Ritalin is effective in treating attention deficit hyperactivity disorder (ADHD). However, Ritalin can cause side effects that can range from agitation and sleep problems to potentially severe cardiovascular events.

Keep reading to learn more about the mild and severe side effects of Ritalin and its interactions with other substances.

Packet of Ritalin tablets. Share on Pinterest
Image credit: Getty Images

Ritalin is a prescription-only, synthetic medication that people often use to treat ADHD. Ritalin is a brand-name. It contains the active chemical methylphenidate.

Ritalin is a central nervous system (CNS) stimulant. It works by stimulating the brain chemicals dopamine and norepinephrine, chemicals associated with control and attention.

Dopamine also has strong associations with pleasure and reward. Norepinephrine mobilizes the brain and body to get ready for action and is involved in the fight or flight response.

The U.S. Food and Drug Administration (FDA) have approved Ritalin to treat ADHD in pediatric patients 6 years and older. The symptoms of ADHD include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity.

The FDA also approve Ritalin to treat adult narcolepsy.

Off-label indications, not approved by the FDA, include using Ritalin to treat major depressive disorder and terminal cancer.

Methylphenidate is prone to misuse, just like other stimulants.

Its ability to improve concentration means some people use it to boost cognitive ability.

Ritalin is available as a tablet that a person can take orally and as a patch that allows absorption of the medication through the skin.

For most people prescribed Ritalin, the drug helps them concentrate and gain control over their actions. This can help with day-to-day functioning at school or in their job.

The package insert for methylphenidate provides information covering every aspect of the drug’s use.

It lists many warnings and potential adverse reactions from using the drug. However, everyone reacts to medicines differently. Some people experience very few, if any, side effects from taking Ritalin.

Ritalin is short-acting, so the drug does not stay in the body for an extended period. This means that any side effects usually occur while Ritalin is in a person’s system.

Some mild side effects of Ritalin are:

  • agitation
  • an energized feeling
  • a headache
  • difficulty sleeping
  • moodiness
  • anxiety
  • nausea
  • reduced appetite

{lease note that this is not a comprehensive list of all the side effects. Before taking Ritalin, a person should talk with their doctor about possible side effects and whether Ritalin is the right choice for them.

For people with cardiac problems, a history of seizures, or those prone to anxiety, Ritalin might make matters worse.

A person who receives a prescription for Ritalin should make regular appointments to see their doctor every few months. The doctor can ask about any adverse reactions, check the person’s blood pressure, and make adjustments to the medication if necessary.

Some severe side effects of Ritalin include:

  • cardiovascular reactions, including sudden death, stroke, and heart attack
  • increased blood pressure
  • increased heart rate (tachycardia)
  • psychiatric adverse reactions, including worsening of a pre-existing psychiatric condition
  • development of new psychotic or manic symptoms
  • sustained and sometimes painful erections in males
  • poor circulation, including Raynaud’s phenomenon
  • long-term suppression of growth and weight loss in pediatric patients
  • potential for abuse and dependence*

*Please note that Ritalin carries a Black Box Warning that reads:

“WARNING: ABUSE AND DEPENDENCE CNS stimulants, including Ritalin and Ritalin-SR, other methylphenidate-containing products, and amphetamines, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing, and monitor for signs of abuse and dependence while on therapy.”

Please note that this is not a comprehensive list of all the serious side effects. Before taking Ritalin, a person should talk with their doctor about possible side effects and whether Ritalin is the right choice for them.

Ritalin can suppress growth in children and adolescents, particularly in the first few years of taking the drug. A doctor will monitor the height and weight of young people taking Ritalin.

Research has found that circulation problems, including Raynaud’s disease, have been associated with using methylphenidate. If a person experiences numbness in the fingers or toes, they should contact a doctor immediately.

Stimulant drugs like Ritalin can be addictive and, if misused, can have long-term mental health consequences. Prescribed doses are very unlikely to lead to dependency.

Taking more than the prescribed dose of Ritalin can also put pressure on the heart, nervous system, and immune system, leading to long-term health complications.

In rare cases, Ritalin might trigger an allergic reaction. The most common signs to look out for include:

  • itching
  • nasal congestion, or rhinitis
  • hives (itchy red spots on the skin)
  • rash
  • watery or itchy eyes
  • scratchy throat

Recreational use

Ritalin is not approved for recreational use, and it is illegal to take or possess the substance without a prescription.

If a person is using Ritalin recreationally, or more often than their doctor prescribes, this could be a sign of abuse and dependence.

Some people do take Ritalin recreationally for its stimulating effect. It can give the user a temporary feeling of alertness and energy. It can also lead them to feel overconfident and remove inhibitions, which could lead to risky behavior.

Very high doses of Ritalin can lead to:

  • delusions or hallucinations
  • shakiness or twitching
  • paranoia
  • panic attacks
  • seizures
  • confusion

A person should seek medical attention if they have any of these symptoms.

A pharmaceutical company first marketed methylphenidate as Ritalin in 1954. Since then, it has proven safe for most people as a treatment for ADHD and other conditions.

One review looked at studies into the long-term behavioral effects associated with Ritalin use. The review found that there is currently insufficient evidence to definitely state if Ritalin has long-term side effects on behavior.

When a person takes Ritalin alongside other medications, it can be dangerous. According to the package insert, Ritalin interacts with the following drugs:

  • Monoamine Oxidase Inhibitors (MAOIs): MAOIs include selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, and methylene blue. People should not take Ritalin alongside these medications as it can cause severe and sometimes fatal side effects.
  • Antihypertensive drugs: These include diuretics, calcium channel blockers, angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, and centrally acting alpha-2 receptor agonists.
  • Certain anesthetics: Anesthetics that cause interactions include halothane, isoflurane, enflurane, desflurane, and sevoflurane.

Other possible interactions include:

  • acid reflux drugs, such as antacids, H2 blockers, and proton pump inhibitors
  • blood pressure drugs, such as losartan, valsartan, irbesartan, enalapril, lisinopril, hydrochlorothiazide, and furosemide
  • antipsychotics, such as chlorpromazine and haloperidol
  • seizure medications, such as phenytoin and phenobarbital
  • warfarin
  • caffeine
  • cold or allergy medicines

Before taking Ritalin, a person should tell their doctor or pharmacist about other medications they are taking. The doctor or pharmacist can advise about possible interactions with Ritalin.

Anyone who receives a prescription for Ritalin will need to regularly visit a doctor or other healthcare professional to review their medication needs. As Ritalin is a tightly controlled medication, a person will need a new prescription from a doctor each time.

If the medication loses its effects or has undesirable side effects, a person should tell their doctor. The doctor may adjust the amount of medicine they prescribe. A person taking Ritalin should never change their own dose and must consult a doctor first.

Males should call 911 or their local emergency service if they have an erection that lasts more than 4 hours or becomes painful. This can be a sign of a serious problem that needs immediate treatment.

If a person has numbness in the fingers or toes or changes in skin sensitivity or skin color, they should call 911 or contact their local emergency service.

Chest pain, changes in heartbeat, or breathing difficulties can also be dangerous, and a person should call 911 or their local emergency service immediately.

Doctors have prescribed Ritalin to treat conditions such as ADHD and narcolepsy for decades.

It affects people in different ways but is generally safe when used as directed by a doctor.

Ritalin has the potential to be addictive at any dose and can have some serious adverse effects.