Adult Dosing

ADHD

Ritalin, Methylin, methylphenidate

• Initial: 5-15 mg PO bid-tid 30-45 mins before meals
• Titrate: Increase by 10 mg/day qwk
• Max: 10-60 mg/day

Concerta

• Methylphenidate naive:
• Adults 18-65 yrs: 18 or 36 mg/day PO. Max: 18 mg - 72 mg/day

• Methylphenidate tolerant:
• Table for recommended dose conversion from methylphenidate immediate-release regimens to concerta

Metadate CD

• Initial: 20 mg PO qam
• Titrate: Increase by 10-20 mg/day qwk
• Max: 60 mg/day

Metadate ER, Methylin ER

• Initial: 10-20 mg PO qam
• Titrate: Increase by 10 mg/day qwk
• Max: 60 mg/day

Ritalin LA

• Initial: 20 mg PO qam
• Titrate: Increase by 10 mg/day qwk
• Max: 60 mg/day

Ritalin SR, methylphenidate

• Initial: 20 mg PO qam
• Titrate: Increase by 20 mg/day qwk
• Max: 60 mg/day

Narcolepsy

Metadate ER, Methylin ER

• Initial: 10-20 mg PO qam
• Titrate: Increase by 10 mg/day qwk
• Max: 60 mg/day

Ritalin, Methylin, methylphenidate

• Initial: 5-10 mg PO bid-tid 30-45 mins before meals
• Titrate: Increase by 10 mg/day qwk
• Max: 10-60 mg/day

Ritalin SR, methylphenidate

• Initial: 20 mg PO qam
• Titrate: Increase by 20 mg/day qwk
• Max: 60 mg/day

Note:

• Patients should be advised to avoid consumption of alcohol during treatment with methylphenidate

Pediatric Dosing

ADHD

Ritalin, Methylin, methylphenidate

• Child >6 yrs:
• Initial: 0.3 mg/kg PO bid or 2.5-5 mg PO bid
• Titrate: Increase by 0.1 mg/kg/dose or 5-10 mg/day qwk
• Max: 2 mg/kg/day up to 60 mg/day

Concerta:

• Methylphenidate naive:
• Adolescents 13-17 yrs: 18 mg/day PO. Max: 18 mg - 72 mg/day not to exceed 2 mg/kg/day
• Child 6- 12 yrs: 18 mg/day. Max: 18 - 54 mg/day

• Methylphenidate tolerant:
• Table for recommended dose conversion from methylphenidate immediate-release regimens to concerta

Metadate CD

• Children >6 yrs
• Initial: 20 mg PO qam
• Titrate: Increase by 10-20 mg/day qwk
• MAX: 60 mg/day

Metadate ER, Methylin ER

• Child >6 yrs
• Initial: 0.3-2 mg/kg/day PO div daily/bid or 10 mg PO qam
• Titrate: Increase by 10 mg/day qwk
• Max: 2 mg/kg/day up to 60 mg/day

Ritalin LA

• Children >6 yrs
• Initial: 20 mg PO qam
• Titrate: Increase by 10 mg/day qwk
• Max: 60 mg/day

Ritalin SR, methylphenidate

• Child >6 yrs
• Initial: 0.3-2 mg/kg/day PO div daily/bid or 20 mg PO qam
• Titrate: Increase by 20 mg/day qwk
• Max: 2 mg/kg/day up to 60 mg/day

[Outline]

• Adult Dosing
• Pediatric Dosing

• For the treatment of attention deficit hyperactivity disorder (ADHD) in children of 6 yrs of age and in adults up to the age of 65
• For the treatment of narcolepsy

