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Methylphenidate

Methylphenidate

Definition

Methylphenidate is a mild, central nervous system stimulant. In the United States, the drug is sold under the brand name Ritalin.

Purpose

Methylphenidate is used primarily in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adults. It also may be used to treat the sleep disorder, narcolepsy . In rare cases, it is used to decrease sedation and lethargy from opioid pain medications and to help improve the mood of a terminally ill person suffering from depression.

Description

The mode of action for methylphenidate is not fully understood. It presumably activates the brain stem arousal system and cortex to produce a stimulant effect. The brain stem arousal system increases levels of electrical activity in the brain. The effect of methylphenidate is to produce increased alertness and, although children with ADHD are overactive and have decreased attention spans, in these children, methylphenidate actually decreases motor restlessness and increases attention span. Tablets are available in 5-, 10-, and 20-mg strengths, as well as in an extended release, 20-mg tablet.

Recommended dosage

The recommended dosage of methylphenidate is determined by trial and error based on individual responses. Methylphenidate is usually administered in two or three separate doses each day, preferably 45 minutes before a meal. For children suffering from ADHD, the initial recommended dosage is 5 mg twice daily before breakfast and lunch, increased by 510 mg per week to a maximum of 60 mg per day. The average total dosage is 2030 mg per day, although 1060 mg is not uncommon. For narcolepsy in adults, the recommended dose is 520 mg two to three times a day, 3045 minutes before meals.

The drug should be taken exactly as directed. Methylphenidate can become habit forming if taken in greater amounts or for longer periods than necessary. Individuals should take the last dose of the day before 6 P.M. to decrease sleep difficulties. The tablet should not be broken or crushed, as this changes the time for absorption. If the normal time of administration is missed, people should take the drug as soon as possible. However, two tablets should not be taken at the same time.

Precautions

Methylphenidate has a great potential to produce physical and mental dependence. Administration should not be stopped abruptly. Such action can cause withdrawal symptoms including depression, paranoid feelings, thoughts of suicide , anxiety, agitation, and sleep disturbances. Methylphenidate should not be given to people with extreme anxiety, tension, agitation, severe depression, mental or emotional instability, or a history of alcohol or drug abuse. It is not indicated for use by those with Tourette's syndrome, people with tic disorders , glaucoma, or certain mental health conditions. The drug should be used cautiously by those with high blood pressure, those with a history of seizures , and women who are breast-feeding. Methylphenidate is not typically ordered for women during their childbearing years, unless the physician determines that the benefits outweigh the risks.

Methylphenidate should not be ordered for children younger than six years of age as its safety has not been determined in this age group. People should not drive or operate machinery or appliances until they understand how this drug affects them. They should not drive if they become lightheaded or dizzy. Methylphenidate may cause irregularities in the composition of the blood and produce changes in liver function. People taking methylphenidate should receive regular blood tests.

Side effects

The most common side effects are nervousness, difficulties with sleep, tachycardia, and increased blood pressure. Reducing the dose or changing the time the drug is taken may reduce some side effects. Affected persons should discuss any adverse reactions with their health care professional. Individuals taking methylphenidate should receive regular blood pressure and pulse checks. Methylphenidate also may cause dizziness, irritability, vision changes, drowsiness, and a poor appetite. Less common side effects include chest pain, palpitations, joint pain, skin rash, and uncontrolled movements or speech. Side effects may also include a rapid or irregular heartbeat, stomach upset, nausea, headache, blood in the urine or stools, muscle cramps, red dots on the skin, or bruises. At higher dosages or with long-term use, people may experience weight loss or mental changes such as confusion, false beliefs, mood changes, hallucinations , or feelings that they or their environment are not real.

Interactions

Several drugs may interact adversely with methylphenidate, including anticoagulants and drugs to prevent seizures, combat depression, and treat high blood pressure. The dosages of these drugs may be reduced when taken simultaneously with methylphenidate.

Resources

BOOKS

Adams, Michael and Norman Holland. Core Concepts in Pharmacology. Philadelphia: Lippincott-Raven, 1998.

Breggin, Peter R. and Dick Scruggs. Talking Back to Ritalin: What Doctors Aren't Telling You About Stimulants and ADHD. Boulder, CO: Perseus Book Group, 2001.

