Ritalin (Methylphenidate) belongs to a group of psychostimulants. Ritalin is manufactured by Novartis AG. Ritalin is approved for treatment in children and adults suffering from Attention-Deficit Disorder (ADD) and Attention-Deficit Hyperactivity Disorder (ADHD) by FDA in 1980. Also the drug is used in treatment of narcolepsy (Excessive daytime sleepiness). Ritalin helps patients be concentrated without distracting.

People taking Ritalin may feel calming or stimulating effect. Lower Ritalin doses used in ADHD treatment affect certain chemical substances in the brain and provide calming effect. High doses of the drug work as a stimulator and help people suffering from narcolepsy. Serious adverse reactions may be observed in case of drug overdose, such as hallucinations, hyperactivity and aggression.

Clonidine

Ritalin with Clonidine may cause serious adverse reactions. Your doctor should match correct dose of these two drugs to avoid negative effect.

Warfarin

If Ritalin and Warfarin are used in conjunction, it may increase the level of Warfarin in the blood and increase the risk of bleeding. To prevent it, you are recommended to pass frequent medical examination since you started to use Ritalin.

Compressors

If Ritalin and compressors are used together it may lead to side-effects, particularly, may increase the blood pressure and heart rate. Depending on your condition, your attending physician should check your heart rate and your arterial pressure.

Inhibitors of monoamine oxidase

Interaction between Ritalin and MAOI may lead to potentially life-threatening adverse drug reactions, such as high blood pressure. You are strictly recommended to avoid using of Ritalin and MAOI.

Tricyclic antidepressants

Taking Ritalin with tricyclic antidepressants may increase antidepressant level in the blood and consequently may increase the risk of side-effects. Probably, you will be recommended to reduce a dose of antidepressants to prevent negative interaction.

Ritalin doses over 1mg/kg have not been recommended before because of weakening learning ability and other side-effects. Recently Klein has proved that doses of 1.78 mg/kg (about 50mg a day, in average 20-60mg) do not weaken learning abilities according to the results of WRAT test, Gray Oral Reading Test, Porteus Maze test and Draw-A-Person test. It should be noted that no drug tolerance was observed during 12 weeks. This fact is not admitted by many scientific researchers. Pelham described various symptoms in children associated with different doses of Methylphenidate in 1993.

Methylphenidate is often prescribed in certain doses at breakfast and at lunch. A morning dose frequently exceeds a daytime dose twice as much to prevent sleeplessness. The third daily dose of Ritalin is not recommended because of overdose side-effects, however useful for children (for example, to do homework), and does not increase the quantity of side-effects in children. Though it was not investigated, it was clinically defined that some children sleep better after a dose taken at bedtime. To avoid stomach upset, Ritalin is recommended to be taken before or after a meal. Do not increase or reduce a dose of Methylphenidate without the doctor’s consent.

The most common Ritalin side-effects include appetite loss and sleeplessness. Many children complain of stomach pain and headache. These effects can be decreased after dose adjustment, and usually they disappear after a while.

Also growth (height and weight) impairment was reported. When children cease taking the drug, their height is increased. This effect directly depends on a dose and sometimes is observed during treatment with Methylphenidate. Many clinical trials have been conducted to define possible effects of stimulators on growth, but the conclusions were contradictory. Some divergence is caused by the fact that the most of clinical trials used lower doses, and they did not influence on growth. Many children used high Methylphenidate doses for a long period of time experienced growth impairment.

Growth impairment is important during the treatment in teenagers with attention deficit hyperactivity disorder during their rapid growth. Attending physicians should observe height and weight changes on the regular base. The treatment with stimulators insignificantly decreases systolic blood pressure and heart rate. Though there is an opinion that Ritalin side-effects clinically are not serious, actually no special clinical trials in adult patients who have been under long-term use of stimulators have been conducted to determine cardiovascular changes.

Some parents may complain of short-term (1-2 hours) period but nearly tolerable after the last Ritalin dose administration at noon lasting to 16-00.

Stimulators influence on tic exacerbation in Tourette’s Disorder or on TD occurrence in children who are under the risk of this disease due to similar heredity are not clear yet. Some scientists proved that this reaction was Methylphenidate side-effect and warned that stimulators are not recommended for children suffering from tic or having similar heredity.

You are recommended to pay attention to it. Recent clinical researches investigated frequent cases of combination of attention deficit hyperactivity disorder and TD and it was reported that stimulators can be very useful for these children. Behavior and tic frequency in four children suffering from both syndromes have been observed and measured at school during games. No tic exacerbation has been observed at dose increase to 15mg twice a day (Sverd et al., 1989). Consequently, contra-indications are individual and relative.

Also information on psychotic reactions in children was covered in scientific resources. These reactions are experienced usually as tactile hallucinations, but recently some cases of mania have been reported. These side-effects require immediate cessation of Ritalin use. After termination of the treatment psychotic reactions disappear.

Nervousness and sleeplessness are the most common adverse Ritalin reactions, and as a rule, controlled by lowering doses. Other reactions include hypersensitivity (including skin rash, hives, fever, joint pain, exfoliative dermatitis, erythema multiforme, necrotizing vasculitis, and thrombocytopenic purpura); anorexia; nausea; dizziness; tachycardia; headache; dyskinesia; drowsiness; arterial pressure and change pulse; tachycardia; stenocardia; arrhythmia, stomach ache; weight losses at long-term therapy.

The following contra-indications to Ritalin, depending on food and medicinal products: anxiety, stress and excitement when use Ritalin. Ritalin is counter-indicative also for patients who are intolerable to drugs and patients suffering from glaucoma.

Ritalin is not recommended for children of six years of age as drug safety and efficiency have not been proved for this age group. There is no sufficient information about drug safety and efficiency at long-term Ritalin use in children with minimum brain dysfunction. Ritalin is strictly not recommended in serious exogenous or endogenous depression. Ritalin is not recommended for prophylaxis or treatment of normal fatigue. Arterial pressure should be measured regularly in all patients using Ritalin, especially with hypertension. Sometimes symptoms of temporal blurred vision are observed.

Drug investigation in pregnant women has not been conducted. Therefore, women of childbearing age are recommended to avoid the drug so far till more information is available. Patients with drug and alcohol addiction history and emotionally unstable should take extra care using Ritalin because such patients may increase a drug dosage on own initiative. Chronically drug abuse may lead to drug addiction and physical dependence. Medical observance is required during drug cessation as it helps to reveal serious depression and chronic excessive activity. Patients with agitation may react negatively; it is necessary to stop therapy if necessary.

Ritalin overdose symptoms include fever, tremble, and aggression. Overdose effect may vary depending on how many and how Ritalin was taken, with alcohol or other medications. Hyperactivity, fast breath, muscle pain, shattered nerves, aggression and hallucinations can be considered as overdose symptoms.

During clinical trials various side-effects have been revealed including depression. At the same time Ritalin is often used not as prescribed. Therefore it is hard to say exactly if depression is associated with Ritalin use. If during Methylphenidate use depression symptoms are observed, inform your doctor about it.

The most common side-effect is weight loss for those taking Ritalin. Actually it is not a significant problem. Weight loss is often observed in growing children. If your child during Ritalin use started to lose weight give pills after a meal to reduce the side-effect.

Weight loss is a general symptom during the treatment with Ritalin. That’s why the drug is often used for this purpose. Actually the drug is not approved for weight loss however sometimes use Ritalin is reasonable. In certain cases the doctor may prescribe the drug for a short period of time.