• Hypersensitivity to any of the ingredients of the product
• Marked anxiety
• Tension
• Agitation
• Glaucoma
• Motor tics
• Familial history or diagnosis of Tourette’s syndrome
• Concurrent use with MAO inhibitors or using within 14 days following discontinuation of therapy
• Patients <6yrs of age
• Cardiac structural abnormalities
• Severe coronary artery disease
• Cardiomyopathy
• Severe hypertension
• Angina pectoris
• Cardiac arrhythmias
• Heart failure
• Recent myocardial infarction
• Hyperthyroidism
• Thyrotoxicosis
• Using on the day of the surgery
• Patients having hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency
• Anorexiants, non-selective MAOIs, sibutramine

• Administer cautiously to patients with a history of drug dependence or alcoholism
• Chronic abusive use may lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior
• Parenteral abuse may lead to frank psychotic episodes
• Carefully supervise during withdrawal from abusive use as severe depression may occur
• Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder which may require follow-up

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

See Supplemental Patient Information

• Sudden death has occurred in association with therapy at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems. Avoid using in children or adolescents with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug
• Sudden deaths, stroke, and myocardial infarction may occur in adults taking stimulant drugs at usual doses for ADHD. Adults are more prone of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems
• Hypertension and other cardiovascular conditions may be altered. Monitor patients for larger changes in heart rate and blood pressure
• Carefully undertake history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical examination to assess for the presence of cardiac disease in children, adolescents, or adults who are being considered for treatment with stimulant medications. Further cardiac evaluation if findings suggest such disease (e.g., electrocardiogram and echocardiogram). Prompt cardiac evaluation is necessary on developing symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease
• Exacerbation of symptoms of behaviorol disturbances and thought disorder may occur in patients with a pre-existing psychotic disorder
• Undertake care in using stimulants for treating ADHD in patients with comorbid bipolar disorder
• Adequately screen patients for determining if they are at risk for bipolar disorder prior to initiating treatment with a stimulant; consider detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression
• Treatment-emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania may occur in patients without a prior history of psychotic illness or mania. Consider a possible causal role of the stimulant and discontinue treatment if such symptoms occur
• Aggressive behavior or hostility may occur in patients with ADHD. Monitor patients for the appearance of or worsening of aggressive behavior or hostility
• Lowering of convulsive threshold may occur in patients with prior history of seizures, in patients with prior EEG abnormalities in absence of seizures, and, very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. Discontinue therapy in the presence of seizures
• Cases of painful and prolonged penile erections and priapism have been reported with methylphenidate. Immediate medical attention should be sought if signs or symptoms of painful or prolonged penile erections or priapism are observed
• Long period of suppression of growth may occur. Monitor growth during treatment with stimulants and patients who are not growing or gaining height or weight as expected; interruption of therapy may be required in such patients
• Difficulties with accommodation and blurring of vision may occur in some patients
• Avoid administration in patients with preexisting severe gastrointestinal narrowing
• During prolonged therapy periodically determine CBC, differential, and platelet counts
• Therapy is associated with peripheral vasculopathy, including Raynaud’s phenomenon. Signs and symptoms mostly improve after reduction in dose or discontinuation of drug
• Stimulants used to treat ADHD can cause peripheral vasculopathy, including Raynaud’s phenomenon, hence careful observation for digital changes is necessary during treatment with ADHD stimulants

Cautions: Use cautiously in

• History of cardiovascular disease
• Continual use (may result in psychological or physical dependence)
• Hypertension
• Seizure disorders (may lower seizure threshold)
• Diabetes mellitus
• Bipolar disorder
• Pregnancy or lactation
• Geriatric or debilitated patients
• Hyperthyroidism
• Esophageal motility disorders
• Severe GI narrowing

Supplemental Patient Information

• Instruct patients to report to their physician about any numbness, pain, skin color change, or sensitivity to temperature in fingers or toes
• Advise patients to avoid consumption of alcohol during therapy

Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, Quillivant XR, Ritalin, Ritalin LA, Ritalin-SR interacts with :

	Azilect
	Eldepryl
	Emsam
	Furazolidone
	Furoxone
	Isocarboxazid
	Linezolid
	Marplan
	Methblue
	Methylene Blue
	Nardil
	Parnate
	Phenelzine
	Rasagiline
	Safinamide
	Selegiline
	Tranylcypromine
	Urolene Blue
	Xadago
	Zelapar
	Zyvox

Pregnancy Category:C

Breastfeeding: Safety Unknown. Methylphenidate levels in milk are very low and might not affect nursing infants adversely. The effects of methylphenidate in milk on the neurological development of the infant have not been well evaluated. Large dosages of methylphenidate might interfere with milk production, especially in women whose lactation is not well established. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 30 May 2011) Manufacturer advises caution.

