Concerta interactions: Alcohol, medications, and other factors

Concerta (methylphenidate) is a brand-name prescription drug used to treat attention deficit hyperactivity disorder (ADHD).

As with other medications, Concerta can interact with certain other drugs. It can also interact with some supplements, foods, and drinks. An interaction occurs when one substance causes another substance to have a different effect than expected.

For details about Concerta’s interactions, keep reading. For additional information about Concerta, see this article.

In some cases, a factor or condition could prevent your doctor from prescribing Concerta due to the risk of harm. This is known as a contraindication. The contraindications of Concerta include:

Having agitation or anxiety

Before starting treatment with Concerta, tell your doctor if you have agitation or anxiety. The drug may worsen these conditions.

For this reason, doctors typically will not prescribe Concerta for people with severe agitation or anxiety. If you have either of these conditions, your doctor can recommend a treatment option other than Concerta.

Having glaucoma

Before taking Concerta, tell your doctor if you have glaucoma. This condition is caused by a buildup of pressure in the eye, which may lead to vision loss.

Concerta can raise your blood pressure, which can further increase the pressure in your eye. And this could worsen your glaucoma.

Due to this risk, doctors typically will not prescribe Concerta for people with glaucoma. If you have this condition, your doctor can recommend a different treatment for you.

Having Tourette’s syndrome or tics

If you have Tourette’s syndrome or tics, Concerta could worsen your symptoms. (Tourette’s syndrome is a condition that causes tics. These are unwanted, repetitive, or uncontrollable movements that can happen in any part of the body.)

Your doctor will likely not prescribe Concerta if you or a family member has Tourette’s syndrome or tics. If you have one of these conditions, your doctor can recommend a treatment other than Concerta.

Taking a monoamine oxidase inhibitor (MAOI)

Before starting treatment with Concerta, tell your doctor if you take a type of antidepressant called a monoamine oxidase inhibitor (MAOI). Also tell them if you’ve recently stopped taking an MAOI within the past 14 days.

Taking Concerta with an MAOI can cause a hypertensive crisis. (This condition is caused by a rapid and severe increase in blood pressure.) A hypertensive crisis may lead to dangerous effects such as stroke, heart attack, or kidney failure.

Below are examples of MAOIs that can interact with Concerta:

• linezolid (Zyvox)
• methylene blue (ProvayBlue)
• selegiline (Emsam)
• isocarboxazid (Marplan)
• phenelzine (Nardil)

Due to this interaction, doctors typically will not prescribe Concerta with current or recent use of an MAOI. If you’re taking an MAOI, your doctor will likely have you wait at least 14 days after stopping treatment with the drug. After this time, they may recommend that you start taking Concerta.

Having had an allergic reaction to Concerta or any of its ingredients

If you’ve had an allergic reaction to Concerta or any of its ingredients, your doctor will likely not prescribe Concerta. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Concerta, it’s important to tell your doctor if any of these contraindications apply to you. They can determine whether to prescribe Concerta.

Concerta and alcohol aren’t known to interact. However, it may be safest to avoid consuming alcohol while taking Concerta.

This is because Concerta and alcohol may mask each other’s effects. This can happen because of how each works in the body. Concerta stimulates your central nervous system (CNS), while alcohol depresses it (slows it down). The CNS helps control activities such as breathing, thinking, and more.

So, drinking alcohol while taking Concerta could make it hard to tell whether the drug is working for your condition. And taking Concerta could make it difficult to know the amount of alcohol you’ve consumed.

Keep in mind that doctors typically will not prescribe Concerta for people who have alcohol use disorder. This condition may increase the risk of dependence on Concerta. In fact, Concerta has a boxed warning about this risk. For details, see “Boxed warning: Drug dependence” at the beginning of this article.

If you have questions about Concerta and alcohol, talk with your doctor.

Before you start treatment with Concerta, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, including what not to take with Concerta, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Concerta. Keep in mind that this chart does not include all drugs that may interact with Concerta. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about this interaction, see “When to avoid Concerta” above.
† To learn about side effects of Concerta, see this article.

Here’s a closer look at certain drug interactions of Concerta.

Vasopressors

Vasopressors are medications used to narrow blood vessels.

Certain vasopressors are used to increase blood pressure in emergency situations, such as for severely low blood pressure. Other vasopressors are used to relieve cold and allergy symptoms, such as nasal congestion and sinus pressure.

Interaction result. Taking Concerta with a vasopressor can increase the effect of the vasopressor. This means that taking Concerta with this type of drug could lead to very high blood pressure. And this could result in dangerous effects such as stroke, heart attack, or kidney failure.

Interaction explained. Both Concerta and vasopressors have a risk of high blood pressure when taken individually. Therefore, taking Concerta in combination with a vasopressor may further increase the risk of high blood pressure.