Foreman, John C. and Torben Johansen. Textbook of Receptor Pharmacology. 2nd Ed. Boca Raton, FL: CRC Press,2002.

Markowitz, John S., and C. Lindsay DeVane. The Ritalin Handbook. Kearney, NJ: Morris Publishing, 2000.

Page, Clive P. and Michael Murphy. Integrated Pharmacology. St. Louis: Mosby-Year Book, 2002.

Von Boxtel, Chris, Budiono Santoso, and I. Ralph Edwards. Drug Benefits and Risks: International Textbook of Clinical Pharmacology. New York: John Wiley and Sons,2001.

PERIODICALS

Miller, A. R., C. E. Lalonde, K. M. McGrail, and R. W. Armstrong. "Prescription of methylphenidate to children and youth, 1990-1996." Canadian Medical Journal (2001) 165, no. 11: 1489-1494.

Perring C. "Medicating children: the case of Ritalin." Bioethics (1997) 11, no. 3-4: 228-240.

Sund, A. M., and P. Zeiner. "Does extended medication with amphetamine or methylphenidate reduce growth in hyperactive children?" Norwegian Journal of Psychiatry (2002) 56, no. 1: 53-57.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Telephone:(913) 906-6000. Web site: <http://www.aafp.org>.

American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 19106-1572. Telephone: (800) 523-1546, x2600 or (215) 351-2600. Web site: <http://www.acponline.org>.

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. Fax(202) 682-6850.

American Society for Clinical Pharmacology and Therapeutics; 528 North Washington Street, Alexandria, VA 22314; Phone: (703) 836-6981. Fax: (703) 836-5223.

American Society for Pharmacology and Experimental Therapeutics. 9650 Rockville Pike, Bethesda, MD 20814-3995. Telephone: (301) 530-7060.

National Institute on Drug Abuse: <http://www.nida.nih.gov/Infofax/ritalin.html>.

Nurse's PDR Resource Center. <http://www.nursespdr.com/members/database/>.

L. Fleming Fallon, Jr., M.D., Dr.P.H.

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"Methylphenidate." Gale Encyclopedia of Mental Disorders. . Encyclopedia.com. 25 Jul. 2017 <http://www.encyclopedia.com>.

"Methylphenidate." Gale Encyclopedia of Mental Disorders. . Encyclopedia.com. (July 25, 2017). http://www.encyclopedia.com/psychology/encyclopedias-almanacs-transcripts-and-maps/methylphenidate

"Methylphenidate." Gale Encyclopedia of Mental Disorders. . Retrieved July 25, 2017 from Encyclopedia.com: http://www.encyclopedia.com/psychology/encyclopedias-almanacs-transcripts-and-maps/methylphenidate

Methylphenidate

Methylphenidate

Definition

The generic name for the drug Ritalin, the most commonly prescribed medication for treating children with attention-deficit hyperactivity disorder (ADHD).

Description

Methylphenidate is one of a group of drugs called central nervous system (CNS) stimulants. It is used to treat attention-deficit hyperactivity disorder, narcolepsy (uncontrollable desire for sleep or sudden attacks of deep sleep), and other conditions as determined by a physician or other healthcare provider.

Methylphenidate contributes to the treatment of ADHD by increasing attention and decreasing restlessness in children and adults who are overactive, cannot concentrate for very long, or are easily distracted, and are impulsive. Methylphenidate is intended to be used as part of a total treatment program that also includes social, educational, and psychological treatment.

A central nervous system stimulant, methylphenidate is also used to control narcolepsy, a condition characterized by an overpowering desire to sleep. Methylphenidate comes in short- and long-acting tablets. The latter should be swallowed whole, never broken into smaller pieces or chewed.

General use

Initially methylphenidate is prescribed in two daily doses of 2.5 mg each, taken at breakfast and lunch time. The dosage is gradually increased until the daily amount reaches 10.0 mg. The dosages should be strictly followed, and since anorexia is an important side effect, the dosages should always be accompanied by a meal or snack. The primary side effect of methylphenidate is growth suppression. Others include irritability, restlessness, agitation, nausea , and headaches. Occasionally it causes sleeplessness, in which case the last dosage of the day should be a short-action tablet. Physicians often recommend regular drug-free periods to combat these side effects. In many cases, a child only takes methylphenidate during the school year.