• CNS: Dependency, abuse, nervousness, motor tics, headache, dizziness, transient drowsiness, seizures, anxiety, irritability, tremor, sedation, tension, headache
• NEURO: Paresthesia
• PSYCHIATRY: Tourette syndrome, psychosis, mania, aggressive behavior, stroke, seizures, insomnia, anxiety, depression, restlessness, agitation, aggression, bruxism, decreased libido, confusional state
• EENT: Nasopharyngitis
• CV: MI, arrhythmias, tachycardia, palpitations, angina, changes in BP
• GI: Abdominal pain, nausea, gastrointestinal obstruction, dry mouth, dyspepsia, vomiting, constipation
• HEMA: Leukopenia
• METABOLIC: Suppression of growth, anorexia, weight loss, decreased appetite
• EENT: Visual disturbances, glaucoma, vertigo
• DERM: Rash, hyperhidrosis
• RESP: Cough, oropharyngeal pain, URTI
• MUSC: Muscle tightness
• MISC: Sudden death, fever, hypersensitivity

• CNS stimulant; exact mechanism of action unknown; stimulates CNS; blocks reuptake of norepinephrine and dopamine into the presynaptic neuron and increases release of these monoamines into extraneuronal space
• Mostly metabolized (80%) by the liver via deesterification to alpha-phenylpiperidine acetic acid (PPA); CYP450: none
• Renally excreted: 78-97% (<10% unchanged), feces 1-3%
• Half-Life:
• TABS: 2-3 hrs
• Extended Release TABS: 3-4 hrs

US Trade Name(s)

• Concerta
• Metadate CD
• Metadate ER
• Methylin
• Methylin ER
• Ritalin
• Ritalin LA
• Ritalin-SR
• Quillivant XR

US Availability

methylphenidate (generic)

• TABS: 5, 10, 20 mg
• ETABS: 18, 20, 27, 30, 36, 40, 54 mg
• SOLN: 5 mg/5mL
• SOLN: 10mg/5mL

Concerta

• ETABS : 18, 27, 36, 54 mg

Metadate CD

• ECAPS: 10, 20, 30, 40, 50, 60 mg

Metadate ER

• ETABS: 20 mg

Methylin

• CHEW TABS: 2.5, 5, 10 mg
• TABS: 5, 10, 20 mg
• SOLN: 5 mg/5mL
• SOLN: 10 mg/5mL

Methylin ER

• ETABS: 10, 20 mg

Ritalin

• TABS: 5, 10, 20 mg

Ritalin LA

• ECAPS: 10, 20, 30, 40 mg

Ritalin-SR

• ETABS: 20 mg

Quillivant XR

• Extended release SUSP: 5 mg/ml

Canadian Trade Name(s)

• Biphentin
• Concerta
• Ritalin

Canadian Availability

methylphenidate (generic)

• TABS: 5, 10, 20 mg
• ETABS: 20 mg

Biphentin

• ECAP: 15, 20, 40, 50, 60, 80 mg

Concerta

• ETAB : 18, 27, 36, 54 mg

Ritalin

• TABS: 10, 20 mg

UK Trade Name(s)

• Concerta XL
• Equasym
• Equasym XL
• Medikinet
• Medikinet XL
• Ritalin

UK Availability

methylphenidate (generic)

