Concerta, Daytrana, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin LA, Ritalin SR
Classifications: cerebral stimulant; Therapeutic:cerebral stimulant
Pregnancy Category: C
Controlled Substance: Schedule II
5 mg, 10 mg, 20 mg tablets; 2.5 mg, 5 mg, 10 mg chewable tablets; 5 mg/5 mL, 10 mg/5 mL oral solution; 10 mg, 20 mg, 30 mg, 40 mg sustained release capsules; 10 mg, 18 mg, 20 mg, 27 mg, 36 mg, 54 mg sustained release tablet; 10 mg, 15 mg, 20 mg, 30 mg transdermal patch
Piperidine derivative with actions and abuse potential qualitatively similar to those of amphetamine. Acts mainly on cerebral
cortex exerting a stimulant effect. Results in mild CNS and respiratory stimulation with potency intermediate between amphetamine
Effects are more prominent on mental rather than on motor activities. Also believed to have an anorexiant effect.
Adjunctive therapy in hyperkinetic syndromes characterized by attention deficit disorder, narcolepsy, mild depression, and
apathetic or withdrawn senile behavior.
Hypersensitivity to drug; history of marked anxiety, agitation; aortic stenosis; serious cardic disorders including arrhythmias;
valvular heart disease; ventricular dysfunction; motor tics or Tourette's disease; substance abuse; severe anxiety, psychosis,
major depression, suicidal ideation; glaucoma; pregnancy (category C), lactation, children <6 y of age.
Alcoholic; emotionally unstable patient; abrupt discontinuation; recent MI, anxiety, cardiac arrhythmias, cardiac disease,
dysphagia, older adults; esophageal stricture, GI obstruction, heart failure, hepatic disease, hyperthyroidism, history
of paralytic ileus, cystic fibrosis, mania, radiographic contrast administration, seizure disorder, hypertension; history
Route & Dosage
Adult: PO 10 mg b.i.d. or t.i.d. 3045 min p.c. (range: 2040 mg/d)
Attention Deficit Disorder
Child: PO 510 mg before breakfast and lunch, with a gradual increase of 510 mg/wk as needed (max: 60 mg/d) or 2040
mg sustained release q.d. before breakfast (max dose: 72 mg q.d.) Transdermal patch 10 mg patch worn for 9 hours x 1 wk then taper as needed. Increase no more than once weekly. Apply 2 hr before
Geriatric: PO 2.5 mg in morning before 9 a.m., may increase by 2.55 mg q23d (max: 20 mg/d) divided 7 a.m. and noon
- Give 3045 min before meals. To avoid insomnia, give last dose before 6 p.m.
- Ensure that sustained release form is not chewed or crushed. It must be swallowed whole.
- Can open Metadate CD capsules and sprinkle on food
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%)CNS:
Dizziness, drowsiness, nervousness, insomnia. CV:
Palpitations, changes in BP and pulse rate, angina, cardiac arrhythmias, exacerbation of underlying CV conditions. Special Senses:
Difficulty with accommodation, blurred vision. GI:
Dry throat, anorexia, nausea; HEPATOTOXICITY
; abdominal pain. Body as a Whole:
Hypersensitivity reactions (rash, fever, arthralgia, urticaria, exfoliative dermatitis,
erythema multiforme); long-term growth suppression.
InteractionsDrug: mao inhibitors
may cause hypertensive crisis; antagonizes hypotensive effects of guanethidine, bretylium;
potentiates action of cns stimulants
(e.g. amphetamine, caffeine
); may inhibit metabolism and increase serum levels of fosphenytoin, phenytoin, phenobarbital,
and primidone, warfarin, tricyclic antidepressants
Readily from GI tract. Transdermal absorption increased with heat or inflamed skin. Peak:
1.9 h; 47 h sustained release, 2 h transdermal. Duration:
36 h; 8 h sustained release. Elimination:
Assessment & Drug Effects
- Monitor BP and pulse at appropriate intervals.
- Lab tests: Obtain periodic CBC with differential and platelet counts during prolonged therapy.
- Chronic abusive use can lead to tolerance, psychic dependence, and psychoses.
- Assess patient's condition with periodic drug-free periods during prolonged therapy.
- Supervise drug withdrawal carefully following prolonged use. Abrupt withdrawal may result in severe depression and psychotic
Patient & Family Education
- Report adverse effects to physician, particularly nervousness and insomnia. These effects may diminish with time or require
reduction of dosage or omission of afternoon or evening dose.
- Check weight at least 2 or 3 times weekly and report weight loss. Check height and weight in children; failure to gain in
either should be reported to physician.