Attention Deficit Disorders, Narcolepsy

Attention Deficit Disorders (previously known as Minimal Brain Dysfunction in Children). Other terms being used to describe the behavioral syndrome below include: Hyperkinetic Child Syndrome, Minimal Brain Damage, Minimal Cerebral Dysfunction, Minor Cerebral Dysfunction.

Ritalin (methylphenidate hcl) is indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate-to-severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these symptoms are only of comparatively recent origin. Nonlocalizing (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of central nervous system dysfunction may or may not be warranted.

Special Diagnostic Considerations

Specific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but of special psychological, educational, and social resources.

Characteristics commonly reported include: chronic history of short attention span, distractibility, emotional lability, impulsivity, and moderate-to-severe hyperactivity; minor neurological signs and abnormal EEG. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of one or more of these characteristics.

Drug treatment is not indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is generally necessary. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment of the chronicity and severity of the child's symptoms.

Dosage should be individualized according to the needs and responses of the patient.

Adults

Tablets: 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.

SR Tablets: Ritalin (methylphenidate hcl) -SR tablets have a duration of action of approximately 8 hours. Therefore, Ritalin (methylphenidate hcl) -SR tablets may be used in place of Ritalin (methylphenidate hcl) tablets when the 8-hour dosage of Ritalin (methylphenidate hcl) -SR corresponds to the titrated 8-hour dosage of Ritalin (methylphenidate hcl) . Ritalin (methylphenidate hcl) -SR tablets must be swallowed whole and never crushed or chewed.

Children (6 years and over)

Ritalin (methylphenidate hcl) should be initiated in small doses, with gradual weekly increments. Daily dosage above 60 mg is not recommended.

If improvement is not observed after appropriate dosage adjustment over a one-month period, the drug should be discontinued.

Tablets: Start with 5 mg twice daily (before breakfast and lunch) with gradual increments of 5 to 10 mg weekly.

SR Tablets: Ritalin (methylphenidate hcl) -SR tablets have a duration of action of approximately 8 hours. Therefore, Ritalin (methylphenidate hcl) -SR tablets may be used in place of Ritalin (methylphenidate hcl) tablets when the 8-hour dosage of Ritalin (methylphenidate hcl) -SR corresponds to the titrated 8-hour dosage of Ritalin (methylphenidate hcl) . Ritalin (methylphenidate hcl) -SR tablets must be swallowed whole and never crushed or chewed.

If paradoxical aggravation of symptoms or other adverse effects occur, reduce dosage, or, if necessary, discontinue the drug.

Ritalin (methylphenidate hcl) should be periodically discontinued to assess the child's condition. Improvement may be sustained when the drug is either temporarily or permanently discontinued.

Drug treatment should not and need not be indefinite and usually may be discontinued after puberty.

Tablets 5 mg - round, yellow (imprinted CIBA 7)

Bottles of 100...............................................NDC 0078-0439-05

Tablets 10 mg - round, pale green, scored (imprinted CIBA 3)

Bottles of 100...............................................NDC 0078-0440-05

Tablets 20 mg - round, pale yellow, scored (imprinted CIBA 34)

Bottles of 100...............................................NDC 0078-0441-05

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature]. Protect from light.

Dispense in tight, light-resistant container (USP).

SR Tablets 20 mg - round, white, coated (imprinted CIBA 16)

Bottles of 100...............................................NDC 0078-0442-05

Note: SR Tablets are color-additive free.

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature]. Protect from moisture.

Dispense in tight, light-resistant container (USP).

Novartis Pharmaceuticals Corporation East Hanover, New Jersey 07936.

Last reviewed on RxList: 1/31/2011
This monograph has been modified to include the generic and brand name in many instances.