Ritalin: ADHD Medication

Ritalin (Methylphenidate hydrochloride) is the most commonly prescribed stimulant ADHD medication used to treat symptoms of ADD in children, adolescents, and adults.

By Janice Rodden Medically reviewed by William Dodson, M.D., LF-APA

What is Ritalin? What Does Ritalin Do?
Ritalin vs. Adderall
Ritalin Dosage Information
Ritalin Side Effects
Ritalin Precautions
Ritalin Interactions

What Is Ritalin? What Does Ritalin Do?

Ritalin is the brand name formulation of methylphenidate that is most associated with the medication treatment of ADHD. It’s generic name is methylphenidate hydrochloride. It is a central nervous system stimulant ADHD medication FDA approved to treat attention deficit hyperactivity disorder (ADHD or ADD) in children ages 6-12, adolescents, and adults up to age 65.

Ritalin may improve focus, and decrease impulsivity and hyperactive behavior, three hallmark ADHD symptoms. It contains the same active ingredient as ADHD medications like Concerta and Daytrana. According to the Food and Drug Administration (FDA), Ritalin is a federally controlled substance (“Schedule II Stimulant”) because it can be abused or lead to dependence.

Ritalin is also FDA-approved for the treatment of narcolepsy.

Ritalin vs Adderall: Is Ritalin Better Than Adderall?

Ritalin and Adderall (a common delivery system for a different ADHD medication called amphetamine) are both central nervous system stimulant medications used to treat ADHD and narcolepsy. There is no intrinsic property of either medication that would make it automatically better or more preferred for the treatment of ADHD.

Ritalin and Adderall both have the same level of effectiveness
Ritalin and Adderall both have the same positive response rate of about 70% of people
Ritalin and Adderall both have the same number and severity of side effects
Ritalin and Adderall are very short in their duration of benefits in their immediate released formations (about 4 hours for either one). Both need some sort of extended release delivery system.
Ritalin and Adderall both cost about the same

That said, just about every person will have a clear preference for one molecule — amphetamine (AMPH) or methylphenidate (MPH) — over the other. No known factor predicts who will do best with MPH and who will do better with AMPH. As far as can be determined this preference for one molecule over the other does not run in families

What is the Best Dosage of Ritalin to Treat ADHD Symptoms?

Like other ADHD medications, the optimal dosage of Ritalin varies patient by patient. It is not determined by age, weight, or height, but rather by the interplay of three factors

How efficiently the molecule is absorbed into the body
How efficiently the molecule is removed from the body by either metabolism or excretion
But mostly by how efficiently the molecule cross the blood-brain-barrier as the molecule goes from the blood into a nerve cell

Since these three factors are very difficult to measure, the dose is usually determined by trial and error on the basis of how well it relieves the impairments from ADHD balanced with how tolerable it is. Your doctor may adjust your daily dosage until you or your child experiences the optimal response — that is, the lowest dosage at which you experience the greatest improvement in symptoms without side effects.

Ritalin is available in several formulations:

Short-Acting Tablet: Taken two to three times daily, 30 to 45 minutes before a meal. Available in 5mg, 10mg, and 20mg dosages. Each tablet lasts for approximately three to four hours. Tablets should be swallowed whole with water or other liquids. Dosage should not exceed 60mg daily.
Sustained-Release Tablet (Ritalin SR): Taken 30 to 45 minutes before a meal. Each tablet lasts for approximately 8 hours. Available in only one dosage strength of 20mg. Tablets should be swallowed whole with water or other liquids. Tablets should never by crushed or chewed.
Extended-Release Capsule (Ritalin LA): Taken orally, with or without food, once daily. The first dose is typically taken first thing in the morning; it should be taken at the same time each day for the best results. If your child is unable to swallow the capsule, it can be opened and sprinkled over a spoonful of applesauce. Taken this way, the mixture should be swallowed whole without chewing, followed by a drink of water or other liquid. Capsules should never by crushed or chewed because this destroys the timed-release mechanism. Capsules are available in 10mg, 20mg, 30mg, and 40mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day, or for approximately 8 to 10 hours. Dosage should not exceed 60 mg daily.

Do not drink alcohol while taking this medication, as it can cause the medicine to be released too quickly.

