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Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin LA, Ritalin

SR, PMS-Methylphenidate (methylphenidate)

Classification: central nervous system stimulant

Indication (Use): Tx. of ADHD (adjunct), symptomatic treatment of narcolepsy, Unlabeled

uses: Management of some form of refractory depression

Normal dosage: Adult ~ PO 5-20mg 2-3 times daily as prompt- release tablets. When

maintenance dose is determined, may change to extended release formulation.Narcolepsy: ~

10mg, 2-3 times/day; max 60mg/day

Children ~PO (children >6yr): prompt-release tabs- 0.3mg/kg/dose or 2.5-5mg

before breakfast and lunch; increase by 0.1mg/kg/dose or by 5-10mg/day at weekly intervals (not

to exceed 60mg/day or 2mg/kg/day), when maintenance dose is determined, may change toextended release formulation.Ritalin SR, Metadate ER, may be used in place of the Prompt-

release tabs when the 8-hour dosage corresponds to the titrated 8-hour dosage of the Prompt-

release tablets; Ritalin LA- can be used in place of twice daily regimen given once daily at same

total dose; or in place ofSR product at same dose; Concerta (pts. Who have not taken

methylphenidate previously) 18mg once a day in the morning initially, may be titrated as needed

up to 54mg/day; Concerta (pts who are currently taking other forms of methylphenidate) 18mg

once in the morning if previous dosage was 5mg 2-3 times or 20mg daily as SR product, 36mg

once daily in the morning if previous dose was 10mg 2-3 times a day or 40mg daily as SR

product, 54mg once daily if previous dose was 15mg 2-3 times daily or 60mg once daily. Dosage

may be adjusted in weekly 20mg increments to a max of 60mg/day taken once daily in the

morning

Side Effects: CNS hyperactivity, insomnia, restlessness, tremor, dizziness, h/a, irritability

EENT:blurred vision, CV: hypertension, palpitations, tachycardia, hypotension GI: anorexia,

constipation, , cramps, N/V, dry mouth, metallic taste GU: polyuria, glycosuria, nephrogenic

diabetes insipidus, renal toxicity Derm: rashes Neuro: akathisia, dyskinesia Misc: fever,

hypersensitivity reaction, physical dependence, psychological dependence, suppression of weight

gain (children), tolerance

Nursing implications: Assess V/S, RR prior to admin, Peds: Monitor growth, both height and

weight, PEDS (ADHD): assess attention span, impulse control, interaction with others.

Narcolepsy: Observe frequency of episodes

Patient teaching: Explain the purpose of the medication, thoroughly explain possible side

effects and what adverse reaction to look for, contact Primary care provider (PCP), not to used

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Caffeine-containing beverages, It is possible that the shell of the Concerts could be noticed in the

stool, (no Concern) Advise the parents to notify the childs school of new medication or any

changes in medication. Chk weight 2-3 times a week and report any decreases to PCP.

Administration Principles: Immediate and sustained-released tabs should be administered on

an empty stomach 30-45 min ac, SR tabs should be swallowed whole, NOT crushed, chewed orbroken, Metadate CD and Ritalin LA caps may be opened and sprinkled on COOL applesauce

and ingested entirely followed with a drink of water, Concerta can be taken /s food however,

needs to be taken with water, milk or juice