Precautions

Methylphenidate can be addictive and dosage should be tapered off gradually. Signs of physical dependency include the need to increase the dosage in order to achieve results, mental depression, unusual behavior, and unusual tiredness or weakness. Some medical professionals believe that methylphenidate is prescribed too often. They call for better diagnostic procedures conducted by trained personnel rather than relying primarily on subjective observations by parents and teachers.

The dosage of methylphenidate is different for different people. It is important to follow the prescribing physician's orders or the instructions that appear on the label of the container. Do not change dosages unless a physician approves such an alteration.

Side effects

Any serious reaction to the drug, such as shortness of breath, irregular heartbeat, or allergic reaction, should be reported to one's doctor. Less severe, more common side effects include blurred vision, insomnia, drowsiness, gastrointestinal distress (nausea or vomiting ), dizziness , headaches, and possible addiction .

Interactions

Persons taking methylphenidate should be aware of the possible adverse interactions with the following drugs: amphetamines, appetite suppressants, caffeine , chlophedianol, cocaine, asthma medication, cold, sinus and hay fever medications, nabilone, pemoline, monoamine oxidase inhibitors, and pimozide. Methylphenidate is also affected by epilepsy, Tourette's syndrome, glaucoma, high blood pressure, psychosis, severe anxiety , and tics .

Parental concerns

The use of methyphenidate has been subject to controversy over the last several years. Parents concerned about whether the drug is being properly prescribed for their children should seek out the opinion of the most suitable physician for the type of problems their child is having. If a parent is uncomfortable with a physician's response, they should not hesitate to get a second opinion.

KEY TERMS

Attention deficit hyperactivity disorder (ADHD) A condition in which a person (usually a child) has an unusually high activity level and a short attention span. People with the disorder may act impulsively and may have learning and behavioral problems.

Narcolepsy A life-long sleep disorder marked by four symptoms: sudden brief sleep attacks, cataplexy (a sudden loss of muscle tone usually lasting up to 30 minutes), temporary paralysis, and hallucinations. The hallucinations are associated with falling asleep or the transition from sleeping to waking.

Resources

BOOKS

Castro, E. A., and R. W. Hill. Getting Rid of Ritalin: How Neurofeedback Can Successfully Treat Attention Deficit Disorder without Drugs. Charlottesville, VA: Hampton Roads Publishing Company, 2002.

DeGrandpre, Richard J. Ritalin Nation: Rapid-Fire Culture and the Transformation of Human Consciousness. New York: Norton, 2000.

Ferreiro, Carmen. Ritalin and Other Methylphenidate-Containing Drugs. Langhorne, PA: Chelsea House Publishers, 2004.

Greenhill, Laurence L., and Bette B. Osman. Ritalin: Theory and Practice. Larchmont, NY: Mary Ann Liebert Incorporated, 2000.

PERIODICALS

Golan, N., et al. "Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder." Sleep 27, no. 2 (2004): 2616.

Mott, T. F., and L. Leach. "Is methylphenidate useful for treating adolescents with ADHD?" Journal of Family Practice 53, no. 8 (2004): 65961.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 662112672. Web site: <www.aafp.org/>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 600071098. Web site: <www.aap.org/>.

American College of Physicians. 190 N. Independence Mall West, Philadelphia, PA 191061572. Web site: <www.acponline.org/>

American Medical Association. 515 N. State Street, Chicago, IL 60610. Web site: <www.ama-assn.org/>.

American Osteopathic Association. 142 East Ontario Street, Chicago, IL 60611. Web site: <www.osteopathic.org/>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Web site: <www.psych.org/>. National Institute of Mental Health. 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 208929663. Web site: <www.nimh.nih.gov/home.cfm>.

OTHER

"ADHD Medicines." Kid's Health. Available online at <http://kidshealth.org/kid/feel_better/things/ritalin.html> (accessed November 11, 2004).

"Methylphenidate (Ritalin)." National Institute of Drug Abuse. Available online at <www.nida.nih.gov/Infofax/ritalin.html> (accessed November 11, 2004).

"Methylphenidate." Internet Mental Health. Available online at <www.mentalhealth.com/drug/p30-r03.html> (accessed November 11, 2004).

"Ritalin: Miracle Drug or Cop-Out?" Public Broadcasting System. Available online at <www.pbs.org/wgbh/pages/frontline/shows/medicating/readings/publicinterest.html> (accessed November 11, 2004).

