AdultPediatricDosage Forms & Strengths tablet: Schedule II Ritalin 5mg 10mg 20mg capsule, extended-release: Schedule II 10mg (Aptensio XR, Ritalin LA, Metadate CD) 15mg (Aptensio XR) 20mg (Aptensio XR, Ritalin LA, Metadate CD) 25mg (Adhansia XR) 30mg (Aptensio XR, Ritalin LA, Metadate CD) 35mg (Adhansia XR) 40mg (Aptensio XR, Ritalin LA, Metadate CD) 45mg (Adhansia XR) 50mg (Aptensio XR, Metadate CD) 55mg (Adhansia XR) 60mg (Aptensio XR, Ritalin LA, Metadate CD) 70mg (Adhansia XR) 85mg (Adhansia XR) capsule, extended release/delayed release: Schedule II 20mg (Jornay PM) 40mg (Jornay PM) 60mg (Jornay PM) 80mg (Jornay PM) 100mg (Jornay PM) tablet, extended-release: Schedule II 10mg (Methylin, generics) 18mg (Concerta, Relexxii) 20mg (Methylin, generics) 27mg (Concerta, Relexxii) 36mg (Concerta, Relexxii) 45mg (Relexxii) 54mg (Concerta, Relexxii) 63mg (Relexxii) 72mg (Relexxii) extended-release tablet, chewable (scored): Schedule II QuilliChew ER 20mg 30mg 40mg tablet, chewable: Schedule II Methylin 2.5mg 5mg 10mg oral solution: Schedule II Methylin 5mg/5mL 10mg/5mL Attention Deficit Hyperactivity Disorder Adhansia XR: 25 mg PO qAM initially; may titrate upward in increments of 10-15 mg at intervals of at least 5 days; dosages >85 mg/day associated with increased incidence of certain adverse reactions Aptensio XR: 10 mg PO qDay in AM; may increase weekly by 10-mg increments; not to exceed 60 mg/day Concerta: Initial for methylphenidate-naïve, 18-36 mg PO qDay; may increase by 18-mg increments at weekly intervals; maintenance dose is 18-72 mg/day Metadate CD: Initial, 20 mg PO qAM before breakfast; may increase in 10- to 20-mg increments; not to exceed 60 mg/day Methylin ER: Duration of action ~8 hr; may use in place of methylphenidate IR tablets when 8-hr dosage of methylphenidate ER corresponds to titrated 8-hr dosage of methylphenidate IR; not to exceed 60 mg/day Ritalin (immediate-release tablets and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; may gradually increase dose at weekly intervals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate QuilliChew ER (chewable extended-release tablets): 20 mg PO qAM initially; may titrate up or down weekly in increments of 10 mg, 15 mg, or 20 mg; not to exceed 60 mg/day Jornay PM: Initial, 20 mg PO qDay in the evening; may titrate weekly in increments of 20 mg; not to exceed 100 mg/day; initiate dosing at 8:00 pm; adjust timing of administration between 6:30 pm and 9:30 pm to optimize tolerability and efficacy the next morning and throughout the day Relexxii: Initial for methylphenidate-naïve, 18-36 mg PO qDay; may increase by 18-mg increments at weekly intervals; maintenance dose is 18-72 mg/day; not to exceed 72 mg/day Ritalin LA: Initial, 20 mg PO qAM; may adjust dose in weekly 10-mg increments, not to exceed 60 mg/day (patients requiring a lower initial dose may begin with 10 mg) Narcolepsy Methylin, Ritalin (immediate-release tablets and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate Methylin ER: Duration of action is approximately 8 hr; may use in place of methylphenidate IR tablets when 8-hr dosage of methylphenidate ER corresponds to the titrated 8-hr dosage of methylphenidate IR Dosage Modifications Dose reduction and discontinuation If paradoxical aggravation of symptoms or other adverse reactions occur, reduce dosage, or, if necessary, discontinue drug Periodically discontinue treatment to assess condition If improvement not observed after appropriate dosage adjustment over a one-month period, discontinue treatment Conversion from methylphenidate to Concerta or Relexxii Currently on methylphenidate 5 mg BID or TID: Start Concerta or Relexxii at 18 mg qAM Currently on methylphenidate 10 mg BID or TID: Start Concerta or Relexxii at 36 mg qAM Currently on methylphenidate 15 mg BID or TID: Start Concerta or Relexxii at 54 mg qAM Currently on methylphenidate 20 mg BID or TID: Start Concerta or Relexxii at 72 mg qAM Renal impairment Since renal clearance is