Ritalin interactions: Alcohol, medications, and other factors

Before you start treatment with Ritalin, 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. (To learn whether Ritalin interacts with supplements, herbs, or vitamins, see the “Ritalin and other interactions” section below.)

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

Here’s a table of drugs that can interact with Ritalin. Keep in mind that this table doesn’t include all drugs that may interact with Ritalin. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about this interaction, see “When to avoid Ritalin” below.

In some cases, factors or conditions could prevent your doctor from prescribing Ritalin due to the risk of harm. These are known as contraindications. Ritalin contraindications include:

Taking monoamine oxidase inhibitors

If you take a monoamine oxidase inhibitor (MAOI), your doctor will likely not prescribe Ritalin. (MAOIs are a type of antidepressant.) Taking Ritalin with an MAOI can cause very high blood pressure. This may lead to serious effects, such as stroke, heart attack, and kidney failure.

Below are examples of MAOIs that may interact with Ritalin:

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

If you’re taking an MAOI, your doctor will likely have you wait at least 2 weeks after stopping treatment. At this time, they may tell you it’s safe to start taking Ritalin.

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

If you’ve had an allergic reaction to Ritalin or any of its ingredients, your doctor will likely not prescribe Ritalin. 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 Ritalin, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Ritalin.

Ritalin has been reported to interact with alcohol.

Ritalin and alcohol work in opposite ways. As a result, they may mask each other’s effects. Specifically, taking Ritalin could make it hard to know the amount of alcohol you’ve consumed. And drinking alcohol could make it hard to tell whether Ritalin is working for your condition.

Drinking alcohol while taking Ritalin LA* could also increase your risk of certain side effects of Ritalin LA. Examples included headache, excessive sweating, and dry mouth. This is because alcohol can cause most of the drug to be released into your body as soon as you take it.

If you have questions about avoiding alcohol while taking Ritalin, talk with your doctor or pharmacist.

* Ritalin LA comes as extended-release oral capsules. Extended-release means the drug is slowly released into your body over a long period of time.

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

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant. They’re prescribed to treat mental health conditions, including depression and anxiety.

Interaction result. Taking Ritalin with an SSRI can increase the risk of serotonin syndrome. This condition is caused by a high level of the chemical serotonin in the body.

Interaction explained. Taking Ritalin with an SSRI may cause your body to break down the SSRI more slowly than usual. This could raise the level of the SSRI in your body, increasing your risk of SSRI side effects. These side effects include serotonin syndrome.

Examples of SSRI drugs. Here are some SSRIs that may interact with Ritalin:

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

Steps you or your doctor may take. Before starting Ritalin treatment, tell your doctor if you’re taking an SSRI. They can recommend whether it’s safe for you to take these medications together. If your doctor tells you that it’s safe, they may lower your SSRI dosage. Doing so can help lower your risk of side effects.

If you take Ritalin with an SSRI, watch for symptoms of serotonin syndrome. Examples include confusion, excessive sweating, and very high fever. If you have these symptoms, tell your doctor right away. However, if your symptoms seem severe or life threatening, call 911 or a local emergency number.

If you develop serotonin syndrome, your doctor can recommend how to manage this condition. They’ll likely have you stop treatment with Ritalin or the SSRI.

To learn more about Ritalin and SSRIs, talk with your doctor or pharmacist.

Beta-blockers

Beta-blockers can be prescribed to treat high blood pressure and other heart conditions.

Interaction result. Taking Ritalin with a beta-blocker could make the beta-blocker less effective than usual.

Interaction explained. Ritalin has the opposite effect of beta-blockers. Specifically, Ritalin treatment may cause certain heart and blood vessel problems, such as fast heart rate and high blood pressure. Among other uses, beta-blockers treat high blood pressure and help lower heart rate. As a result, taking Ritalin with a beta-blocker could make the beta-blocker less effective for these conditions.

