Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin LA, Ritalin

SR, PMS-Methylphenidate (methylphenidate)

Classification: central nervous system stimulant

Indication (Use): Tx. of ADHD (adjunct), symptomatic treatment of narcolepsy, Unlabeled

uses: Management of some form of refractory depression

Normal dosage: Adult ~ PO 5-20mg 2-3 times daily as prompt- release tablets. When
maintenance dose is determined, may change to extended release formulation. Narcolepsy: ~
10mg, 2-3 times/day; max 60mg/day

Children ~PO (children >6yr): prompt-release tabs- 0.3mg/kg/dose or 2.5-5mg

before breakfast and lunch; increase by 0.1mg/kg/dose or by 5-10mg/day at weekly intervals (not
to exceed 60mg/day or 2mg/kg/day), when maintenance dose is determined, may change to
extended release formulation. Ritalin SR, Metadate ER, may be used in place of the Prompt-
release tabs when the 8-hour dosage corresponds to the titrated 8-hour dosage of the Prompt-
release tablets; Ritalin LA- can be used in place of twice daily regimen given once daily at same
total dose; or in place of SR product at same dose; Concerta (pts. Who have not taken
methylphenidate previously) 18mg once a day in the morning initially, may be titrated as needed
up to 54mg/day; Concerta (pts who are currently taking other forms of methylphenidate) 18mg
once in the morning if previous dosage was 5mg 2-3 times or 20mg daily as SR product, 36mg
once daily in the morning if previous dose was 10mg 2-3 times a day or 40mg daily as SR
product, 54mg once daily if previous dose was 15mg 2-3 times daily or 60mg once daily. Dosage
may be adjusted in weekly 20mg increments to a max of 60mg/day taken once daily in the
morning

Side Effects: CNS hyperactivity, insomnia, restlessness, tremor, dizziness, h/a, irritability
EENT: blurred vision, CV: hypertension, palpitations, tachycardia, hypotension GI: anorexia,
constipation, , cramps, N/V, dry mouth, metallic taste GU: polyuria, glycosuria, nephrogenic
diabetes insipidus, renal toxicity Derm: rashes Neuro: akathisia, dyskinesia Misc: fever,
hypersensitivity reaction, physical dependence, psychological dependence, suppression of weight
gain (children), tolerance

Nursing implications: Assess V/S, RR prior to admin, Peds: Monitor growth, both height and
weight, PEDS (ADHD): assess attention span, impulse control, interaction with others.
Narcolepsy: Observe frequency of episodes

Patient teaching: Explain the purpose of the medication, thoroughly explain possible side
effects and what adverse reaction to look for, contact Primary care provider (PCP), not to used
Caffeine-containing beverages, It is possible that the shell of the Concerts could be noticed in the
stool, (no Concern) Advise the parents to notify the child’s school of new medication or any
changes in medication. Chk weight 2-3 times a week and report any decreases to PCP.

Administration Principles: Immediate and sustained-released tabs should be administered on

an empty stomach 30-45 min ac, SR tabs should be swallowed whole, NOT crushed, chewed or
broken, Metadate CD and Ritalin LA caps may be opened and sprinkled on “COOL” applesauce
and ingested entirely followed with a drink of water, Concerta can be taken /s food however,
needs to be taken with water, milk or juice