decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. fosinoprilMonitor Closely (1)methylphenidate transdermal decreases effects of fosinopril by anti-hypertensive channel blocking. Use Caution/Monitor.fosphenytoinMonitor Closely (1)methylphenidate transdermal will increase the level or effect of fosphenytoin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. hydrochlorothiazideMonitor Closely (1)methylphenidate transdermal decreases effects of hydrochlorothiazide by anti-hypertensive channel blocking. Use Caution/Monitor.imipramineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of imipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. indapamideMonitor Closely (1)methylphenidate transdermal decreases effects of indapamide by anti-hypertensive channel blocking. Use Caution/Monitor.irbesartanMonitor Closely (1)methylphenidate transdermal decreases effects of irbesartan by anti-hypertensive channel blocking. Use Caution/Monitor.isocarboxazidContraindicated (1)methylphenidate transdermal and isocarboxazid both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.lacosamideMonitor Closely (1)methylphenidate transdermal will increase the level or effect of lacosamide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. lamotrigineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of lamotrigine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. lisinoprilMonitor Closely (1)methylphenidate transdermal decreases effects of lisinopril by anti-hypertensive channel blocking. Use Caution/Monitor.lorazepamMonitor Closely (1)methylphenidate transdermal will increase the level or effect of lorazepam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. losartanMonitor Closely (1)methylphenidate transdermal decreases effects of losartan by anti-hypertensive channel blocking. Use Caution/Monitor.methsuximideMonitor Closely (1)methylphenidate transdermal will increase the level or effect of methsuximide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. methyclothiazideMonitor Closely (1)methylphenidate transdermal decreases effects of methyclothiazide by anti-hypertensive channel blocking. Use Caution/Monitor.metolazoneMonitor Closely (1)methylphenidate transdermal decreases effects of metolazone by anti-hypertensive channel blocking. Use Caution/Monitor.midazolamMonitor Closely (1)methylphenidate transdermal will increase the level or effect of midazolam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. midazolam intranasalMonitor Closely (1)methylphenidate transdermal will increase the level or effect of midazolam intranasal by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. moexiprilMonitor Closely (1)methylphenidate transdermal decreases effects of moexipril by anti-hypertensive channel blocking. Use Caution/Monitor.nortriptylineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of nortriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. olmesartanMonitor Closely (1)methylphenidate transdermal decreases effects of olmesartan by anti-hypertensive channel blocking. Use Caution/Monitor.oxcarbazepineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of oxcarbazepine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. paroxetineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of paroxetine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. perampanelMonitor Closely (1)methylphenidate transdermal will increase the level or effect of perampanel by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. perindoprilMonitor Closely (1)methylphenidate transdermal decreases effects of perindopril by anti-hypertensive channel blocking. Use Caution/Monitor.phenelzineContraindicated (1)methylphenidate transdermal and phenelzine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.phenobarbitalMonitor Closely (1)methylphenidate transdermal will increase the level or effect of phenobarbital by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. phenytoinMonitor Closely (1)methylphenidate transdermal will increase the level or effect of phenytoin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. pregabalinMonitor Closely (1)methylphenidate transdermal will increase the level or effect of pregabalin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. primidoneMonitor Closely (1)methylphenidate transdermal will increase the level or effect of primidone by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. propranololMonitor Closely (1)methylphenidate transdermal decreases effects of propranolol by anti-hypertensive channel blocking. Use Caution/Monitor.protriptylineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of protriptyline by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. quinaprilMonitor Closely (1)methylphenidate transdermal decreases effects of quinapril by anti-hypertensive channel blocking. Use Caution/Monitor.ramiprilMonitor Closely (1)methylphenidate transdermal decreases effects of ramipril by anti-hypertensive channel blocking. Use Caution/Monitor.rasagilineContraindicated (1)methylphenidate transdermal and rasagiline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.risperidoneMonitor Closely (1)methylphenidate transdermal will increase the level or effect of risperidone by unspecified interaction mechanism. Use Caution/Monitor. When coadministered with methylphenidate, changes in dosage of either or both medications, may increase the risk of extrapyramidal symptoms (EPS). Monitor for signs of EPS.rufinamideMonitor Closely (1)methylphenidate transdermal will increase the level or effect of rufinamide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. sacubitril/valsartanMonitor