Examples of beta-blockers. Here are some beta-blockers that may interact with Ritalin:

• bisoprolol
• metoprolol (Lopressor, Toprol XL, others)
• propranolol (Inderal LA, InnoPran XL, others)

Steps you or your doctor may take. Before starting Ritalin treatment, tell your doctor if you’re already taking a beta-blocker. They can recommend whether it’s safe to take these medications together. If your doctor says it’s safe, they’ll check to make sure the beta-blocker is working as usual.

To learn more about Ritalin and beta-blockers, talk with your doctor or pharmacist.

Bupropion

Bupropion (Wellbutrin SR, Wellbutrin XL) is an antidepressant. It’s prescribed to treat certain types of depression.

Interaction result. Taking Ritalin with bupropion may increase the risk of side effects from either drug.

Interaction explained. Both Ritalin and bupropion may cause seizures when taken individually. Taking these drugs together may further increase the risk of seizures.

Steps you or your doctor may take. Before taking Ritalin, be sure your doctor knows if you’re taking bupropion. They can advise you on whether it’s safe to take these medications together.

If your doctor prescribes Ritalin while you’re taking bupropion, they may lower your bupropion dosage. Doing so can help lower your risk of seizures. (To learn about bupropion’s dosage, see this article.)

To learn more about Ritalin and bupropion, talk with your doctor or pharmacist.

Ritalin 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 Ritalin.

Ritalin interactions with supplements

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

Ritalin has been reported to interact with caffeine supplements. Taking Ritalin and caffeine supplements may increase the risk of certain side effects with Ritalin. Examples include high blood pressure, nausea, and insomnia.

Before you start Ritalin treatment, tell your doctor if you take caffeine supplements. They’ll likely recommend that you avoid these supplements while taking Ritalin.

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

Ritalin interactions with herbs

Ritalin has been reported to interact with the herbal supplement St. John’s wort. This supplement is used to ease symptoms of depression and certain other conditions.

Taking Ritalin with St. John’s wort can increase the risk of serotonin syndrome. This condition is caused by a high level of the chemical serotonin in the body. Symptoms may include confusion, excessive sweating, and very high fever.

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

Ritalin and vitamins

There are no specific reports of vitamins interacting with Ritalin LA or Ritalin. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Ritalin.

Ritalin interactions with food

Ritalin has been reported to interact with foods and drinks that contain caffeine. Examples include chocolate, green tea, coffee, and some soft drinks.

Keep in mind that the amount of caffeine in foods and drinks is typically much less than what’s in a caffeine supplement.* However, foods and drinks with caffeine may still increase the risk of certain side effects with Ritalin. Examples include high blood pressure, insomnia, and nausea.

To learn more about specific foods or drinks that may interact with Ritalin, talk with your doctor.

* To learn more about this, see “Ritalin interactions with supplements” above.

Ritalin and vaccines

There are no specific reports of vaccines interacting with Ritalin LA or Ritalin. To learn more about getting certain vaccines while taking Ritalin, talk with your doctor.

Ritalin and lab tests

There are no specific reports of lab tests interacting with Ritalin LA or Ritalin. To learn more about getting specific lab tests while taking Ritalin, talk with your doctor.

RITALIN INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Ritalin.

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

Before you start treatment with Ritalin, tell your doctor and pharmacist if you use 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 U.S. states to varying degrees.

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

Health conditions or factors that might interact with Ritalin include:

Drug dependence or alcohol use disorder. Doctors typically will not prescribe Ritalin for people with drug dependence or alcohol use disorder. These conditions may increase the risk of misuse and dependence with Ritalin. In fact, the drug has a boxed warning about this risk. To learn more, see “Boxed warning: Misuse and dependence” at the top of this article.

Heart problems, including high blood pressure. Before taking Ritalin, tell your doctor if you have high blood pressure. Also tell them if you have a heart problem such as irregular heart rhythm. Ritalin may cause serious heart problems, including heart attack, in people who have these conditions.