Examples of vasopressor drugs. Below are some vasopressors that may interact with Concerta:

• phenylephrine (Sudafed PE)
• pseudoephedrine (Sudafed)
• midodrine (Orvaten)

Steps you or your doctor may take. Due to this risk, doctors will watch your blood pressure closely if you take Concerta with a vasopressor. If you develop high blood pressure, your doctor can advise you on the right treatment.

If you’re interested in treating a cold or allergies while taking Concerta, talk with your doctor or pharmacist. They can tell you which allergy drugs contain a vasopressor and whether it’s safe to take allergy medication with Concerta.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant.

Interaction result. Taking Concerta with an SSRI can increase the risk of side effects from the SSRI. This includes serotonin syndrome, which is caused by a high level of the chemical serotonin in the body.

Interaction explained. Taking Concerta with an SSRI may cause your body to break down the SSRI more slowly than usual. This means that taking Concerta with an SSRI could raise the level of the SSRI in your system. The higher level could increase your risk of side effects from the SSRI.

Examples of SSRI drugs. Below are examples of SSRIs that may interact with Concerta:

• sertraline (Zoloft)
• fluoxetine (Prozac)
• citalopram (Celexa)
• escitalopram (Lexapro)

Steps you or your doctor may take. Before starting Concerta treatment, tell your doctor if you’re taking an SSRI. They can recommend whether it’s safe to take these medications together. If your doctor says it’s safe, they may give you a lower dosage of the SSRI than what’s usually prescribed. Taking a lower dosage can help reduce the level of the SSRI in your body, which could decrease your risk of side effects.

If your doctor prescribes Concerta while you’re taking an SSRI, watch for symptoms of serotonin syndrome. Examples include nausea and vomiting, hallucinations, and changes in blood pressure. If you develop these symptoms, talk with your doctor immediately. They can instruct you on how to treat this condition.

However, you should call 911 or your local emergency number right away if your symptoms seem severe or life threatening.

Warfarin

Warfarin (Jantoven) is a blood thinner. The drug is used to help prevent or treat blood clots in certain situations.

Interaction result. Taking Concerta with warfarin can increase the risk of side effects of warfarin.

Interaction explained. Taking Concerta with warfarin may cause your body to break down warfarin more slowly than usual. As a result, Concerta may raise the level of warfarin in your body. Having a higher level of warfarin could increase your risk of side effects of warfarin, including serious bleeding.

Steps you or your doctor may take. Before taking Concerta, tell your doctor if you’re already taking warfarin. They can recommend whether it’s safe to take these medications together. If your doctor says it’s safe, they may give you a lower dosage of warfarin than usual. Taking a lower dosage can help reduce the level of warfarin in your body. And having a lower level of the drug could decrease your risk of side effects.

If your doctor prescribes Concerta with warfarin, they may order certain blood tests more often than usual. (These tests are used to check the thickness of your blood, which can help doctors determine your risk of bleeding.)

Be sure to tell your doctor if you have symptoms of severe bleeding while taking Concerta and warfarin together. Symptoms can include bloody stool, bloody urine, and coughing up blood. If you have these symptoms, tell your doctor right away. They can advise you on how to manage this side effect.

Concerta may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Concerta.

Concerta interactions with supplements

Before you start treatment with Concerta, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Concerta may interact with caffeine supplements, increasing the risk of certain side effects with Concerta. Examples of these effects include insomnia, anxiety, and irritability. (To learn more about side effects of Concerta, see this article.)

Before you start taking Concerta, tell your doctor if you take caffeine supplements. They may be able to suggest a different treatment.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Concerta interactions with herbs

Concerta may interact with the herbal supplement St. John’s wort.

Taking Concerta with St. John’s wort can increase the risk of serotonin syndrome. This condition is due to a high level of the chemical serotonin in the body. Serotonin syndrome can cause symptoms such as nausea and vomiting, hallucinations, and changes in blood pressure.

Before you start Concerta treatment, tell your doctor if you take St. John’s wort. They may be able to help identify an alternative for you that doesn’t have this risk.

Concerta and vitamins

There have been no specific reports of vitamins interacting with Concerta. However, it’s possible that interactions with vitamins could be recognized in the future. This is why it’s important to check with your doctor or pharmacist before taking any of these products during Concerta treatment.

Concerta interactions with food

Concerta may interact with certain foods and drinks that contain caffeine. Examples include chocolate, coffee, green tea, and some soft drinks.

The amount of caffeine in foods and drinks may be much less than what’s typically in a caffeine supplement.* However, caffeinated foods and drinks may still increase the risk of certain side effects with Concerta. Examples include insomnia, anxiety, and irritability. (To learn more about side effects of Concerta, see this article.)

If you have questions about specific foods or drinks that may interact with Concerta, talk with your doctor.

* To learn more, see “Concerta interactions with supplements” above.

Concerta and vaccines

No vaccines have been reported to interact with Concerta. To learn more about getting specific vaccines during Concerta treatment, talk with your doctor.