not an important route of clearance, renal insufficiency is expected to have little effect on pharmacokinetics of methylphenidate ER tablets Hepatic impairment \No experience with use in patients with hepatic insufficiency Dosing Considerations Before initiating Assess for presence of cardiac disease (eg, family history of sudden death or ventricular arrhythmia) Assess risk of abuse before prescribing and monitor for signs of abuse and dependence during therapy Maintain careful prescription records, educate patients about abuse, and periodically re-evaluate need for use Dosage Forms & Strengths tablet: Schedule II Ritalin 5mg 10mg 20mg capsule, extended-release: Schedule II 10mg (Aptensio XR, Ritalin LA, Metadate CD) 15mg (Aptensio XR) 20mg (Aptensio XR, Ritalin LA, Metadate CD) 25mg (Adhansia XR) 30mg (Aptensio XR, Ritalin LA, Metadate CD) 35mg (Adhansia XR) 40mg (Aptensio XR, Ritalin LA, Metadate CD) 45mg (Adhansia XR) 50mg (Aptensio XR, Metadate CD) 55mg (Adhansia XR) 60mg (Aptensio XR, Ritalin LA, Metadate CD) 70mg (Adhansia XR) 85mg (Adhansia XR) capsule, extended release/delayed release: Schedule II 20mg (Jornay PM) 40mg (Jornay PM) 60mg (Jornay PM) 80mg (Jornay PM) 100mg (Jornay PM) tablet, extended-release: Schedule II 10mg (Methylin, generics) 18mg (Concerta, Relexxii) 20mg (Methylin, generics) 27mg (Concerta, Relexxii) 36mg (Concerta, Relexxii) 45mg (Relexxii) 54mg (Concerta, Relexxii) 63mg (Relexxii) 72mg (Relexxii) extended-release tablet, chewable (scored): Schedule II QuilliChew ER 20mg 30mg 40mg tablet, chewable: Schedule II Methylin 2.5mg 5mg 10mg transdermal patch: Schedule II Daytrana 10mg 15mg 20mg 30mg oral solution: Schedule II Methylin 5mg/5mL 10mg/5mL oral suspension, extended-release: Schedule II Quillivant XR 25mg/5mL (following reconstitution) extended-release tablet, oral disintegrating Cotempla XR-ODT 8.6mg 17.3mg 25.9mg Attention Deficit Hyperactivity Disorder <6 years: Safety and efficacy not established ≥6 years Aptensio XR: 10 mg PO qDay in AM; may increase weekly by 10-mg increments; not to exceed 60 mg/day Adhansia XR: 25 mg PO qAM initially; may titrate up in increments of 10-15 mg at intervals of at least 5 days; dosages ≥70 mg/day associated with increased incidence of certain adverse reactions Cotempla XR-ODT (oral disintegrating tablets): 17.3 mg PO qAM initially; may titrate upward weekly by 8.6-17.3 mg increments; not to exceed 51.8 mg/day Methylin, Ritalin (immediate-release tablets and oral solution): 5 mg PO BID 30-45 minutes before breakfast and lunch initially; may increase by 5-10 mg/day at weekly intervals; not to exceed 60 mg/day divided BID/TID Methylin ER: May be given in place of immediate-release products once daily dose is titrated and the titrated 8-hr dosage corresponds to SR or ER tablet size; not to exceed 60 mg/day Metadate CD, Ritalin LA: Initial, 20 mg PO qAM; may increase by 10 mg (Ritalin LA) or 10-20 mg (Metadate CD) qWeek to not to exceed 60 mg/day Quillivant XR (6-12 years): 20 mg PO qAM initially; may titrate at weekly intervals by weekly 10- to 20-mg increments; not to exceed 60 mg/day QuilliChew ER (chewable extended-release tablets): 20 mg PO qAM initially; may be titrated up or down weekly in increments of 10 mg, 15 mg, or 20 mg, not to exceed 60 mg/day Immediate-release weight-based dosing Initial: 0.3 mg/kg/dose PO before breakfast and lunch; may increase by 0.1 mg/kg/dose qWeek Maintenance: 0.3-1 mg/kg PO before breakfast and lunch; not to exceed 2 mg/kg/day PO divided q12hr Concerta or Relexxii (methylphenidate-naïve) Initial: 18 mg PO qDay; dosage may be increased by 18 mg/day at weekly intervals Do not exceed 54 mg/day in children (6-12 years) and 72 mg/day in adolescents (13-17 years) Jornay PM Initial: 20 mg PO qDay in the evening; may titrate weekly in increments of 20 mg; not to exceed 100 mg/day Initiate dosing at 8:00 p.m.; adjust timing of administration between 6:30 pm and 9:30 pm to optimize tolerability and efficacy the next morning and