Brand names: Methylphenidate
Central Nervous System Stimulant
Route: Oral
FDA Black Box Warning
WARNING: ABUSE, MISUSE, AND ADDICTION Methylphenidate hydrochloride extended-release capsules have a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction. Misuse and abuse of CNS stimulants, including methylphenidate hydrochloride extended-release capsules, can result in overdose and death [see Overdosage ( 10 )] , and this risk is increased with higher doses or unapproved methods of administration, such as snorting or injection. Before prescribing methylphenidate hydrochloride extended-release capsules, assess each patient’s risk for abuse, misuse, and addiction. Educate patients and their families about these risks, proper storage of the drug, and proper disposal of any unused drug. Throughout treatment with methylphenidate hydrochloride extended-release capsules, reassess each patient’s risk of abuse, misuse, and addiction and frequently monitor for signs and symptoms of abuse, misuse, and addiction [see Warnings and Precautions ( 5.1 ), Drug Abuse and Dependence ( 9.2 )]. WARNING: ABUSE, MISUSE, AND ADDICTION See full prescribing information for complete boxed warning. Methylphenidate hydrochloride extended-release capsules have a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction. Misuse and abuse of CNS stimulants, including methylphenidate hydrochloride extended-release capsules, can result in overdose and death ( 5.1 , 9.2 , 10 ). • Before prescribing methylphenidate hydrochloride extended-release capsules, assess each patient’s risk for abuse, misuse, and addiction. • Educate patients and their families about these risks, proper storage of the drug, and proper disposal of any unused drug. • Throughout treatment, reassess each patient’s risk and frequently monitor for signs and symptoms of abuse, misuse, and addiction.
Contraindications
4 CONTRAINDICATIONS • Hypersensitivity to methylphenidate or other components of methylphenidate hydrochloride extended-release capsules. Hypersensitivity reactions, such as angioedema and anaphylactic reactions, have been reported in patients treated with methylphenidate [see Adverse Reactions ( 6.1 )] . • Concomitant treatment with monoamine oxidase inhibitors (MAOIs), or within 14 days following discontinuation of treatment with an MAOI, because of the risk of hypertensive crises [see Drug Interactions ( 7.1 )] . • Known hypersensitivity to methylphenidate or product components ( 4 ). • Concurrent treatment with a monoamine oxidase inhibitor (MAOI) or use of an MAOI within the preceding 14 days ( 4 ).
Pregnancy & Breastfeeding
8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications, including methylphenidate hydrochloride extended-release capsules during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for ADHD medications at 1-866-961-2388 or visiting https://womensmentalhealth.org/adhd-medications/ . Risk Summary Published studies and postmarketing reports on methylphenidate use during pregnancy have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. There may be risks to the fetus associated with the use of CNS stimulants use during pregnancy (see Clinical Considerations) . No effects on morphological development were observed in embryo-fetal development studies with oral administration of methylphenidate to pregnant rats and rabbits during organogenesis at doses up to 10 and 15 times, respectively, the maximum recommended human dose (MRHD) of 60 mg/day given to adolescents on a mg/m 2 basis. However, spina bifida was observed in rabbits at a dose 52 times the MRHD given to adolescents. A decrease in pup body weight was observed in a pre- and post-natal development study with oral administration of methylphenidate to rats throughout pregnancy and lactation at doses 6 times the MRHD given to adolescents (see Data) . The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Clinical Considerations Fetal/Neonatal Adverse Reactions CNS stimulants, such as methylphenidate hydrochloride extended-release capsules, can cause vasoconstriction and thereby decrease p
18 interactions on record
Concomitant use can cause hypertensive crisis with potentially fatal outcomes including death, stroke, myocardial infarction, and aortic dissection. Contraindicated within 14 days of MAOI discontinuation.
Source: NLP:methylphenidate
Sympathomimetic medication; concomitant use is contraindicated due to risk of hypertensive crisis.
Source: NLP:safinamide mesylate
Concomitant use may increase risk of sudden blood pressure and heart rate increase during surgery. Avoid use on day of surgery.
Source: NLP:methylphenidate
Methylphenidate may inhibit metabolism of this tricyclic drug. Downward dose adjustments may be required and plasma concentrations should be monitored.
Source: NLP:methylphenidate
Methylphenidate increases plasma levels of tricyclic antidepressants including clomipramine.
Source: NLP:clomipramine hydrochloride
Methylphenidate may increase plasma levels of clomipramine; close supervision and dosage adjustment recommended.
Source: NLP:clomipramine hydrochloride capsules
Methylphenidate may inhibit metabolism of this tricyclic drug. Downward dose adjustments may be required and plasma concentrations should be monitored.
Source: NLP:methylphenidate
May increase phenytoin serum levels; monitoring of phenytoin levels recommended.
Source: NLP:fosphenytoin sodium
Methylphenidate may inhibit metabolism of this tricyclic drug. Downward dose adjustments may be required and plasma concentrations should be monitored.
Source: NLP:methylphenidate
Binds to dopamine transporter with high affinity and may interfere with Ioflupane I-123 imaging results.
Source: NLP:ioflupane i-123
Chronic administration may result in inadequate sedation with midazolam due to decreased absorption.
Source: NLP:midazolam hydrochloride
Methylphenidate may inhibit metabolism of coumarin anticoagulants. Downward dose adjustments may be required and coagulation times should be monitored.
Source: NLP:methylphenidate
Methylphenidate may inhibit metabolism of this anticonvulsant. Downward dose adjustments may be required.
Source: NLP:methylphenidate
Methylphenidate may inhibit metabolism of this anticonvulsant. Downward dose adjustments may be required.
Source: NLP:methylphenidate
May increase phenytoin serum levels; monitoring of phenytoin levels recommended.
Source: NLP:extended phenytoin sodium
Methylphenidate may inhibit metabolism of this anticonvulsant. Downward dose adjustments may be required.
Source: NLP:methylphenidate
Concomitant use with methylphenidate may increase the risk of extrapyramidal symptoms (EPS), especially with dosage changes. Monitor for EPS symptoms.
Source: NLP:risperidone
Methylphenidate may inhibit metabolism of SSRIs. Downward dose adjustments may be required and plasma concentrations should be monitored.
Source: NLP:methylphenidate