Ritalin Side Effects
Ritalin Side Effects from the Physicians' Desk Reference®
Generic name: Methylphenidate hydrochloride
Other brand names: Concerta", default", Metadate, Methylin
RITALIN-SR® methylphenidate hydrochloride USP sustained-release tablets.
WARNINGS - Ritalin should not be used in children under six years,
since safety and efficacy in this age group have not been established.
Sufficient data on safety and efficacy of long-term use of Ritalin in children
are not yet available. Although a causal relationship has not been established,
suppression of growth (ie, weight gain, and/or height) has been reported with
the long-term use of stimulants in children. Therefore, patients requiring
long-term therapy should be carefully monitored.
Nervousness and insomnia are the most common adverse reactions but are
usually controlled by reducing dosage and omitting the drug in the afternoon or
evening. Other reactions include hypersensitivity (including skin rash,
urticaria, fever, arthralgia, exfoliative dermatitis, erythema multiforme with
histopathological findings of necrotizing vasculitis, and thrombocytopenic
purpura); anorexia; nausea; dizziness; palpitations; headache; dyskinesia;
drowsiness; blood pressure and pulse changes, both up and down; tachycardia;
angina; cardiac arrhythmia; abdominal pain; weight loss during prolonged
therapy. There have been rare reports of Tourette's syndrome. Toxic psychosis
has been reported. Although a definite causal relationship has not been
established, the following have been reported in patients taking this drug:
leukopenia and/or anemia; a few instances of scalp hair loss. In children, loss
of appetite, abdominal pain, weight loss during prolonged therapy, insomnia, and
tachycardia may occur more frequently; however, any of the other adverse
reactions listed above may also occur.
Ritalin should be given cautiously to emotionally unstable patients, such as
those with a history of drug dependence or alcoholism, because such patients may
increase dosage on their own initiative. Chronically abusive use can lead to
marked tolerance and psychic dependence with varying degrees of abnormal
behavior. Frank psychotic episodes can occur, especially with parental abuse.
Careful supervision is required during drug withdrawal, since severe depression
as well as the effects of chronic over activity can be unmasked. Long-term
follow-up may be required because of the patient's basic personality
Why is this drug prescribed?
Ritalin and other brands of methylphenidate are mild central nervous system
stimulants used in the treatment of attention deficit hyperactivity disorder in
children. With the exception of Ritalin LA, Concerta and Metadate CD, these
products are also used in adults to treat narcolepsy (an uncontrollable desire
When given for attention deficit disorder, this drug should be an integral
part of a total treatment program that includes psychological, educational, and
social measures. Symptoms of attention deficit disorder include continual
problems with moderate to severe distractibility, short attention span,
hyperactivity, emotional changeability, and impulsiveness.
Most important fact about this drug
Excessive doses of this drug over a long period of time can produce
addiction. It is also possible to develop tolerance to the drug, so that larger
doses are needed to produce the original effect. Because of these dangers, be
sure to check with your doctor before making any change in dosage; and withdraw
the drug only under your doctor's supervision.
How should you take this medication?
Follow your doctor's directions carefully. It is recommended that
methylphenidate be taken 30 to 45 minutes before meals. If the drug interferes
with sleep, give the child the last dose before 6 p.m. Ritalin-SR, Ritalin LA,
Metadate CD, Methylin ER, and Concerta are long-acting forms of the drug, taken
less frequently. They should be swallowed whole, never crushed or chewed.
(Ritalin LA and Metadate CD may also be given by sprinkling the contents of the
capsule on a tablespoon of cool applesauce and administering immediately,
followed by a drink of water.)
If you miss a dose...
Give it to the child as soon as you remember. Give the remaining doses for the
day at regularly spaced intervals. Do not give 2 doses at once.
Keep out of reach of children. Store below 86 degrees Fahrenheit in a tightly
closed, light-resistant container. Protect Ritalin-SR from moisture.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity,
inform your doctor as soon as possible. Only your doctor can determine if it is
safe for you to continue giving this drug.
More common side effects may include:
Inability to fall or stay asleep, nervousness
These side effects can usually be controlled by reducing the dosage and
omitting the drug in the afternoon or evening.
In children, loss of appetite, abdominal pain, weight loss during long-term
therapy, inability to fall or stay asleep, and abnormally fast heartbeat are
more common side effects.
Less common or rare side effects may include:
Abdominal pain, abnormal heartbeat, abnormal muscular movements, blood pressure
changes, chest pain, dizziness, drowsiness, fever, hair loss, headache, hives,
jerking, joint pain, loss of appetite, nausea, palpitations (fluttery or
throbbing heartbeat), pulse changes, rapid heartbeat, reddish or purplish skin
spots, skin reddening, skin inflammation with peeling, skin rash, Tourette's
syndrome (severe twitching), weight loss during long-term treatment
Why should this drug not be prescribed?
This drug should not be prescribed for anyone experiencing anxiety, tension, and
agitation, since the drug may aggravate these symptoms.
Anyone sensitive or allergic to this drug should not take it.