L. Fleming Fallon, Jr., MD, DrPH

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"Methylphenidate." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Encyclopedia.com. 25 Jul. 2017 <http://www.encyclopedia.com>.

"Methylphenidate." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Encyclopedia.com. (July 25, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/methylphenidate

"Methylphenidate." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Retrieved July 25, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/methylphenidate

Methylphenidate

Methylphenidate


Methylphenidate is a mild stimulant prescribed to individuals (usually for children, and sometimes controversially) who have behavioral problems characterized by hyperactivity and short attention span. The National Institute of Mental Health estimates that approximately 35 percent of the general population has attention-deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD). The administration of methylphenidate to children diagnosed with hyperactivity and/or attention-deficit disorder can have a calming effect on the children and can enable them to focus on schoolwork. Methylphenidate is also used to treat narcolepsy, a sleep disorder characterized by a permanent and overwhelming feeling of sleepiness and fatigue.

Methylphenidate is similar to amphetamine and, like amphetamine, stimulates the central nervous system (CNS), which consists of the brain and spinal cord. Stimulant drugs affect mood and alertness, and depress food appetite by increasing levels of several neurotransmitters in the brain. Although the exact therapeutic mode of action of methylphenidate is not known, the drug has been shown to elevate levels of some of these neurotransmitters, primarily dopamine and norepinephrine (noradrenaline).

Dopamine and norepinephrine are excitatory neurotransmitters. When nerve cells in the brain are stimulated, neurotransmitters stored in vesicles in nerve cell endings are released to extracellular spaces (synapses). The liberated chemical messengers can then interact with receptors on an adjacent nerve cell and can generate a new nerve signal (a nerve impulse). When levels of dopamine or norepinephrine are depressed, regions of the brain that rely on the two substances to regulate nerve impulse conduction are unable to function properly. Research has shown that children with ADD or ADHD have lower levels of dopamine in the CNS. It is believed that drugs acting as CNS stimulants, such as amphetamine, cocaine, and methylphenidate, compensate for lowered levels of excitatory neurotransmitters (i.e., dopamine and norepinephrine) in the brain. Indeed, administration of methylphenidate to healthy adult men has been found to increase dopamine levels.

Different theories have been proposed to explain how methylphenidate increases levels of dopamine in the brain. One such theory propounds that methylphenidate causes dopamine to remain longer in extracellular spaces. Once a neurotransmitter has transmitted its message, it dissociates from the receptor to which it was bound and is taken up by the nerve cell from which it was originally released. Researchers at Brookhaven National Laboratory have demonstrated that methylphenidate inhibits this "reuptake" of dopamine by nerve cells. As a result, extracellular dopamine levels are increased, and the neurotransmitter continues to be available to initiate nerve impulses.

Ritalin is the brand name of a formulation of methylphenidate that is available in tablet form. Ritalin tablets are most often prescribed to children, aged 7 to 18, who have been diagnosed with ADHD. However, individuals who suffer from anxiety or panic disorders are warned not to take the drug, as Ritalin may aggravate symptoms of agitation and/or anxiety. Nervousness and insomnia are the most common side effects associated with Ritalin. There have also been reports of the onset of Tourette's syndrome, a neurological disorder characterized by repeated and involuntary body movements (tics), or at least of symptoms resembling those of Tourette's, in patients taking Ritalin, and therefore patients with this disorder are advised not to take Ritalin. In April 2002 the National Institutes of Health reported that a combination of Ritalin and Clonidine, a drug often used to treat hypertension , is more effective in the treatment of ADHD than either drug alone. Furthermore, Clonidine is reported to have a tic-suppressing effect, and it is believed that the drug may counteract the apparent tic-accentuating effect of methylphenidate.

During the early 1990s, reports of abuse of methylphenidate began to appear. Nonmedical use of the drug for its stimulant effects impelled the U.S. Drug Enforcement Administration (DEA) to regulate the manufacture, distribution, and prescription of methylphenidate. Because methylphenidate is related to amphetamine, it can be addictive and result in physical and psychological dependence.

see also Neurochemistry; Neurotransmitters; Pharmaceutical Chemistry.