Concerta and lab tests

Lab tests and Concerta have not been reported to interact with each other. For additional information about having specific lab tests while you take Concerta, talk with your doctor.

Concerta interaction with cannabis or CBD

Cannabis (also called marijuana or “weed”) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Concerta.

Taking Concerta with cannabis or cannabis products may lead to certain side effects. Examples include having a fast heart rate, high blood pressure, or severe heart damage.

Before you start treatment with Concerta, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Concerta. Before you take Concerta, be sure to talk with your doctor about your health history. Concerta may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Concerta include:

• History of drug dependence or alcohol use disorder. Doctors typically will not prescribe Concerta if you have a history of drug dependence or alcohol use disorder. This is because Concerta has a boxed warning about the risk of drug dependence. To learn more, see “Boxed warning: Drug dependence” at the top of this article.
• Agitation or anxiety. If you have severe agitation or anxiety, your doctor will likely not prescribe Concerta. For details, see “When to avoid Concerta” above.
• Glaucoma. If you have glaucoma, your doctor may not prescribe Concerta for you. For details, see “When to avoid Concerta” above.
• Tourette’s syndrome or tics. If you have Tourette’s syndrome or tics, doctors are not likely to prescribe Concerta for you. For details, see the “When to avoid Concerta” section above.
• Allergic reaction. If you’ve had an allergic reaction to Concerta or any of its ingredients, your doctor will likely not prescribe Concerta. For more information, see “When to avoid Concerta” above.
• Mental health conditions, such as bipolar disorder or psychosis. If you have a mental health condition such as bipolar disorder or psychosis, talk with your doctor before taking Concerta. The drug may worsen these conditions. Your doctor can recommend whether Concerta is the right treatment option for you.
• Heart problems, including high blood pressure. Before taking Concerta, tell your doctor if you have high blood pressure or heart problems such as an irregular heart rhythm. Concerta may lead to serious heart problems, such as heart attack, in people who have these conditions. If you have high blood pressure or heart problems, your doctor may prescribe a treatment other than Concerta.
• Problems with your esophagus, stomach, or intestines. Because Concerta tablets do not change shape when swallowed, they could block your intestines if you have certain digestive problems. (Examples of problems include short bowel syndrome and peritonitis.) Before taking Concerta, tell your doctor if you have any problems with your esophagus, stomach, or intestines. They can help determine whether it’s safe to take Concerta.
• Circulation problems. Before taking Concerta, tell your doctor if you or a family member has circulation problems. Concerta can cause circulation problems such as Raynaud’s syndrome. Therefore, the drug could worsen your condition. Your doctor can advise you on whether it’s safe to take Concerta.
• Seizures. Concerta may cause seizures. If you already have seizures, your risk of this side effect may be higher than usual. Your doctor can determine whether Concerta is a safe treatment option for you.
• Pregnancy. It’s not known whether Concerta is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Concerta. They can talk with you about the risks and benefits of taking the drug while pregnant. For details about the use of Concerta during pregnancy, see this article.
• Breastfeeding. It’s not known whether Concerta passes into breast milk or if the drug causes side effects in a breastfed child. For more information about taking Concerta while breastfeeding, talk with your doctor.

Here are some frequently asked questions about Concerta and possible interactions.

Can I take Concerta with other stimulant drugs, such as Vyvanse?

It may be safest to avoid taking Concerta with other stimulant drugs.

Concerta is a stimulant drug. Taking Concerta with another stimulant could increase your risk of side effects from both medications. For this reason, your doctor is not likely to prescribe Concerta in combination with stimulants.

Examples of stimulant drugs include:

• lisdexamfetamine (Vyvanse)
• amphetamine/dextroamphetamine (Adderall, Adderall XR)
• methamphetamine (Desoxyn)
• dextroamphetamine (Dexedrine, Xelstrym)

To learn more about Concerta and stimulants, talk with your doctor or pharmacist.

Can I take Concerta with an over-the-counter pain reliever, such as Tylenol or Advil?

Yes, it should be safe to take Concerta with an over-the-counter pain reliever, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, others). Concerta is not known to interact with these medications.

If you have additional questions about taking an over-the-counter pain reliever with Concerta, talk with your doctor or pharmacist.

You can take certain steps to help prevent interactions with Concerta. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or take cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the label of Concerta and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Concerta does not come with paperwork, you can ask your pharmacist to print a copy for you.) If this information is difficult to understand, ask your doctor or pharmacist to help explain it.

You can also help prevent interactions with Concerta by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Concerta. These resources might help:

• Overview of Concerta. For a general overview of Concerta, you can see this article.
• Side effects. If you’re interested in the side effects of Concerta, see this article. Another option is to refer to the Concerta prescribing information.
• Drug comparison. Find outhow Concerta compares with Adderall and Vyvanse.
• Facts about your condition. To learn more about attention deficit hyperactivity disorder (ADHD), see our list of related articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.