If you have a heart problem or high blood pressure, your doctor may prescribe a treatment other than Ritalin.

Circulation problems. Before starting Ritalin treatment, tell your doctor if you have a circulation problem. Ritalin may cause circulation problems such as Raynaud’s syndrome. If you already have a circulation problem, the drug could worsen your condition. Your doctor can recommend whether it’s safe to take Ritalin.

Certain mental health conditions. If you have a mental health condition, such as psychosis or bipolar disorder, tell your doctor before taking Ritalin. The drug may worsen these conditions. Your doctor can advise you on whether Ritalin is the right treatment option.

Pregnancy. It’s not known whether Ritalin is safe to take during pregnancy. If you’re pregnant or can become pregnant, talk with your doctor before starting Ritalin treatment. They can talk with you about the risks and benefits of taking the drug during pregnancy.

If you take Ritalin while pregnant, consider enrolling in a pregnancy registry. This registry helps collect information on the safety of Ritalin during pregnancy. To learn more, call 866-961-2388 or visit the registry website. You can also talk with your doctor.

Breastfeeding. It isn’t known whether Ritalin is safe to take while breastfeeding. The drug can pass into breast milk. However, it’s not known whether the drug may cause side effects in a child who’s breastfed. To learn more about taking Ritalin while breastfeeding, talk with your doctor.

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

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

How do interactions of Ritalin vs. Adderall XR compare?

Ritalin and amphetamine/dextroamphetamine (Adderall XR*) have some of the same interactions. But these medications have different active ingredients, so they have different interactions as well.

For example, both Ritalin and Adderall XR may interact with certain antidepressants, including monoamine oxidase inhibitors.† Adderall XR may also interact with triptans for migraine and H2 blockers for heartburn. But Ritalin is not known to interact with these medications. Adderall XR may also interact with other drugs that Ritalin isn’t known to interact with.

Similar to Ritalin, Adderall XR is prescribed to treat narcolepsy and attention deficient hyperactivity disorder (ADHD). To learn more about Adderall XR’s interactions, see this article. If you have questions about Ritalin vs. Adderall treatment for ADHD, talk with your doctor or pharmacist.

* “XR” is short for extended release, which means the drug releases slowly into the body over time.
† For details about this interaction, see “When to avoid Ritalin” above.

What is the best antidepressant to take with Ritalin?

The best antidepressant to take with Ritalin depends on certain factors and your doctor’s recommendation. It’s also important to consider the risk of an interaction between Ritalin and the antidepressant.

Ritalin interacts with many antidepressants, including:

• monoamine oxidase inhibitors such as isocarboxazid (Marplan)*
• serotonin-norepinephrine reuptake inhibitors such as duloxetine (Cymbalta)
• selective serotonin reuptake inhibitors such as citalopram (Celexa)†
• tricyclic antidepressants such as amitriptyline
• bupropion (Wellbutrin SR, Wellbutrin XL)†

Taking Ritalin with these antidepressants may increase the risk of side effects from either drug. Examples include very high blood pressure and serotonin syndrome. (This is a condition caused by a high level of serotonin in the body.)

Your doctor can recommend whether it’s safe to take Ritalin with a specific antidepressant.

* For details about this interaction, see “When to avoid Ritalin” above.
† For details about this interaction, see “Drug interactions in depth” above.

You can take certain steps to help prevent interactions with Ritalin. Your doctor and pharmacist are key resources. They’ll be able to answer any questions you may have before you start treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use 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 Ritalin label 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 Ritalin doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

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

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

• Overview of Ritalin. For a general overview of Ritalin, you can read this article.
• Dosage specifics. To learn about the dosage of Ritalin, see this article.
• Cost. If you’d like to learn about Ritalin and cost, read this article.
• Facts about your condition. To learn more about your condition, see our attention deficit hyperactivity disorder hub.

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.