Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.promazineMonitor Closely (1)promazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.promethazineMonitor Closely (1)promethazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.propranololMonitor Closely (1)methylphenidate will decrease the level or effect of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.protriptylineMonitor Closely (1)protriptyline, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.quetiapineMonitor Closely (1)quetiapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.quinaprilMonitor Closely (1)methylphenidate will decrease the level or effect of quinapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.rabeprazoleMonitor Closely (1)rabeprazole decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.ramiprilMonitor Closely (1)methylphenidate will decrease the level or effect of ramipril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.rasagilineContraindicated (1)rasagiline increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.risperidoneMonitor Closely (1)risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.ropiniroleMonitor Closely (1)ropinirole, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.rotigotineMonitor Closely (1)rotigotine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.sacubitril/valsartanMonitor Closely (1)methylphenidate will decrease the level or effect of sacubitril/valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.safinamideContraindicated (1)safinamide increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.salmeterolMonitor Closely (1)salmeterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.selegilineContraindicated (1)selegiline increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.selegiline transdermalContraindicated (1)selegiline transdermal increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.serdexmethylphenidate/dexmethylphenidateMonitor Closely (3)serdexmethylphenidate/dexmethylphenidate increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode. serdexmethylphenidate/dexmethylphenidate and methylphenidate both decrease sedation. Use Caution/Monitor. serdexmethylphenidate/dexmethylphenidate and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sevofluraneSerious - Use Alternative (1)sevoflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.sodium zirconium cyclosilicateMonitor Closely (1)sodium zirconium cyclosilicate will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Check specific recommendations for drugs that exhibit pH-dependent solubility that may affect their systemic exposure and efficacy. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Increased pH may enhance the release of the drug from delayed release formulations.solriamfetolMonitor Closely (1)methylphenidate and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sotalolMonitor Closely (1)methylphenidate will decrease the level or effect of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.sufentanil SLMonitor Closely (1)sufentanil SL, methylphenidate. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.telmisartanMonitor Closely (1)methylphenidate will decrease the level or effect of telmisartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.terazosinMonitor Closely (1)methylphenidate will decrease the level or effect of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.terbutalineMonitor Closely (1)terbutaline and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.thioridazineMonitor Closely (1)thioridazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.thiothixeneMonitor Closely (1)thiothixene increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.timololMonitor Closely (1)methylphenidate will decrease the level or effect of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.trandolaprilMonitor Closely (1)methylphenidate will decrease the level or effect of trandolapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.tranylcypromineContraindicated (1)tranylcypromine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI.trazodoneMonitor Closely (1)methylphenidate increases toxicity of trazodone by Other (see comment). Modify Therapy/Monitor Closely. Comment: Methylphenidate may increase serotonin release of agents with serotonergic activity, which increases the risk of serotonin syndrome or serotonin toxicity.trifluoperazineMonitor Closely (2)trifluoperazine, methylphenidate. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. trifluoperazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.trimipramineMonitor Closely (1)trimipramine, methylphenidate. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.valsartanMonitor Closely (1)methylphenidate will decrease the level or effect of valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.verapamilMonitor Closely (1)methylphenidate will decrease the level or effect of verapamil by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.warfarinMonitor Closely (1)methylphenidate increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.yerba mateMinor (1)yerba mate increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.yohimbeSerious - Use Alternative (1)yohimbe, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.ziprasidoneMonitor Closely (1)ziprasidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. >10% ER capsules (adults) Insomnia (16%) Decreased appetite (11%) Adhansia XR (patients aged 6-12 years) Decreased appetite (35%) Upper abdominal pain (15%) Affect lability (13%) Nausea or vomiting (13%) Decreased weight (12%) Adhansia XR (patients aged 12-17 years) Decreased appetite (20%) Aptensio XR Headache (10.9%) Concerta or Relexxii (adults) Decreased appetite (25.3%) Headache (22.2%) Dry mouth (14%) Nausea (12.8%) Insomnia (12.3%) Jornay PM Any insomnia (33%) Decreased appetite (19%) Metadate CD Headache (12%) 1-10% Adhansia XR (adults) Dry mouth (9%) Initial insomnia (6%) Nausea (6%) Diarrhea (4%) Feeling jittery (4%) Decreased weight (4%) Headache (4%) Fatigue (3%) Upper