WARNINGS - Ritalin should not be used in
children under six years, since safety and efficacy in this age group have
not been established. Sufficient data on safety and efficacy of long-term
use of Ritalin in children are not yet available. Although a causal
relationship has not been established, suppression of growth (ie, weight
gain, and/or height) has been reported with the long-term use of
stimulants in children. Therefore, patients requiring long-term therapy
should be carefully monitored.
ADVERSE REACTIONS Nervousness and insomnia are the most common adverse reactions but are
usually controlled by reducing dosage and omitting the drug in the
afternoon or evening. Other reactions include hypersensitivity (including
skin rash, urticaria, fever, arthralgia, exfoliative dermatitis, erythema
multiforme with histopathological findings of necrotizing vasculitis, and
thrombocytopenic purpura); anorexia; nausea; dizzines; palpitations;
headache; dyskinesia; drowsiness; blood pressure and pulse changes, both
up and down; tachycardia; angina; cardiac arrhythmia; abdominal pain;
weight loss during prolonged therapy. There have been rare reports of
Tourette's syndrome. Toxic psychosis has been reported. Although a
definite causal relationship has not been established, the following have
been reported in patients taking this drug: leukopenia and/or anemia; a
few instances of scalp hair loss. In children, loss of appetite, abdominal
pain, weight loss during prolonged therapy, insomnia, and tachycardia may
occur more frequently; however, any of the other adverse reactions listed
above may also occur.
Ritalin should be given cautiously to emotionally unstable patients, such
as those with a history of drug dependence or alcoholism, because such
patients may increase dosage on their own initiative. Chronically abusive
use can lead to marked tolerance and psychic dependence with varying
degrees of abnormal behavior. Frank psychotic episodes can occur,
especially with parental abuse. Careful supervision is required during
drug withdrawal, since severe depression as well as the effects of chronic
over activity can be unmasked. Long-term follow-up may be required because
of the patient's basic personality disturbances.
Why is this drug prescribed?
Ritalin and other brands of methylphenidate are mild central nervous
system stimulants used in the treatment of attention deficit hyperactivity
disorder in children. With the exception of Ritalin LA, Concerta and
Metadate CD, these products are also used in adults to treat narcolepsy
(an uncontrollable desire to sleep).
When given for attention deficit disorder, this drug should be an
integral part of a total treatment program that includes psychological,
educational, and social measures. Symptoms of attention deficit disorder
include continual problems with moderate to severe distractibility, short
attention span, hyperactivity, emotional changeability, and impulsiveness.
Most important fact about this drug
Excessive doses of this drug over a long period of time can produce
addiction. It is also possible to develop tolerance to the drug, so that
larger doses are needed to produce the original effect. Because of these
dangers, be sure to check with your doctor before making any change in
dosage; and withdraw the drug only under your doctor's supervision.
How should you take this medication?
Follow your doctor's directions carefully. It is recommended that
methylphenidate be taken 30 to 45 minutes before meals. If the drug
interferes with sleep, give the child the last dose before 6 p.m.
Ritalin-SR, Ritalin LA, Metadate CD, Methylin ER, and Concerta are
long-acting forms of the drug, taken less frequently. They should be
swallowed whole, never crushed or chewed. (Ritalin LA and Metadate CD may
also be given by sprinkling the contents of the capsule on a tablespoon of
cool applesauce and administering immediately, followed by a drink of
--If you miss a dose...
Give it to the child as soon as you remember. Give the remaining doses
for the day at regularly spaced intervals. Do not give 2 doses at once.
Keep out of reach of children. Store below 86 degrees Fahrenheit in a
tightly closed, light-resistant container. Protect Ritalin-SR from
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Only your doctor can
determine if it is safe for you to continue giving this drug.
More common side effects may include:
Inability to fall or stay asleep, nervousness
These side effects can usually be controlled by reducing the dosage and
omitting the drug in the afternoon or evening.
In children, loss of appetite, abdominal pain, weight loss during
long-term therapy, inability to fall or stay asleep, and abnormally fast
heartbeat are more common side effects.
Less common or rare side effects may include:
Abdominal pain, abnormal heartbeat, abnormal muscular movements, blood
pressure changes, chest pain, dizziness, drowsiness, fever, hair loss,
headache, hives, jerking, joint pain, loss of appetite, nausea,
palpitations (fluttery or throbbing heartbeat), pulse changes, rapid
heartbeat, reddish or purplish skin spots, skin reddening, skin
inflammation with peeling, skin rash, Tourette's syndrome (severe
twitching), weight loss during long-term treatment
Why should this drug not be prescribed?
This drug should not be prescribed for anyone experiencing anxiety,
tension, and agitation, since the drug may aggravate these symptoms.
Anyone sensitive or allergic to this drug should not take it.
This medication should not be taken by anyone with the eye condition
known as glaucoma, anyone who suffers from tics (repeated, involuntary
twitches), or someone with a family history of Tourette's syndrome (severe
and multiple tics).
This drug is not intended for use in children whose symptoms may be
caused by stress or a psychiatric disorder.
This medication should not be used for the prevention or treatment of
normal fatigue, nor should it be used for the treatment of severe
This drug should not be taken during treatment with drugs classified as
monoamine oxidase inhibitors, such as the antidepressants Nardil and
Parnate, nor for the 2 weeks following discontinuation of these drugs.
Special warnings about this medication
Your doctor will do a complete history and evaluation before
prescribing this drug. He or she will take into account the severity of
the symptoms, as well as your child's age.
This drug should not be given to children under 6 years of age; safety
and effectiveness in this age group have not been established.
There is no information regarding the safety and effectiveness of
long-term treatment in children. However, suppression of growth has been
seen with the long-term use of stimulants, so your doctor will watch your
child carefully while he or she is taking this drug.
