(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.valsartanmethylphenidate will decrease the level or effect of valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.verapamilmethylphenidate will decrease the level or effect of verapamil by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.warfarinmethylphenidate increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.ziprasidoneziprasidone 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.Minor (5)amantadineamantadine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Potential for additive CNS stimulation.American ginsengAmerican ginseng increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.desmopressindesmopressin increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.guaranaguarana increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.yerba mateyerba mate increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.albuterolMonitor Closely (1)albuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.aluminum hydroxideMonitor Closely (1)aluminum hydroxide 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.amantadineMinor (1)amantadine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Potential for additive CNS stimulation.American ginsengMinor (1)American ginseng increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.amitriptylineMonitor Closely (1)amitriptyline, 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.amlodipineMonitor Closely (1)methylphenidate will decrease the level or effect of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.amoxapineMonitor Closely (1)amoxapine, 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.apomorphineMonitor Closely (1)apomorphine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.arformoterolMonitor Closely (1)arformoterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.aripiprazoleMonitor Closely (1)aripiprazole 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.armodafinilMonitor Closely (1)armodafinil increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.asenapineMonitor Closely (1)asenapine 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.aspirin/citric acid/sodium bicarbonateMonitor Closely (1)aspirin/citric acid/sodium bicarbonate 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.atomoxetineMonitor Closely (1)methylphenidate will increase the level or effect of atomoxetine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.azilsartanMonitor Closely (1)methylphenidate will decrease the level or effect of azilsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.benazeprilMonitor Closely (1)methylphenidate will decrease the level or effect of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.benzhydrocodone/acetaminophenMonitor Closely (1)benzhydrocodone/acetaminophen, 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.benzphetamineContraindicated (1)benzphetamine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.bromocriptineMonitor Closely (1)bromocriptine, methylphenidate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS stimulation.cabergolineSerious - Use Alternative (1)cabergoline, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.caffeineMonitor Closely (1)caffeine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.calcium carbonateMonitor Closely (1)calcium carbonate 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.candesartanMonitor Closely (1)methylphenidate will decrease the level or effect of candesartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.captoprilMonitor Closely (1)methylphenidate will decrease the level or effect of captopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.carbamazepineMonitor Closely (1)carbamazepine decreases effects of methylphenidate by unspecified interaction mechanism. Use Caution/Monitor. Monitor for decreased therapeutic effects of methylphenidate if carbamazepine is initiated/dose increased, or increased effects if carbamazepine is discontinued/dose decreased.cariprazineMonitor Closely (1)cariprazine 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.chlorpromazineMonitor Closely (1)chlorpromazine, 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.cimetidineMonitor Closely (1)cimetidine 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.clevidipineMonitor Closely (1)methylphenidate will decrease the level or effect of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.clomipramineMonitor Closely (1)clomipramine, 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.clozapineMonitor Closely (1)clozapine 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.cocaine topicalMonitor Closely (1)cocaine topical increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.desfluraneSerious - Use Alternative (1)desflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.desipramineMonitor Closely (1)desipramine, 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.desmopressinMinor (1)desmopressin increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.dexfenfluramineMonitor Closely (1)dexfenfluramine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.dexlansoprazoleMonitor Closely (1)dexlansoprazole 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.dexmethylphenidateMonitor Closely (1)dexmethylphenidate increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.dextroamphetamineMonitor Closely (1)dextroamphetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.didanosineMonitor Closely (1)didanosine will decrease the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Interaction specifically associated with Ritalin LA.diethylpropionContraindicated (1)diethylpropion increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.dihydroergotamineSerious - Use Alternative (1)dihydroergotamine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.dihydroergotamine intranasalSerious - Use Alternative (1)dihydroergotamine intranasal, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.diltiazemMonitor Closely (1)methylphenidate will decrease the level or effect of diltiazem by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.dobutamineMonitor Closely (1)dobutamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.dopamineMonitor Closely (1)dopamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.dopexamineMonitor Closely (1)dopexamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.doxapramSerious - Use Alternative (1)doxapram increases effects of methylphenidate by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.doxepinMonitor Closely (1)doxepin, 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.dronabinolMonitor Closely (1)methylphenidate will increase the level or effect of dronabinol by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.enalaprilMonitor Closely (1)methylphenidate will decrease the level or effect of enalapril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.ephedrineMonitor Closely (1)ephedrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.epinephrineMonitor Closely (1)epinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.epinephrine inhaledMonitor Closely (1)methylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.epinephrine racemicMonitor Closely (1)epinephrine racemic and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.eprosartanMonitor Closely (1)methylphenidate will decrease the level or effect of eprosartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.ergoloid mesylatesSerious - Use Alternative (1)ergoloid mesylates, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.ergotamineSerious - Use Alternative (1)ergotamine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.esketamine intranasalMonitor Closely (1)esketamine intranasal, methylphenidate. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .esomeprazoleMonitor Closely (1)esomeprazole 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.ethanolSerious - Use Alternative (1)ethanol increases levels of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Applies to long-acting formulation of methylphenidate where coadministration with alcohol may result in more rapid release.etherSerious - Use Alternative (1)ether increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.famotidineMonitor Closely (2)famotidine will increase the level or effect of methylphenidate by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies only to extended release formulation famotidine 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.felodipineMonitor Closely (1)methylphenidate will decrease the level or effect of felodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.fenfluramineMonitor Closely (1)fenfluramine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.fluphenazineMonitor Closely (2)fluphenazine, 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. fluphenazine 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.formoterolMonitor Closely (1)formoterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.fosinoprilMonitor Closely (1)methylphenidate will decrease the level or effect of fosinopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.fosphenytoinMonitor Closely (1)methylphenidate will increase the level or effect of fosphenytoin by unknown mechanism. Use Caution/Monitor. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased.green