Methylphenidate (Ritalin).

How Does Methylphenidate (Ritalin) Work?

Methylphenidate (Ritalin) increases dopamine and norepinephrine levels in the brain. These two neurotransmitters are important for attention, focus and impulse control. Enhancing dopamine and norepinephrine activity helps regulate brain activity, improve concentration, and manage impulse control.

It’s important to note that Ritalin is a Schedule II controlled substance. Schedule II substances have known medical uses but are severely restricted since they have a high potential for psychological or physical dependence and addiction when misused.

Conditions Methylphenidate (Ritalin) Treats

Ritalin is commonly used to treat the following conditions.

Off-Label Uses

Under medical supervision, Ritalin may also be used off-label for treatment-resistant depression and Parkinson’s disease.

A study in French patients found that adverse side effects were more often classed as “serious” when patients used methylphenidate off-label. This may indicate that off-label usage is more likely to lead to adverse side effects, but more research is needed.Dosage and Administration

The following information summarizes what you need to know about methylphenidate’s formulations, dosage guidelines, and safety measures.

Different Formulations of Methylphenidate

Methylphenidate comes in various formulations, including:

• Immediate-release tablets, chewables, and oral solutions.
• Extended-release capsules (Concerta), tablets, and chewable.

Methylphenidate usually takes 20 to 30 minutes to take effect. The immediate-release effects last up to five hours, and the extended-release effects last up to eight.

All forms of methylphenidate come in various concentrations. For example, immediate-release tablets are available in three dosages: 5mg, 10mg, and 20mg.

Dosage Guidelines

Methylphenidate is usually prescribed in dosages of 2.5 to 20 mg orally per day, with children six or older taking lower dosages. Higher dosages are divided into multiple doses throughout the day, preferably 30 to 45 minutes before meals.

Extended-release methylphenidate usually starts at 20 mg for all populations.

Dosages may increase in 5 to 10 mg steps weekly as needed up to 60 mg per day.

Care providers may also prescribe a combination of immediate and extended-release methylphenidate or translation from one to the other according to patient needs.

How to Take Methylphenidate Safely

To take methylphenidate safely, follow these instructions:

• Take the medication as prescribed, without adjusting the dose yourself. Taking medications other than prescribed is misused and increases the chance of dependence or addiction.
• For extended-release forms, take them in the morning to minimize sleep disturbances.
• Take your last dose before 6 pm to avoid sleep disturbances.
• Avoid crushing, chewing, or dissolving extended-release tablets. Swallow them whole with water.
• Do not drive under the effects of methylphenidate if one of your side effects is impaired judgment or slowed reaction time.
• Don’t drink alcohol when taking methylphenidate.
• If you feel chest pain, shortness of breath, or faint while using methylphenidate, seek medical attention immediately.
• Inform your care provider if you’re pregnant. Methylphenidate has unknown effects on breastfeeding infants.
• Do not take methylphenidate if you have used an MAO inhibitor for 14 days.

Side Effects of Methylphenidate (Ritalin)

Methylphenidate has similar effects to all other stimulants and may cause the following side effects.

Common Side Effects

• Trouble falling asleep
• Decreased appetite
• Headaches
• Irritability or moodiness
• Headache and stomach ache
• Nervousness
• Sudden weight loss

If you have heart problems, high blood pressure, or a family history of heart disease or sudden death, you should inform your doctor before taking methylphenidate.

Serious Side Effects

• Increased heart rate or blood pressure
• Hallucinations
• Severe anxiety
• New or worsened psychosis in individuals with and without existing mental illnesses

• Overdose symptoms may include nausea, dry mouth, vomiting, diarrhea, anxiety, agitation, and restlessness.

You should not take methylphenidate if you have glaucoma, severe high blood pressure, a heart problem, an overactive thyroid, a family history of tics or Tourette’s syndrome, or severe anxiety.

Long-Term Use Risks

The long-term risks of methylphenidate are not as well-known as its long-term effects and risks. The most commonly cited long-term risks are cardiovascular issues and reduced growth in children.

A study found that methylphenidate is safe for children and teens over two years old. However, the study notes that participants who took methylphenidate had a higher pulse rate and blood pressure than participants who didn’t.

The study noted no increased risk of psychiatric or neurological side effects and no significant evidence of negative impacts on growth.

Is Methylphenidate (Ritalin) Addictive?

As a Schedule II controlled substance, methylphenidate has a high potential for dependence and addiction if misused.

Its potential for misuse stems from its stimulant properties, which may lead to some using methylphenidate as a way to experience euphoria (“get high”) or boost academic performance.

Methylphenidate is sometimes misused by grinding and snorting tablets or diluting the tablets in water and injecting them intravenously. Both methods may lead to severe side effects.

However, methylphenidate is safe and has a low potential for abuse and addiction when used as prescribed by the care provider.

Alternatives to Methylphenidate (Ritalin)

Methylphenidate is highly effective at treating narcolepsy and ADHD, but it is not the only available option. Here are some medications and lifestyle adjustments that may support your treatment without using methylphenidate.

Other Stimulant Medications

• Adderall (amphetamine): Similar to Ritalin, but may have different side effect profiles.
• Vyvanse (lisdexamfetamine): A long-acting stimulant often preferred for its consistent effects.
• Focalin: A good substitute for immediate-release methylphenidate. It often has a smoother effect with fewer side effects for some users, as it requires a lower dose than Ritalin to achieve similar therapeutic effects.
• Concerta: A good substitute for extended-release methylphenidate lasting ten to 12 hours. 

Non-stimulant Options

There are multiple nonstimulant options for ADHD and narcolepsy.

While care providers overwhelmingly prefer stimulants due to their effectiveness, non-stimulants may be effective in some cases, such as for people who don’t respond well to stimulants or experience severe side effects.

Alternatives include:

• Atomoxetine (Strattera): Non-stimulant, selective norepinephrine reuptake inhibitor (SNRI) medication for ADHD that ​​boosts the amount of norepinephrine in the brain. It’s useful for people who experience limited benefits from stimulants.
• Viloxazine (Qelbree): Nonstimulant SNRI that improves ADHD symptoms in children 6 to 17 years old. Further research is required since it was FDA-approved in 2021.

Sometimes, a combination of stimulant and non-stimulant medications may also be prescribed by your care provider.

Behavioral and Lifestyle Interventions

Combining medication with behavioral therapy often yields the best results. Strategies include:

• Getting regular exercise and a balanced diet.
• Performing mindfulness practices.
• For ADHD, cognitive-behavioral therapy (CBT), mindfulness-based cognitive therapy, and dialectical behavioral therapy.
• For narcolepsy, receiving cognitive behavioral treatment for narcolepsy (CBT-N).

Frequently Asked Questions About Methylphenidate (Ritalin)