This medication should not be taken by anyone with the eye condition known as
glaucoma, anyone who suffers from tics (repeated, involuntary twitches), or
someone with a family history of Tourette's syndrome (severe and multiple tics).
This drug is not intended for use in children whose symptoms may be caused by
stress or a psychiatric disorder.
This medication should not be used for the prevention or treatment of normal
fatigue, nor should it be used for the treatment of severe depression.
This drug should not be taken during treatment with drugs classified as
monoamine oxidase inhibitors, such as the antidepressants Nardil and Parnate,
nor for the 2 weeks following discontinuation of these drugs.
Special warnings about this medication
Your doctor will do a complete history and evaluation before prescribing this
drug. He or she will take into account the severity of the symptoms, as well as
your child's age.
This drug should not be given to children under 6 years of age; safety and
effectiveness in this age group have not been established.
There is no information regarding the safety and effectiveness of long-term
treatment in children. However, suppression of growth has been seen with the
long-term use of stimulants, so your doctor will watch your child carefully
while he or she is taking this drug.
Blood pressure should be monitored in anyone taking this drug, especially
those with high blood pressure.
Some people have had visual disturbances such as blurred vision while being
treated with this drug.
The use of this drug by anyone with a seizure disorder is not recommended. Be
sure your doctor is aware of any problem in this area. Caution is also advisable
for anyone with a history of emotional instability or substance abuse, due to
the danger of addiction.
Possible food and drug interactions when taking this medication
If this medication is taken with certain other drugs, the effects of either can
be increased, decreased, or altered. It is especially important to check with
your doctor before combining this drug with the following:
Antiseizure drugs such as phenobarbital, Dilantin and Mysoline
Antidepressant drugs such as Tofranil, Anafranil, Norpramin, and Effexor
Blood thinners such as Coumadin
Drugs that restore blood pressure, such as EpiPen
MAO inhibitors (drugs such as the antidepressants Nardil and Parnate)
This drug should not be given to children under 6 years of age. Drug
treatment should not, and need not, be indefinite and usually can be
discontinued after puberty.
If you suspect an overdose, seek medical attention immediately.
- Symptoms of Ritalin overdose may include:
Agitation, confusion, convulsions (may be followed by coma), delirium,
dryness of mucous membranes, enlarging of the pupil of the eye, exaggerated
feeling of elation, extremely elevated body temperature, flushing,
hallucinations, headache, high blood pressure, irregular or rapid heartbeat,
muscle twitching, sweating, tremors, vomiting
Ritalin Side Effects from
The Essential Guide to Psychiatric Drugs
STIMULANT ANTIDEPRESSANT DRUGS
Depression may also be treated with drugs called psychostimulants. Use of such
drugs is reserved for only two situations: (1) patients who have failed to
respond to at least two other antidepressants and psychotherapy and who are
seriously depressed, and (2) patients with serious and usually terminal medical
illnesses such as cancer or AIDS who are depressed and too sick to take other
kinds of antidepressants. The reason for these restrictions is that the
stimulant drugs are addictive. They include amphetamines, sometimes called
"speed" or "uppers," methylphenidate (Ritalin), and pemoline (Cylert). The drugs
produce a short-term mood elevation even in people who are not depressed.
College students take them to stay awake all night and finish term papers. In
most people the effects of these stimulant drugs are short-lived and there is
often a letdown or "crash" after they wear off. During this "crash" the patient
can feel very depressed, sleepy, and sluggish. Furthermore, and very much unlike
the other drugs discussed so far in this chapter, stimulant drugs have the
potential to induce "tolerance." People who abuse amphetamines and other
stimulants--usually in attempts to lose weight or stay awake for prolonged
periods--often find that a dose that had worked for a while is suddenly
ineffective and they need a higher dose. They then become "tolerant" to the
higher dose and have to increase the dose again. Soon, the person is addicted to
the drug. Stopping it suddenly leads to a severe withdrawal reaction
characterized by bad depression and extreme fatigue. Suicides have been reported
in people who suddenly stop taking amphetamines. Given all these problems, why
even mention the stimulant drugs? Simply because they are the only drugs that
work for some depressed patients. A very small group of usually chronically
depressed patients seems to be resistant to every other treatment for
depression. These people usually function at a fairly low level relative to
their ability and they feel sad and blue all of the time. They complain of
fatigue, low interest in life, and inability to concentrate. Many say they have
been depressed since childhood. Another small group of patients with very
serious medical problems also develops depression. Sometimes the medical
problems they have make other antidepressant drugs unsafe, or the medical
problems so magnify the side effects of the other antidepressants that the dying
patient is made even more uncomfortable. Stimulant drugs may actually be the
safest choice in this situation. For these two groups of patients stimulant
drugs may be the only answer, even though the patient will probably become
addicted. This is not to be taken lightly. The decision to place a patient on a
stimulant drug for depression is serious and must be done only after all other
efforts are declared either unsafe or ineffective. The patient must understand
that he will probably become addicted to the medication and that he should never
stop taking it abruptly.