaesth during surgery. Serious adverse events (including sudden death) w/ centrally acting α-2 agonists (eg, clonidine). Pharmacodynamic interactions w/ direct & indirect dopamine agonists (including DOPA & TCAs) & dopamine antagonists (antipsychotics eg, haloperidol). Risk of serotonin syndrome w/ serotonergic drugs eg, SSRIs & SNRIs. May inhibit the metabolism of coumarin anticoagulants, anticonvulsants (phenobarb, primidone, phenytoin), phenylbutazone & TCAs (imipramine, desipramine). Exacerbated CNS adverse reactions w/ alcohol.

Other CNS Drugs & Agents for ADHD

N06BA04 - methylphenidate ; Belongs to the class of centrally-acting sympathomimetics. Used as CNS stimulant.

DD, P₁S₁S₃