• TABS: 5, 10, 20 mg

Concerta XL

• ETABS : 18, 27, 36 mg

Equasym, Medikinet

• TABS: 5, 10, 20 mg

Equasym XL

• ECAPS: 10, 20, 30 mg

Medikinet XL

• ECAPS: 10, 20, 30, 40 mg

Ritalin

• TABS: 10 mg

Australian Trade Name(s)

• Attenta
• Concerta
• Ritalin 10
• Ritalin LA

Australian Availability

methylphenidate (generic)

• TABS: 10 mg

Attenta

• TABS: 10 mg

Concerta

• ETABS : 18, 27, 36, 54 mg

Ritalin 10

• TABS: 10 mg

Ritalin LA

• ECAPS: 10, 20, 30, 40 mg

[Outline]

Psychiatric

CNS Stimulants

Pricing data from www.DrugStore.com in U.S.A.

• Methylphenidate HCl 10 MG TABS [Bottle] (MALLINCKRODT)
  20 mg = $22.24
  30 mg = $33.36
• Methylin ER 10 MG TBCR [Bottle] (MALLINCKRODT PHARM)
  20 mg = $21.99
  30 mg = $29.98
• Metadate CD 20 MG CPCR [Bottle] (UCB PHARMA)
  20 mg = $100.99
  30 mg = $148.48
• Concerta 18 MG TBCR [Bottle] (JANSSEN)
  20 mg = $129.99
  30 mg = $194.96
• Ritalin LA 20 MG CP24 [Bottle] (NOVARTIS)
  20 mg = $100.99
  30 mg = $150.97
• Methylphenidate HCl 5 MG TABS [Bottle] (MALLINCKRODT)
  20 mg = $29.99
  30 mg = $44.99
• Metadate CD 10 MG CPCR [Bottle] (UCB PHARMA)
  20 mg = $98.99
  30 mg = $148.97
• Ritalin LA 40 MG CP24 [Bottle] (NOVARTIS)
  20 mg = $101.98
  30 mg = $151.97
• Ritalin LA 30 MG CP24 [Bottle] (NOVARTIS)
  20 mg = $100.99
  30 mg = $150.97
• Metadate CD 30 MG CPCR [Bottle] (UCB PHARMA)
  20 mg = $99.99
  30 mg = $148.48
• Ritalin 5 MG TABS [Bottle] (NOVARTIS)
  20 mg = $41.2
  30 mg = $61.8
• Ritalin 10 MG TABS [Bottle] (NOVARTIS)
  20 mg = $29.99
  30 mg = $41.99
• Ritalin 20 MG TABS [Bottle] (NOVARTIS)
  20 mg = $42.39
  30 mg = $63.58
• Metadate ER 20 MG TBCR [Bottle] (UCB PHARMA)
  20 mg = $48.99
  30 mg = $73.97
• Concerta 27 MG TBCR [Bottle] (JANSSEN)
  20 mg = $133.99
  30 mg = $200.98
• Ritalin LA 10 MG CP24 [Bottle] (NOVARTIS)
  20 mg = $100.99
  30 mg = $150.97
• Concerta 36 MG TBCR [Bottle] (JANSSEN)
  20 mg = $132.99
  30 mg = $195.98
• Concerta 54 MG TBCR [Bottle] (JANSSEN)
  20 mg = $144.99
  30 mg = $211.96
• Methylphenidate HCl 20 MG TABS [Bottle] (MALLINCKRODT)
  20 mg = $20.99
  30 mg = $31.49
• Methylin 10 MG TABS [Bottle] (MALLINCKRODT PHARM)
  20 mg = $13.99
  30 mg = $20.98
• Metadate CD 60 MG CPCR [Bottle] (UCB PHARMA)
  20 mg = $162.99
  30 mg = $244.97
• Metadate ER 10 MG TBCR [Bottle] (UCB PHARMA)
  20 mg = $31.99
  30 mg = $47.98

