Ritalin

Last reviewed on RxList: 7/13/2021
Ritalin Side Effects Center

Pharmacy Editor: Eni Williams, PharmD, PhD

What Is Ritalin?

Ritalin (methylphenidate) is a central nervous system stimulant prescribed for treating narcolepsy (uncontrollable sleepiness), and attention-deficit hyperactivity disorder (ADHD). Ritalin is available as a generic drug.

What Are Side Effects of Ritalin?

Common side effects of Ritalin include:

Dosage for Ritalin

Ritalin recommended dose is 10-60 mg daily given in 2 or 3 divided doses.

What Drugs, Substances, or Supplements Interact with Ritalin?

Ritalin may interact with blood thinners, clonidine, dobutamine, epinephrine, isoproterenol, cold/allergy medicine that contains phenylephrine (a decongestant), potassium citrate, sodium acetate, sodium bicarbonate, citric acid and potassium citrate, sodium citrate and citric acid, medications to treat high or low blood pressure, stimulant medications, diet pills, seizure medicines, or antidepressants. Tell your doctor all medications and supplements you use.

Ritalin During Pregnancy or Breastfeeding

There are no adequate studies of Ritalin in pregnant women. It is not known if methylphenidate is secreted in breast milk.Consult your doctor before breastfeeding.

Additional Information

Our Ritalin Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. articles.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

QUESTION

The abbreviated term ADHD denotes the condition commonly known as: See Answer
Ritalin Consumer Information

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Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • signs of heart problems--chest pain, trouble breathing, feeling like you might pass out;
  • signs of psychosis--hallucinations (seeing or hearing things that are not real), new behavior problems, aggression, hostility, paranoia;
  • signs of circulation problems--numbness, pain, cold feeling, unexplained wounds, or skin color changes (pale, red, or blue appearance) in your fingers or toes; or
  • penis erection that is painful or lasts 4 hours or longer (rare).

Methylphenidate can affect growth in children. Tell your doctor if your child is not growing at a normal rate.

Common side effects may include:

  • excessive sweating;
  • mood changes, feeling nervous or irritable, sleep problems (insomnia);
  • fast heart rate, pounding heartbeats or fluttering in your chest, increased blood pressure;
  • loss of appetite, weight loss;
  • dry mouth, nausea, stomach pain; or
  • headache.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Ritalin (Methylphenidate Hcl)

SLIDESHOW

ADHD Symptoms in Children See Slideshow
Ritalin Professional Information

SIDE EFFECTS

The following are discussed in more detail in other sections of the labeling:

  • Abuse and Dependence [see BOX WARNING, WARNINGS AND PRECAUTIONS, Drug Abuse And Dependence]
  • Known hypersensitivity to methylphenidate or other ingredients of Ritalin and Ritalin-SR [see CONTRAINDICATIONS]
  • Hypertensive crisis with Concomitant Use of Monoamine Oxidase Inhibitors [see CONTRAINDICATIONS, DRUG INTERACTIONS]
  • Serious Cardiovascular Reactions [see WARNINGS AND PRECAUTIONS]
  • Blood Pressure and Heart Rate Increases [see WARNINGS AND PRECAUTIONS]
  • Psychiatric Adverse Reactions [see WARNINGS AND PRECAUTIONS]
  • Priapism [see WARNINGS AND PRECAUTIONS]
  • Peripheral Vasculopathy, Including Raynaud’s Phenomenon [see WARNINGS AND PRECAUTIONS]
  • Long-Term Suppression of Growth [see WARNINGS AND PRECAUTIONS]

The following adverse reactions associated with the use of Ritalin, Ritalin-SR, and other methylphenidate products were identified in clinical trials, spontaneous reports, and literature. Because these reactions were reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency reliably or to establish a causal relationship to drug exposure.

Adverse Reactions Reported With Ritalin And Ritalin-SR

Infections and Infestations: nasopharyngitis

Blood and the Lymphatic System Disorders: leukopenia, thrombocytopenia, anemia

Immune System Disorders: hypersensitivity reactions, including angioedema, and anaphylaxis

Metabolism and Nutrition Disorders: decreased appetite, reduced weight gain, and suppression of growth during prolonged use in pediatric patients

Psychiatric Disorders: insomnia, anxiety, restlessness, agitation, psychosis (sometimes with visual and tactile hallucinations), depressed mood

Nervous System Disorders: headache, dizziness, tremor, dyskinesia, including choreoatheetoid movements, drowsiness, convulsions, cerebrovascular disorders (including vasculitis, cerebral hemorrhages and cerebrovascular accidents), serotonin syndrome in combination with serotonergic drugs

Eye Disorders: blurred vision, difficulties in visual accommodation

Cardiac Disorders: tachycardia, palpitations, increased blood pressure, arrhythmias, angina pectoris

Respiratory, Thoracic, and Mediastinal Disorders: cough

Gastrointestinal Disorders: dry mouth, nausea, vomiting, abdominal pain, dyspepsia

Hepatobiliary Disorders: abnormal liver function, ranging from transaminase elevation to severe hepatic injury

Skin and Subcutaneous Tissue Disorders: hyperhidrosis, pruritus, urticaria, exfoliative dermatitis, scalp hair loss, erythema multiforme rash, thrombocytopenic purpura

Musculoskeletal and Connective Tissue Disorders: arthralgia, muscle cramps, rhabdomyolysis

Investigations: weight loss (adult ADHD patients)

Additional Adverse Reactions Reported With Other Methylphenidate-Containing Products

The list below shows adverse reactions not listed for Ritalin and Ritalin-SR that have been reported with other methylphenidate-containing products.