Nanette M. Wachter

Bibliography

Goldman, Larry S., et al. (1998) "Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents." Journal of the American Medical Association 279(14):11001107.

Internet Resources

National Institute of Drug Abuse. National Institutes of Health. Available from <http://www.nida.nih.gov/>.

National Institute of Neurological Disorders and Stroke. Available from <http://www.ninds.nih.gov/>.

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"Methylphenidate." Chemistry: Foundations and Applications. . Encyclopedia.com. 25 Jul. 2017 <http://www.encyclopedia.com>.

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"Methylphenidate." Chemistry: Foundations and Applications. . Retrieved July 25, 2017 from Encyclopedia.com: http://www.encyclopedia.com/science/news-wires-white-papers-and-books/methylphenidate

Methylphenidate

Methylphenidate

Definition

Methylphenidate is a mild central nervous system stimulant. This drug is sold under the brand name Ritalin in the United States.

Purpose

Methylphenidate can be used to decrease sedation and lethargy from opioid pain medications. In addition, methylphenidate may improve the mood of a cancer patient suffering from feelings of depression , often raises a patient's energy level, and may improve his or her appetite. This drug is also used to treat attention deficit disorder in children and the sleep disorder narcolepsy.

Description

Exactly how methylphenidate acts in the brain is not clear. It is believed to trigger arousal systems or increase the release of brain chemicals. It produces added alertness.

Recommended dosage

How the patient responds to treatment will determine the recommended dose. The usual dose for adults when methylphenidate is ordered with opiate pain medication is 2.5 mg. to 15 mg., daily or twice per day. This drug should be taken exactly as directed. It can become habit-forming if taken in greater amounts or for longer periods than is necessary. Patients should take the last dose of the day before 6 P. M. to decrease sleep difficulties. Patients should not crush or break this medication. If a dose is missed, the patient should take it as soon as possible. Patients should not take two pills at the same time.

Precautions

Methylphenidate can produce physical and mental dependence. Patients should not suddenly stop taking it. A sudden discontinuation of the drug can cause withdrawal symptoms, including depression, paranoid feelings, thoughts of suicide, anxiety, agitation, and sleep disturbances.

Methylphenidate should not be given to patients with extreme anxiety, tension, agitation, severe depression, instability, or a history of alcohol or drug abuse. It is not indicated for use in those with Tourette's syndrome, people with tics, glaucoma, or some mental-health conditions. This drug should be used cautiously in patients with high blood pressure, those with a history of seizures, and women who are breastfeeding. Methylphenidate is not typically ordered for women during their childbearing years, unless the doctor determines that the benefits outweigh the risks. Methylphenidate should not be ordered for patients less than six years of age. Its safety has not been determined in this age group.

Side effects

The most common side effects are nervousness, sleep difficulties, a rapid heartbeat, and increased blood pressure. Reducing the dose or changing the time the drug is taken may reduce some side effects. Patients should discuss any adverse reactions with their doctor. Patients should receive regular blood pressure and pulse checks while on this drug. Methylphenidate also may cause dizziness, irritability, vision changes, drowsiness, and a poor appetite. Patients may experience chest pain, palpitations, joint pain, skin rash, and uncontrolled movements or speech. Patients may develop a rapid or irregular heartbeat, stomach upset, nausea, headache, blood in the urine or stools, muscle cramps, red dots on the skin, or bruises. Patients should not drive or operate machinery or appliances until they understand how this drug affects them. Patients should not drive if they become lightheaded or dizzy. Methylphenidate may cause irregularities in the makeup of the blood and produce changes in liver function. Patients should receive regular blood work.

At higher doses or with long-term use, patients may experience confusion, false beliefs, mood changes, hallucinations, feelings that they or their environment are not real, and weight loss .

Interactions

Several drugs may interfere with methylphenidate, including anticoagulants (blood thinners), and drugs to prevent seizures, combat depression and treat high blood pressure.

Debra Wood, R.N.

KEY TERMS

Narcolepsy

Disorder that causes people to suddenly fall asleep

Opiate

Remedy containing or derived from opium, or any drug that induces sleep

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methylphenidate

methylphenidate (mee-thyl-fen-id-ayt) n. a drug that stimulates the central nervous system. It is administered by mouth to treat attention-deficit/hyperactivity disorder in children. Trade names: Concerta, Equasym XL, Ritalin.

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