throughout the day Narcolepsy <6 years Safety and efficacy not established ≥6 years Methylin, Ritalin (immediate-release tablets and oral solution): 5 mg PO q12hr; may increase by 5-10 mg/day weekly; not to exceed 60 mg/day Methylin ER,: May be given in place of immediate-release products once the daily dose is titrated and the titrated 8-hour dosage corresponds to ER tablet size; not to exceed 60 mg/day Dosage Modifications Dose reduction and discontinuation If paradoxical aggravation of symptoms or other adverse reactions occur, reduce dosage, or, if necessary, discontinue drug Periodically discontinue treatment to assess condition If improvement not observed after appropriate dosage adjustment over a one-month period, discontinue treatment Conversion from methylphenidate to Concerta or Relexxii Currently on methylphenidate 5 mg BID or TID: Start Concerta or Relexxii at 18 mg qAM Currently on methylphenidate 10 mg BID or TID: Start Concerta or Relexxii at 36 mg qAM Currently on methylphenidate 15 mg BID or TID: Start Concerta or Relexxii at 54 mg qAM Currently on methylphenidate 20 mg BID or TID: Start Concerta or Relexxii at 72 mg qAM Renal impairment Since renal clearance is not an important route of clearance, renal insufficiency is expected to have little effect on pharmacokinetics of methylphenidate ER tablets Hepatic impairment No experience with use in patients with hepatic insufficiency Dosing Considerations Before initiating Assess for presence of cardiac disease (eg, family history of sudden death or ventricular arrhythmia) Assess risk of abuse before prescribing and monitor for signs of abuse and dependence while on therapy Maintain careful prescription records, educate patients about abuse, and periodically re-evaluate the need for use Limitations of use (Aptensio XR) Patients <6 years of age experienced higher plasma exposure than patients aged ≥6 at the same dose and high rates of adverse reactions, most notably weight loss Interaction CheckerEnter a drug name and methylphenidateNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (12)benzphetaminebenzphetamine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.diethylpropiondiethylpropion increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.isocarboxazidisocarboxazid 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.linezolidlinezolid increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phendimetrazinephendimetrazine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.phenelzinephenelzine 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.phenterminephentermine increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.rasagilinerasagiline 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.safinamidesafinamide 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.selegilineselegiline 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 transdermalselegiline 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.tranylcyprominetranylcypromine 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.Serious - Use Alternative (18)cabergolinecabergoline, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.desfluranedesflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.dihydroergotaminedihydroergotamine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.dihydroergotamine intranasaldihydroergotamine intranasal, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.doxapramdoxapram increases effects of methylphenidate by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.ergoloid mesylatesergoloid mesylates, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.ergotamineergotamine, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.ethanolethanol 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.etherether increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.iobenguane I 123methylphenidate decreases effects of iobenguane I 123 by Other (see comment). Avoid or Use Alternate Drug. Comment: Based on the mechanism of action of