Blood pressure should be monitored in anyone taking this drug,
especially those with high blood pressure.
Some people have had visual disturbances such as blurred vision while
being treated with this drug.
The use of this drug by anyone with a seizure disorder is not
recommended. Be sure your doctor is aware of any problem in this area.
Caution is also advisable for anyone with a history of emotional
instability or substance abuse, due to the danger of addiction.
Possible food and drug interactions
when taking this medication
If this medication is taken with certain other drugs, the effects of
either can be increased, decreased, or altered. It is especially important
to check with your doctor before combining this drug with the following:
Antiseizure drugs such as phenobarbital, Dilantin and Mysoline
Antidepressant drugs such as Tofranil, Anafranil, Norpramin, and Effexor
Blood thinners such as Coumadin
Drugs that restore blood pressure, such as EpiPen
MAO inhibitors (drugs such as the antidepressants Nardil and Parnate)
This drug should not be given to children under 6 years of age.
Drug treatment should not, and need not, be indefinite and usually can be
discontinued after puberty.
If you suspect an overdose, seek medical attention immediately.
Symptoms of Ritalin overdose may include:
Agitation, confusion, convulsions (may be followed by coma), delirium,
dryness of mucous membranes, enlarging of the pupil of the eye,
exaggerated feeling of elation, extremely elevated body temperature,
flushing, hallucinations, headache, high blood pressure, irregular or
rapid heartbeat, muscle twitching, sweating, tremors, vomiting
Side Effects from
The Essential Guide to Psychiatric Drugs
STIMULANT ANTIDEPRESSANT DRUGS Depression may also be treated with drugs called psychostimulants. Use
of such drugs is reserved for only two situations: (1) patients who have
failed to respond to at least two other antidepressants and psychotherapy
and who are seriously depressed, and (2) patients with serious and usually
terminal medical illnesses such as cancer or AIDS who are depressed and
too sick to take other kinds of antidepressants.The reason for these
restrictions is that the stimulant drugs are addictive. They include
amphetamines, sometimes called "speed" or "uppers,"
methylphenidate (Ritalin), and pemoline (Cylert).
The drugs produce a short-term mood elevation even in people who are not
depressed. College students take them to stay awake all night and finish
term papers.In most people the effects of these stimulant drugs are
short-lived and there is often a letdown or "crash" after they
wear off. During this "crash" the patient can feel very
depressed, sleepy, and sluggish. Furthermore, and very much unlike the
other drugs discussed so far in this chapter, stimulant drugs have the
potential to induce "tolerance." People who abuse amphetamines
and other stimulants--usually in attempts to lose weight or stay awake for
prolonged periods--often find that a dose that had worked for a while is
suddenly ineffective and they need a higher dose. They then become
"tolerant" to the higher dose and have to increase the dose
again. Soon, the person is addicted to the drug. Stopping it suddenly
leads to a severe withdrawal reaction characterized by bad depression and
extreme fatigue. Suicides have been reported in people who suddenly stop
taking amphetamines.Given all these problems, why even mention the
stimulant drugs? Simply because they are the only drugs that work for some
depressed patients. A very small group of usually chronically depressed
patients seems to be resistant to every other treatment for depression.
These people usually function at a fairly low level relative to their
ability and they feel sad and blue all of the time. They complain of
fatigue, low interest in life, and inability to concentrate. Many say they
have been depressed since childhood.Another small group of patients with
very serious medical problems also develops depression. Sometimes the
medical problems they have make other antidepressant drugs unsafe, or the
medical problems so magnify the side effects of the other antidepressants
that the dying patient is made even more uncomfortable. Stimulant drugs
may actually be the safest choice in this situation.For these two groups
of patients stimulant drugs may be the only answer, even though the
patient will probably become addicted. This is not to be taken lightly.
The decision to place a patient on a stimulant drug for depression is
serious and must be done only after all other efforts are declared either
unsafe or ineffective. The patient must understand that he will probably
become addicted to the medication and that he should never stop taking it
"Recent research by Nora Volkow, MD at The
Brookhaven National Laboratory in Upton, New York has helped us to
understand how RITALIN acts on our children's brains. We know
through established research that cocaine works by blocking about
50% of the brains dopamine transporters. This allows dopamine to
build up in the brain and cause euphoria/pleasure. Volkow predicted
that because of RITALINS similarity to cocaine, that it would have
similar effects on the dopamine, but would block fewer dopamine
transporters. Volkow and her colleagues were shocked, to say the
least, when they found that the typical dose of 0.5 mg/kg given to
children blocked 70% of dopamine transporters.
So why isn't Ritalin as addictive as cocaine in these doses? Because
the two drugs differ in the actual time it takes for it to work.
Cocaine has immediate effects on dopamine, whereas it takes about an
hour for RITALN to work its magic. Volkow states, 'It is the speed
at which you increase dopamine that appears to b a key element of
the addiction process'.
Research by Brandon, et al in 2001 showed that RITALIN actually
increased a reaction to cocaine in adulthood which means that
exposure to Ritalin earlier in life, made exposure to cocaine later
in life more addictive. Also, Rush and Baker published a study in
the same year showing that the physiological effects of oral cocaine
and Ritalin were strikingly similar."
Source: THE HEALTH
This website is operated by Ablechild.org
(Parents for Label and Drug Free Education). The intent of this site
is to educate and inform the public on the issues surrounding ADD/ADHD,
the testing, and the drugs involved. Since there is no medical proof
of any ADD or ADHD "disorder", we ask that you do not use this
site for medical reasons. For real medical solutions please contact your
doctor - for real educational solutions contact your school.