The pharmaceutical drug methylphenidate -- sold under the brand names of Ritalin, Concerta and Daytrana -- is known as an amphetamine variant.
It is used to treat attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), as well as the excessive daytime sleepiness associated with narcolepsy and chronic fatigue syndrome.
Uses of Ritalin
Methylphenidate is a stimulant with direct effects on the central nervous system. It has an alerting, sleep-deferring action and can improve attention to repetitive tasks. It improves focus and organization and can decrease daytime drowsiness. It also may have a mood-elevating effect. It is used to treat the following disorders:
You may be prescribed a standard or extended-release formulation of the drug. These vary slightly in how long it takes the body to metabolize them, but their effects are the same.
How Does it Work?
The exact mechanism of action of methylphenidate is not known. Neurotransmitters are chemicals that serve as messengers between nerve cells (neurons). Methylphenidate increases the level of two important neurotransmitters -- called norepinephrine and dopamine -- in the brain. It accomplishes this by partially blocking their removal and by increasing their release into the space between neurons.
Methyphenidrate works in the striatum and prefrontal cortex, regions of the brain that are important to concentration. It may also improve the distribution of resources, including glucose, so that the brain can function more efficiently.
Who Should Not Use It?
It is not approved for children younger than 6 years old. It should not be used by people taking tricyclic antidepressants and MAO inhibitors, two drugs used to treat depression, so make certain your medical provider is aware of all medications you are taking. It may not be appropriate in individuals with certain medical conditions, including severe arrhythmias, coronary artery disease, structural heart problems, hypertension, or liver damage. In addition, it may be contraindicated in those with Tourette’s syndrome, motor tics, agitation, and glaucoma.
What Are Common Side Effects?
There are many potential side effects of any drug. Although an individual would not be expected to have all of them -- and may indeed not have any of them -- some which may commonly occur include:
- Nervousness
- Insomnia
- Anorexia (decreased appetite)
- Abdominal pain
- Weight loss (long-term use)
- Tachycardia (rapid heart rate)
- Nausea
- Motor tics
- Headache
- Palpitations (irregular heartbeat)
- Dizziness
- Fever
- Rash
- Urticaria (hives)
- Depression (transient)
- Drowsiness
- Dyskinesia (abnormal movement)
- Angina (chest pain)
- Blood pressure changes
- Visual disturbances
- Elevated liver transaminases
What Are Potential Serious Reactions?
With the use of any drug, there are also risks of serious side effects. These occur more rarely, but include:
- Dependency or abuse
- Psychosis
- Mania
- Aggressive behavior
- Tourette’s syndrome (rare)
- Arrhythmias (irregular heart rhythms)
- Myocardial infarction (heart attack)
- Stroke
- Sudden death
- Seizures
- Growth suppression (long-term use)
- Hypersensitivity (allergic) reaction
- Exfoliative dermatitis
- Erythema multiforme
- Thrombocytopenic purpura
- Leukopenia (low white blood cell count)
- Neuroleptic malignant syndrome
- Cerebral arteritis (inflammation of cerebral arteries)
- Hepatic coma
What Safety Precautions and Monitoring Should Occur?
The use of methylphenidate during pregnancy should be approached cautiously, weighing possible fetal risk against maternal benefit. Caution is also advised with lactation as the safety of this is unknown.
In individuals with cardiac risk factors, an initial cardiac evaluation should be done including blood pressure and heart rate measurement prior to starting the medication, with dose increases, and periodically during treatment. In pediatric patients, height and weight should be monitored at baseline and periodically. Additional blood work may be indicated, and close follow-up with your medical provider is very important.
Sources:
“Methylphenidate.” Epocrates Rx. Version 1.127, 2008. Epocrates, Inc. San Mateo, California. Katzung, B.G. Basic & Clinical Pharmacology. 9th edition, 2004. 134-140. The McGraw-Hill Companies, Inc. New York.