As with all medications, follow your Ritalin prescription instructions exactly. If a patient experiences upset stomach as a side effect, this medication can be taken with food. Taking Ritalin late in the day can disrupt sleep.

Some patients report developing a tolerance to Ritalin after long-term use. If you notice that your dosage is no longer controlling your symptoms, talk to your doctor to plan a course of action.

What are the Side Effects of Ritalin?

Most people taking Ritalin do not experience any side effects. That said, the most common side effects associated with Ritalin are as follows:

headache
decreased appetite
stomachache
nervousness
difficulty sleeping
irritability
sweating
shaking
increased heart rate
weight loss
dizziness

Other possible side effects include that some people believe that the stimulant medications slowed growth in some children, priapism (a penis erection that does not resolve after more than four hours), and eyesight changes or blurred vision.

If side effects are bothersome, or do not go away in a day or two, talk to your doctor. Most people taking this medication do not experience any of these side effects.

Ritalin and Heart or Blood Pressure Related Problems

Report to your doctor any heart-related problems or a family history of heart and blood pressure problems. Patients with structural cardiac abnormalities and other serious heart problems have experienced sudden death, stroke, heart attack, and increased blood pressure while taking Ritalin, though a casual relationship has never been found. Stimulants can increase blood pressure and heart rate. Physicians should monitor these vital signs closely during treatment. Call your doctor immediately if you or your child experiences warning signs such as chest pain, shortness of breath, or fainting while taking Ritalin.

Ritalin and Mental Illness

Disclose to your physician all mental health issues including any family history of suicide, bipolar illness, tics, or depression. Ritalin may create new or exacerbate existing behavior problems, bipolar illness, or Tourette’s syndrome. The FDA recommends evaluating patients for bipolar disorder, tics, and Tourette’s syndrome prior to stimulant administration. It can cause psychotic or manic symptoms in children and teenagers. Call your doctor immediately if you or your child experiences new or worsening mental health symptoms including hallucinations or sudden suspicions.

Ritalin and Circulation Problems

Discuss circulation problems with your doctor before taking Ritalin, which has been known to cause numbness, coolness, or pain in fingers or toes, including Raynaud’s phenomenon. Report to your doctor any new blood-flow problems, pain, skin color changes, or sensitivities to temperature while taking Ritalin.

Ritalin and Substance Abuse

Stimulants like Ritalin have a potential for abuse and addiction, especially among people who do not have ADHD. It is a “Schedule II Stimulant,” a designation that the Drug Enforcement Agency uses for drugs with a high potential for abuse. Other Schedule II drugs include Dexedrine, Adderall, and cocaine. People with a history of drug abuse should use caution when trying this medication. Taking the medication exactly as prescribed can reduce potential for abuse.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Who Can Take Ritalin? Medication Precautions

You should not take Ritalin if you have any of the following conditions:

allergy or hypersensitivity to Ritalin or any of the ingredients in Ritalin medications
unmanaged glaucoma
tics
history of Tourette’s syndrome
or if you are taking monoamine oxidase inhibitors (MAOIs)

Use caution while taking Ritalin if you have a history of heart or mental problems, abnormal brain wave tests, circulation problems, or esophagus/stomach/intestine problems.

If you’re thinking of becoming pregnant, discuss the use of Ritalin with your doctor. Animal studies indicate a potential risk of fetal harm. Nonetheless, the FDA lists methylphenidate in Pregnancy Category C, which means that no risk has ever been established but it cannot be ruled out either. Ritalin is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

The safety of Ritalin for children under age six has not been established by the FDA but it has been studied many times in government-funded studies and found to be both safe and effective for ADHD down to 3 years of age.

Store Ritalin in a secure place out of the reach of children, and at room temperature. Do not share your Ritalin prescription with anyone, even another person with ADHD. Sharing prescription medication is illegal, and can cause harm.

What Interactions Are Associated with Ritalin?

Before taking Ritalin, discuss all other active prescription medications with your doctor. Ritalin can have a dangerous, possibly fatal, interaction with MAOI antidepressants.

Tell your doctor if you are taking seizure medications, blood thinners, blood pressure medication, or any medication containing a decongestant.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking Ritalin before having any surgery or laboratory tests. Ritalin can have a dangerous interaction with certain anesthetics. The above is not a complete list of all possible drug interactions.