MethylphenidateNursing considerations

Side effects by what to assess

Sources: [1][2][3][4][5][6][7][8][9][10][11]

Blood pressure

Why

Hypertension from stimulant effect

When

Throughout treatment

Normal

Below 120/80 mm Hg.

Sources: [1][2]

Body weight

Why

Weight loss and slowed growth (track height too in children)

When

Closely in children during treatment

Act on

Not growing or gaining weight as expected: treatment may need interruption

Sources: [1][2]

Heart rate

Why

Tachycardia

When

Throughout treatment

Normal

60 to 100 beats per minute in adults at rest.

Sources: [1][2]

High-alert status

Methylphenidate and other CNS stimulants are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

Abuse, misuse, and addiction. Methylphenidate has a high potential for abuse and misuse that can progress to a substance use disorder, including addiction. Misuse can cause overdose and death, with higher risk at higher doses or when snorted or injected. Assess abuse risk before prescribing, teach patients and families about safe storage and disposal, and keep reassessing and monitoring for signs of misuse throughout treatment.

Sources: [1]

Antidote or reversal

No specific antidote. Overdose causes sympathomimetic toxicity: fast arrhythmias, high or low blood pressure, agitation, confusion, hallucinations, seizures, and life-threatening hyperthermia (above 104°F) with rhabdomyolysis. Give supportive care, consider multiple drug ingestion, and contact Poison Help or a toxicologist; dialysis does not help because of the large volume of distribution and rapid metabolism.

Sources: [1]

Patient teaching

• This medicine can be misused and cause addiction; keep it locked up, never share or sell it, and dispose of unused tablets through a take-back program
• Get help right away for chest pain with exertion, unexplained fainting, or other heart symptoms
• It can raise blood pressure and pulse
• Report hallucinations, unusual suspicion of others, or extreme mood changes
• Get emergency care for a painful erection or one that lasts longer than 4 hours
• Report numbness, pain, color change, or temperature sensitivity in fingers or toes, or unexplained wounds on them
• It can slow a child's growth; height and weight will be checked
• Report new or worse tics
• Tell your prescriber if you are pregnant or breastfeeding; a pregnancy registry for ADHD medicines exists

Sources: [1][2][3][4]

Sound-alike and look-alike names

• methylphenidate and methadone
• Ritalin and ritodrine

Sources: [1][2]

Adult dose

ADHD or narcolepsy, adults

Average 20 to 30 mg per day in 2 or 3 divided doses, preferably 30 to 45 minutes before meals. Maximum 60 mg per day.

Sources: [1]

Renal adjustment

Not studied in renal impairment, but less than 1% of a dose is excreted unchanged in urine and the main metabolite, ritalinic acid, has little or no activity, so little effect is expected. No adjustment is given.

Sources: [1]

Hepatic adjustment

Not studied in hepatic impairment; little effect is expected because it is broken down mainly by nonmicrosomal esterases found throughout the body. No adjustment is given. Abnormal liver function, up to severe hepatic injury, has been reported.

Sources: [1][2]

Mechanism

A CNS stimulant that inhibits presynaptic reuptake of dopamine and norepinephrine and increases their release into the synapse; how this treats ADHD and narcolepsy is unknown. It is a racemic mix in which the d-threo enantiomer is the more active form. Peak plasma level comes about 2 hours after a tablet, and it is metabolized mainly by de-esterification to ritalinic acid, which has little or no activity and is excreted in urine.

Sources: [1][2][3]