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

• 24 HR Concerta 18 MG Extended Release Tablet (ALZA Corporation)
• 24 HR Metadate 40 MG Extended Release Capsule (UCB, Inc.)
• 24 HR Metadate 60 MG Extended Release Capsule (UCB, Inc.)
• 8 HR Ritalin-SR 20 MG Extended Release Tablet (Novartis Pharmaceuticals Corporation)
• Concerta 27 MG 24 HR Extended Release Tablet (ALZA Corporation)
• Concerta 36 MG 24 HR Extended Release Tablet (ALZA Corporation)
• Concerta 36 MG 24 HR Extended Release Tablet (Caremark L.L.C.)
• Concerta 54 MG 24 HR Extended Release Tablet (ALZA Corporation)
• Concerta 54 MG 24 HR Extended Release Tablet (Caremark L.L.C.)
• Metadate 10 MG Extended Release Tablet (UCB, Inc.)
• Metadate 50 MG 24 HR Extended Release Capsule (UCB, Inc.)
• Metadate CD 10 MG 24 HR Extended Release Capsule (UCB, Inc.)
• Metadate CD 20 MG 24 HR Extended Release Capsule (UCB, Inc.)
• Metadate CD 30 MG 24 HR Extended Release Capsule (UCB, Inc.)
• Metadate ER 20 MG Extended Release Tablet (UCB, Inc.)
• Methylin 10 MG Chewable Tablet (Sciele Pharma, Inc.)
• Methylin 10 MG Oral Tablet (Mallinckrodt Inc.)
• Methylin 2.5 MG Chewable Tablet (Sciele Pharma, Inc.)
• Methylin 20 MG Oral Tablet (Mallinckrodt Inc.)
• Methylin 5 MG Chewable Tablet (Sciele Pharma, Inc.)
• Methylin 5 MG Oral Tablet (Mallinckrodt Inc.)
• Methylin ER 10 MG Extended Release Tablet (Mallinckrodt Inc.)
• Methylin ER 20 MG Extended Release Tablet (Mallinckrodt Inc.)
• Methylphenidate 10 MG Oral Tablet (Physicians Total Care, Inc.)
• Methylphenidate 10 MG Oral Tablet (UCB Pharma, Inc.)
• Methylphenidate 10 MG Oral Tablet (UCB, Inc.)
• Methylphenidate 10 MG Oral Tablet (Watson Laboratories, Inc.)
• Methylphenidate 20 MG Extended Release Tablet (Physicians Total Care, Inc.)
• Methylphenidate 20 MG Extended Release Tablet (UCB Pharma, Inc.)
• Methylphenidate 20 MG Oral Tablet (Physicians Total Care, Inc.)
• Methylphenidate 20 MG Oral Tablet (UCB Pharma, Inc.)
• Methylphenidate 20 MG Oral Tablet (UCB, Inc.)
• Methylphenidate 20 MG Oral Tablet (Watson Laboratories, Inc.)
• Methylphenidate 5 MG Oral Tablet (Physicians Total Care, Inc.)
• Methylphenidate 5 MG Oral Tablet (STAT RX USA LLC)
• Methylphenidate 5 MG Oral Tablet (UCB Pharma, Inc.)
• Methylphenidate 5 MG Oral Tablet (UCB, Inc.)
• Methylphenidate 5 MG Oral Tablet (Watson Laboratories, Inc.)
• Ritalin 10 MG 24 HR Extended Release Capsule (Novartis Pharmaceuticals Corporation)
• Ritalin 10 MG Oral Tablet (Novartis Pharmaceuticals Corporation)
• Ritalin 20 MG Oral Tablet (Novartis Pharmaceuticals Corporation)
• Ritalin 5 MG Oral Tablet (Novartis Pharmaceuticals Corporation)
• Ritalin LA 20 MG 24 HR Extended Release Capsule (Novartis Pharmaceuticals Corporation)
• Ritalin LA 30 MG 24 HR Extended Release Capsule (Novartis Pharmaceuticals Corporation)
• Ritalin LA 40 MG 24 HR Extended Release Capsule (Novartis Pharmaceuticals Corporation)