respiratory tract infection (2%) Irritability (2%) Nausea (2%) Dysmenorrhea (2%) Adhansia XR (patients aged 6-12 years) Insomnia (10%) Irritability (10%) Headache (10%) Heart rate increased (5%) Adhansia XR (patients aged 12-17 years) Weight decreased (7%) Insomnia (6%) Nausea (6%) Initial insomnia (5%) Upper abdominal pain (4%) Dizziness (3%) Dry mouth (3%) Vomiting (3%) Aptensio XR Insomnia (9.8%) Upper abdominal pain (8.2%) Decreased appetite (4.9%) Nausea or vomiting (3.8%) Dizziness (2.2%) Concerta or Relexxii (pediatric patients) Upper abdominal pain (6.2%) Irritability (5.8%) Vomiting (2.8%) Nasopharyngitis (2.8%) Insomnia (2.8%) Pyrexia (2.2%) Dyspepsia (2.2%) Dizziness (1.9%) Cough (1.9%) Vomiting (1.7%) Constipation (1.4%) Oropharyngeal pain (1.2%) Concerta or Relexxii (adults) Anxiety (8.2%) Dizziness (6.7%) Decreased weight (6.5%) Hyperhidrosis (5.1%) Tachycardia (4.8%) Initial insomnia (4.3%) Depressed mood (3.9%) Palpitations (3.1%) Nervousness (3.1%) Restlessness (3.1%) Tremor (2.7%) Upper respiratory tract infection (2.2%) Agitation (2.2%) Muscle tightness (1.9%) Vertigo (1.7%) Vision blurred (1.7%) Anorexia (1.7%) Aggression (1.7%) Bruxism (1.7%) Depression (1.7%) Libido decreased (1.7%) Oropharyngeal pain (1.7%) Affect liability (1.4%) Paresthesia (1.2%) Sedation (1.2%) Tension headache (1.2%) Confusional state (1.2%) Tension (1.2%) Jornay PM Headache (10%) Vomiting (9%) Blood pressure diastolic increased (7%) Nausea (6%) Psychomotor hyperactivity (5%) Nasopharyngitis (3%) Pharyngitis streptococcal (3%) Contusion (3%) Back pain (3%) Rash (2%) Metadate CD Anorexia (9%) Abdominal pain (7%) Insomnia (5%) Frequency Not Defined Headache Hypertension Nausea Nervousness Toxic psychosis Seizures Tachycardia Angina Cardiac arrhythmia Cerebral occlusion Increased/decreased pulse Cerebral arteritis Cerebral hemorrhage Raynaud's phenomenom Vasculitis Anxiety Anger Agitation Irritability Vertigo Fatigue Erythema multiform Hyperhidrosis Rash Urticaria Exfoliative dermatitis Dysmenorrhea Constipation Xerostomia Vomiting Weight loss Erectile dysfunction Muscle tightness Paresthesia Blurred vision Necrotizing vasculitis Increased cough Dyspnea Sinusitis Upper respiratory tract infection Postmarketing Reports Blood and lymphatic system disorders: Pancytopenia, thrombocytopenia, thrombocytopenic purpura Cardiac disorders: Angina pectoris, bradycardia, extrasystole, supraventricular tachycardia, ventricular extrasystole, hypertension Eye disorders: Diplopia, mydriasis, visual impairment General Disorders: Chest pain, chest discomfort, hyperpyrexia, long-term growth suppression Hepatobiliary disorders: Hepatocellular injury, acute hepatic failure Immune system disorders: Hypersensitivity reactions such as angioedema, anaphylactic reactions, auricular swelling, bullous conditions, exfoliative conditions, urticaria, pruritus, rashes, eruptions, and exanthemas Investigations: Alkaline phosphatase increased, bilirubin increased, hepatic enzyme increased, platelet count decreased, white blood cell count abnormal, severe hepatic injury Musculoskeletal, connective tissue and bone disorders: Arthralgia, myalgia, muscle twitching, rhabdomyolysis Nervous system disorders: Convulsion, grand mal convulsion, dyskinesia, serotonin syndrome in combination with serotonergic drugs, lethargy, somnolence Psychiatric disorders: Disorientation, hallucination, hallucination auditory, hallucination visual, libido changes, mania, depression, drug dependence Urogenitial system: Priapism Vascular system: Peripheral vasculopathy, including Raynaud phenomenon Skin and subcutaneous tissue disorders: Alopecia, erythema Black Box Warnings Abuse and dependence CNS stimulants, including methylphenidate-containing products, and amphetamines, have a high potential for abuse and dependence Assess the risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy Contraindications Hypersensitivity to methylphenidate or other components of product Coadministration with monoamine oxidase inhibitors (MAOIs) or within 14 days after discontinuing MAOIs Concerta Motor tics or family history or diagnosis of Tourette syndrome Glaucoma Patients with marked anxiety, tension, and agitation Metadate CD Contains sucrose; do not administer to patients with hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency Cautions Assess risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy May cause an increase in blood pressure (BP) and heart rate (HR); monitor for hypertension and tachycardia Prolonged and painful erections, sometimes requiring surgical intervention, reported with methylphenidate products, including another formulation of methylphenidate hydrochloride extended-release tablets, in both pediatric and adult patients Priapism was not reported with drug initiation but developed during treatment, often after an increase in dose and during a period of drug withdrawal (drug holidays or during discontinuation); if such reaction occurs, seek immediate medical attention CNS stimulants are associated with peripheral vasculopathy, including Raynaud phenomenon; signs and symptoms are usually intermittent and generally improve after dose reduction or discontinuing treatment; monitor for digital changes is necessary during treatment; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients Closely monitor growth (weight and height) in pediatric patients treated with stimulants; patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted Stimulants may lower the convulsive threshold in patients with a history of seizures, in patients with prior EEG abnormalities in absence of seizures, and, very rarely, in patients without a history of seizures and no prior EEG evidence of seizures; if seizures occur, discontinue drug Difficulties with accommodation and blurry vision reported Periodic complete blood cell count, differential, and platelet counts are advised during prolonged therapy Potential bowel obstruction Concerta or Relexxii Tablet formulation is nondeformable and does not