Generic Name

Methylphenidate

---

Classification

FDA Approved Indications

• Attention deficit hyperactivity disorder (ADHD) in children and adults

Mechanism of Action

Methylphenidate blocks the reuptake of dopamine and norepinephrine into neurons, increasing their concentration in the synaptic cleft, which improves attention and reduces impulsivity and hyperactivity.

Dosage and Administration

Adult: Typically start with 10-20 mg once or twice daily; titrate based on response and tolerability.

Pediatric: Starting dose varies by age and formulation, commonly 5 mg twice daily, titrated gradually.

Geriatric: Use with caution, start at lower doses due to potential for increased sensitivity.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; monitor for adverse effects and efficacy.

Pharmacokinetics

Absorption: Rapidly absorbed; peak plasma levels in 1-2 hours for oral formulations.

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Hepatic Via de-ethylation and other pathways.

Excretion: Primarily renal, with some fecal excretion.

Half Life: 3-4 hours for immediate-release; longer for extended-release formulations.

Contraindications

• Severe sensitivity to methylphenidate or other stimulants.
• Use with MAO inhibitors within 14 days.
• History of drug abuse, severe anxiety, tension, or agitation.

Precautions

• Monitor blood pressure, heart rate, and growth in children.
• Assess for history of cardiovascular disease, substantial anxiety, or history of substance abuse.
• Use with caution in patients with psychosis or bipolar disorder.

Adverse Reactions - Common

• Insomnia (Common)
• Loss of appetite (Common)
• Headache (Common)
• Stomach pain (Common)

Adverse Reactions - Serious

• Cardiovascular events (e.g., sudden death, stroke) (Uncommon; contraindicated in severe cardiac issues)
• Psychiatric events (e.g., new or worsening mental health) (Rare)

Drug-Drug Interactions

• Monoamine oxidase inhibitors (concurrent use contraindicated)
• Acidifying or alkalizing agents affecting absorption
• Other CNS stimulants

Drug-Food Interactions

• Avoid caffeine and other stimulants

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed.
• Report chest pain, palpitations, or new psychiatric symptoms.
• Avoid alcohol and other CNS depressants.
• Properly dispose of unused medication.
• Do not crush or cut patch or tablets.

Special Considerations

Black Box Warnings:

• Potential for abuse and dependence.
• Sudden death and serious cardiovascular events, especially in children with underlying heart conditions.

Genetic Factors: Genetic variations may affect metabolism and response.

Lab Test Interference: May affect growth hormone levels or other hormonal assays.

Overdose Management

Signs/Symptoms: Restlessness, tremors, hyperreflexia, hallucinations, seizures, rapid heartbeat, hypertension.

Treatment: Supportive care, activated charcoal if early, benzodiazepines for seizures, ICU monitoring as needed.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F), away from light and moisture.

Stability: Stable under recommended conditions for prescribed duration.