Methylphenidate is a stimulant that can help treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. Most people know it as Ritalin, although many other brands of the drug are available.
In this article, we explain how methylphenidate works and discuss its side effects, dosages, and risks.
Methylphenidate is a central nervous stimulant that helps increase dopamine levels in the brain.
Dopamine is a neurotransmitter that promotes feelings of motivation and reward. More dopamine may help a person concentrate better and reduce other symptoms of ADHD.
Doctors can prescribe either immediate- or extended-release versions of the drug. The immediate-release version rapidly dissolves, producing fast results that can also fade quickly.
The extended-release version dissolves more slowly, offering longer lasting effects. The most suitable brand and formulation depend on a person’s symptoms and the risk of certain side effects, among other factors.
Brands of methylphenidate include:
The Food and Drug Administration (FDA) have only approved methylphenidate to treat ADHD and narcolepsy, but off-label use is common. Therefore, doctors may sometimes prescribe the drug to treat other conditions, such as depression.
Some people abuse the drug to enhance mental performance. For example, a student might take methylphenidate to help them study longer or because they believe that it will help them perform better on a test.
A 2018 pilot study found that Adderall, another ADHD medication, did not improve performance in people who do not have ADHD. Although Adderall is chemically distinct from methylphenidate, both are stimulants and popular performance-enhancing drugs.
The data provide preliminary evidence that stimulants, including methylphenidate, may only have beneficial effects in people with ADHD.
The most common side effects of methylphenidate include:
- anxiety and agitation, especially in people with a history of these symptoms
- stomachaches, diarrhea, and other gastrointestinal symptoms
- heart rate and blood pressure changes, including rapid heart rate and high blood pressure
- trouble sleeping
- changes in appetite
- weight loss
Making slight changes to the dosage of the drug or the way a person takes the medication may prevent some side effects. For example, a person might find that they only get dizzy when they take methylphenidate on an empty stomach or that they can prevent insomnia by taking the medication in the morning rather than in the afternoon.
Less common side effects include:
- changes in sexual function, including a prolonged and painful erection
- vasculopathy, which refers to various problems with the blood vessels
- blurred vision
- manic episodes
- chest pain
Research on children who take Ritalin suggests that the drug may temporarily slow their growth, but more research is necessary to confirm this effect.
There is a risk of people abusing methylphenidate as a performance-enhancing drug. The practice is especially prevalent among college students, 17% of whom may misuse stimulants, according to a 2015 analysis.
Methylphenidate is potentially addictive. The risk of addiction increases in people who either take it without a medical need or take higher doses than their doctor recommends.
The correct dosage of methylphenidate depends on the formulation — immediate or extended release — as well as a person’s age, symptoms, overall health, and response to the drug.
Methylphenidate is not suitable for children below the age of 6 years.
For children and adolescents taking an extended-release formula, the starting dosage for the brand Concerta is 18 milligrams (mg) once per day. If this is ineffective, a doctor will increase the daily dose incrementally until it is effective. The maximum daily dose is 54 mg for children aged 6–12 years and 72 mg for adolescents.
When taking immediate-release methylphenidate, a person must divide their overall daily dose into two or three parts to maintain consistent levels of dopamine and norepinephrine.
For children over 6 years old, the FDA recommend a starting dosage of 5 mg twice per day if they are taking the brand Ritalin. A doctor may gradually increase this daily dose by 5 mg or 10 mg a week, not exceeding 60 mg.
For an adult taking Ritalin, the usual dosage is 20–30 mg per day. However, some people may need more or less than this, so it is vital to work directly with a doctor.
People who take methylphenidate should follow the treatment regimen that their doctor recommends. To increase the effectiveness of Ritalin and reduce the risk of side effects, they can try:
- taking it 30–45 minutes before a meal
- drinking plenty of water throughout the day
- avoiding taking the drug in the afternoon and early evening if it causes sleeplessness
- monitoring any new or worsening side effects and reporting them to a doctor
Methylphenidate can cause dangerous side effects when a person takes it with monoamine oxidase inhibitors (MAOIs) or drugs that may raise blood pressure.
It may also decrease the effectiveness of:
- drugs that lower blood pressure
- blood thinners and drugs to prevent blood clots
- anticonvulsant drugs
- tricyclic antidepressants
As with other drugs, alcohol may change how methylphenidate works, so it is best to ask a doctor whether it is safe to drink while taking this medication.
People with a history of alcohol use disorder and other addictions may be more likely to abuse methylphenidate, so it is crucial to discuss a full medical history with a doctor.
The FDA have approved methylphenidate to treat children over the age of 6 years. However, treatment guidelines recommend using other strategies first, including therapy and lifestyle interventions.
The American Academy of Pediatrics (AAP) encourage parents and caregivers of children taking methylphenidate to enroll their child in therapy to help them manage ADHD symptoms.
The AAP suggest that methylphenidate may be appropriate in younger children, but only after other interventions have proved to be ineffective.
The drug label for methylphenidate classifies it as a class C drug for pregnant women, which means that studies on animals suggest that it may have negative effects. There is no high-quality research in humans to confirm its safety during pregnancy. However, class C drugs may still be useful in cases where doctors consider the benefits to outweigh the risks.
Studies on rats suggest that high doses of Ritalin may cause congenital abnormalities. Doctors do not know whether Ritalin gets into a woman’s breast milk, or whether it could affect a breastfed baby.
Methylphenidate is not effective for everyone, and some people develop unpleasant side effects. These individuals may get better results from other stimulant drugs, such as Adderall.
The FDA have also approved three nonstimulant drugs for ADHD:
- Strattera (atomoxetine)
- Kapvay (clonidine)
- Intuniv (guanfacine)
In some cases, a doctor might recommend other drugs, such as antidepressants, to help with ADHD and related symptoms.
Medication is not the only treatment for ADHD. Therapy can help children and adults manage ADHD symptoms, control their impulses and emotions, and perform better at work and school.
ADHD symptoms can range from very mild to very severe. For people with moderate-to-severe ADHD, stimulant medication may rapidly improve symptoms.
Over time, a person might need to amend the dosage or switch to an alternative medication if their body develops a tolerance.
Working with a doctor who is knowledgeable about the treatment of ADHD is key. A doctor can ensure that a person has the right diagnosis, make evidence-based treatment recommendations, and monitor for side effects and drug interactions.