Closely (1)methylphenidate transdermal decreases effects of sacubitril/valsartan by anti-hypertensive channel blocking. Use Caution/Monitor.safinamideContraindicated (1)methylphenidate transdermal and safinamide both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.selegilineContraindicated (1)methylphenidate transdermal and selegiline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.selegiline transdermalContraindicated (1)methylphenidate transdermal and selegiline transdermal both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.sertralineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of sertraline by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. sotalolMonitor Closely (1)methylphenidate transdermal decreases effects of sotalol by anti-hypertensive channel blocking. Use Caution/Monitor.spironolactoneMonitor Closely (1)methylphenidate transdermal decreases effects of spironolactone by anti-hypertensive channel blocking. Use Caution/Monitor.stiripentolMonitor Closely (1)methylphenidate transdermal will increase the level or effect of stiripentol by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. telmisartanMonitor Closely (1)methylphenidate transdermal decreases effects of telmisartan by anti-hypertensive channel blocking. Use Caution/Monitor.terlipressinMonitor Closely (1)methylphenidate transdermal and terlipressin both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.tiagabineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of tiagabine by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. tolvaptanMonitor Closely (1)methylphenidate transdermal and tolvaptan both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.topiramateMonitor Closely (1)methylphenidate transdermal will increase the level or effect of topiramate by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. trandolaprilMonitor Closely (1)methylphenidate transdermal decreases effects of trandolapril by anti-hypertensive channel blocking. Use Caution/Monitor.tranylcypromineContraindicated (1)methylphenidate transdermal and tranylcypromine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of MAOIs and CNS stimulants can cause hypertensive crisis.triamtereneMonitor Closely (1)methylphenidate transdermal decreases effects of triamterene by anti-hypertensive channel blocking. Use Caution/Monitor.trimipramineMonitor Closely (1)methylphenidate transdermal will increase the level or effect of trimipramine by decreasing elimination. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. valproic acidMonitor Closely (1)methylphenidate transdermal will increase the level or effect of valproic acid by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. valsartanMonitor Closely (1)methylphenidate transdermal decreases effects of valsartan by anti-hypertensive channel blocking. Use Caution/Monitor.vasopressinMonitor Closely (1)methylphenidate transdermal and vasopressin both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.vigabatrinMonitor Closely (1)methylphenidate transdermal will increase the level or effect of vigabatrin by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. warfarinMonitor Closely (1)methylphenidate transdermal will increase the level or effect of warfarin by decreasing metabolism. Modify Therapy/Monitor Closely. Decreasing the dose of these drugs may be required when given coadministered with methylphenidate. Consider monitoring plasma drug concentrations (or INR with coumadin), when initiating or discontinuing methylphenidate. zonisamideMonitor Closely (1)methylphenidate transdermal will increase the level or effect of zonisamide by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. >10% Children Decreased appetite (25.5%) Headache (15.3%) Insomnia (13.3%) Nausea (12.2%) Vomiting (10.2%) Adolescents Decreased appetite (25.5%) Headache (12.4%) Irritability (11%) 1-10% Children Weight decreased (9.2%) Irritability (7.1%) Tic (7.1%) Abdominal pain (7.1%) Affect lability (6.1%) Anorexia (5.1%) Tachycardia (1%) Adolescents Nausea (9.7%) Insomnia (6.2%) Weight decreased (5.5%) Dizziness (5.5%) Abdominal pain (4.8%) Anorexia (4.8%) Vomiting (3.4%) <1% Adolescents Tachycardia (0.7%) Postmarketing Reports Cardiac disorders: Palpitations Eye disorders: Visual disturbances, blurred vision, mydriasis, and accommodation disorder General disorders and administration site disorders: Fatigue, application site reactions such as bleeding, bruising, burn, burning, dermatitis, discharge, discoloration, discomfort, dryness, eczema, edema, erosion, erythema, excoriation, exfoliation, fissure, hyperpigmentation, hypopigmentation, induration, infection, inflammation, irritation, pain, papules, paresthesia, pruritus, rash, scab, swelling, ulcer, urticaria, vesicles, and warmth Immune system disorders: Hypersensitivity reactions including generalized erythematous and urticarial rashes, allergic contact dermatitis, angioedema, and anaphylaxis Investigations: BP increased Nervous system disorders: Convulsion, dyskinesia, lethargy, somnolence, serotonin syndrome in combination with serotonergic drugs, and extrapyramidal disorder Psychiatric disorders: Depression, hallucination, nervousness, and libido changes Skin and SC Tissue Disorders: Alopecia 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) and within 14 days following discontinuing MAOIs Motor tics or with a family history or diagnosis of Tourette syndrome Glaucoma Patients with marked anxiety, tension, and agitation Cautions Assess the 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