Blood and Lymphatic Disorders: pancytopenia

Immune System Disorders: hypersensitivity reactions, such as auricular swelling, bullous conditions, eruptions, exanthemas

Psychiatric Disorders: affect lability, mania, disorientation, and libido changes

Nervous System Disorders: migraine

Eye Disorders: diplopia, mydriasis

Cardiac Disorders: sudden cardiac death, myocardial infarction, bradycardia, extrasystole

Vascular Disorders: peripheral coldness, Raynaud's phenomenon

Respiratory, Thoracic, and Mediastinal Disorders: pharyngolaryngeal pain, dyspnea

Gastrointestinal Disorders: diarrhea, constipation

Skin and Subcutaneous Tissue Disorders: angioneurotic edema, erythema, fixed drug eruption

Musculoskeletal, Connective Tissue, and Bone Disorders: myalgia, muscle twitching

Renal and Urinary Disorders: hematuria Reproductive

System and Breast Disorders: gynecomastia

General Disorders: fatigue, hyperpyrexia

Urogenital Disorders: priapism

DRUG INTERACTIONS

Clinically Important Drug Interactions With Ritalin And Ritalin-SR

Table 1 presents clinically important drug interactions with Ritalin and Ritalin-SR.

Table 1: Clinically Important Drug Interactions with Ritalin and Ritalin-SR

Monoamine Oxidase Inhibitors (MAOI)
Clinical Impact Concomitant use of MAOIs and CNS stimulants, including Ritalin and Ritalin-SR can cause hypertensive crisis. Potential outcomes include death, stroke, myocardial infarction, aortic dissection, ophthalmological complications, eclampsia, pulmonary edema, and renal failure [see CONTRAINDICATIONS].
Intervention Concomitant use of Ritalin or Ritalin-SR with MAOIs or within 14 days after discontinuing MAOI treatment is contraindicated.
Examples selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, methylene blue
Antihypertensive Drugs
Clinical Impact Ritalin and Ritalin-SR may decrease the effectiveness of drugs used to treat hypertension [see WARNINGS AND PRECAUTIONS].
Intervention Monitor blood pressure and adjust the dosage of the antihypertensive drug as needed.
Examples Potassium-sparing and thiazide diuretics, calcium channel blockers, angiotensinconverting-enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, centrally acting alpha-2 receptor agonists
Halogenated Anesthetics
Clinical Impact Concomitant use of halogenated anesthetics and Ritalin or Ritalin-SR may increase the risk of sudden blood pressure and heart rate increase during surgery.
Intervention Avoid use of Ritalin or Ritalin-SR in patients being treated with anesthetics on the day of surgery.
Examples halothane, isoflurane, enflurane, desflurane, sevoflurane
Risperidone
Clinical Impact Combined use of methylphenidate with risperidone when there is a change, whether an increase or decrease, in dosage of either or both medications, may increase the risk of extrapyramidal symptoms (EPS)
Intervention Monitor for signs of EPS

Drug Abuse And Dependence

Controlled Substance

Ritalin and Ritalin-SR contain methylphenidate hydrochloride, a Schedule II controlled substance.

Abuse

CNS stimulants, including Ritalin and Ritalin-SR, have a high potential for abuse. Abuse is characterized by impaired control over drug use despite harm, and craving.

Signs and symptoms of CNS stimulant abuse include increased heart rate, respiratory rate, blood pressure, and/or sweating, dilated pupils, hyperactivity, restlessness, insomnia, decreased appetite, loss of coordination, tremors, flushed skin, vomiting, and/or abdominal pain. Anxiety, psychosis, hostility, aggression, and suicidal or homicidal ideation have also been observed. Abusers of CNS stimulants may chew, snort, inject, or use other unapproved routes of administration which may result in overdose and death [see OVERDOSE].

To reduce the abuse of CNS stimulants, including Ritalin and Ritalin-SR, assess the risk of abuse prior to prescribing. After prescribing, keep careful prescription records, educate patients and their families about abuse and on proper storage and disposal of CNS stimulants [see HOW SUPPLIED], monitor for signs of abuse while on therapy, and reevaluate the need for Ritalin and Ritalin-SR use.

Dependence

Tolerance

Tolerance (a state of adaptation in which exposure to a drug results in a reduction of the drug’s desired and/or undesired effects over time) can occur during chronic therapy with CNS stimulants, including Ritalin and Ritalin-SR.

Dependence

Physical dependence (which is manifested by a withdrawal syndrome produced by abrupt cessation, rapid dose reduction, or administration of an antagonist) may occur in patients treated with CNS stimulants, including Ritalin and Ritalin-SR. Withdrawal symptoms after abrupt cessation following prolonged high-dosage administration of CNS stimulants include dysphoric mood; fatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; and psychomotor retardation or agitation.

Read the entire FDA prescribing information for Ritalin (Methylphenidate Hcl)

© Ritalin Patient Information is supplied by Cerner Multum, Inc. and Ritalin Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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