Methylphenidate for ADHD Concerta, Equasym, Medikinet, Ritalin

About methylphenidate

Attention deficit hyperactivity disorder (ADHD) is a fairly common condition that mainly affects a person's behaviour. People with ADHD show persistent restlessness, impulsiveness and/or inattention. You will be given help to understand your (or your child's) emotions and behaviours, but where this is insufficient, medicines such as methylphenidate can be prescribed.

It is not known exactly how methylphenidate works for people with ADHD. Methylphenidate increases the amount of natural chemicals in the brain, including one called dopamine. It is thought that increasing dopamine levels in the parts of the brain responsible for self-control and attention, stimulates them to work better. This then helps to focus attention and improve concentration. It will initially be prescribed by a specialist doctor.

ADHD is usually diagnosed in children, but it can continue through the teenage years and into adulthood. This information leaflet is written for parents or carers of children and young people who have been prescribed methylphenidate.

Before giving methylphenidate

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before your child (or a child in your care) starts taking methylphenidate it is important that your doctor knows:

• If your child has ever had an eating disorder or a severe mood disorder.
• If your child has epilepsy.
• If your child has raised pressure in their eyes (glaucoma).
• If your child has a heart condition or any blood vessel disease.
• If your child has an overactive thyroid gland (hyperthyroidism).
• If your child has uncontrollable movements such as a nervous tic or Tourette's syndrome.
• If your child has an adrenal gland tumour called phaeochromocytoma.
• If it is for a teenager who could be pregnant or is breastfeeding.
• If your child has ever had a drug or alcohol problem.
• If your child is taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal and complementary medicines.
• If your child has ever had an allergic reaction to a medicine.

How to take methylphenidate

• Before starting this treatment, read the manufacturer's printed information leaflet from inside the pack. The leaflet will give you more information about methylphenidate and a full list of side-effects which may be experienced from taking it.
• Make sure you give your child methylphenidate exactly as your doctor tells you to. Your doctor or pharmacist will tell you how many tablets/capsules they should take. The dose will also be on the label of the pack to remind you.
• It is not important whether methylphenidate is taken before or after food, but try to remember to give your child methylphenidate at the same times of day, each day.
• If you do forget a dose, give it as soon as you remember (unless it is nearly time for the next dose, in which case leave out the missed dose). Do not give two doses together to make up for a missed dose.

Taking immediate-release tablets (Ritalin® and Tranquilyn®)

• If your child has been prescribed a tablet which does not have an 'XL' after the brand name (such as Ritalin® and Tranquilyn®) then it is likely they will need to take more than one dose each day. To begin with they may be prescribed just one or two doses each day, but this is likely to be increased after a few weeks to two or three doses every day.
• The dose should be swallowed with a drink of water. If your child has difficulty swallowing the tablets, they can be broken in half along the score line.
• Taking the dose after a meal may help reduce side-effects like feeling sick or indigestion.

Taking modified-release tablets/capsules (Concerta® XL, Equasym® XL, Medikinet® XL)

• These brands contain methylphenidate in a modified-release tablet/capsule which releases it slowly over the day, to give a longer effect. These brands have the letters 'XL' after the brand name. It is usual to take one tablet or capsule each day, in the morning.
• There are several brands of modified-release methylphenidate, but they do not all have the same effect. Because of this, it is important that you always give your child the same brand as they have taken before. Each time you collect a new supply, check the name on the pack to make sure it is their usual brand.
• If your child is taking Concerta® XL tablets, these should be swallowed whole with a drink of water and must not be chewed or crushed.
• If your child is taking Equasym® XL capsules or Medikinet® XL capsules, you can open these and sprinkle the contents on to a spoonful of apple sauce to make it easier for your child to swallow it. If you do this, the mixture must be swallowed straightaway, without chewing.

Getting the most from this treatment

• Keep the regular appointments with your doctor. Your doctor will want to check to ensure that the treatment is helping. Your doctor will also monitor things like weight and height, and do some blood tests.
• There are treatment programmes that will be recommended for you and your child. These will provide you with strategies to improve their behaviour and reduce any long-term impact.
• From time to time your doctor will assess the treatment to make sure it is still required. This may involve stopping methylphenidate for a short while.
• There is a small amount of evidence to show that a change in diet may help some children with ADHD. If you think that diet may be a factor for your child, discuss this with your doctor to see if speaking with a dietician might be of benefit.
• Before buying any medicines for your child, check with your pharmacist which medicines are safe for them to take alongside methylphenidate.
• Your child should not drink alcohol while on methylphenidate.
• If your child is due to have an operation, it is important that you tell the person carrying out the treatment that they are taking methylphenidate.
• Your child should not stop taking methylphenidate unless your doctor tells them to do so. This is because stopping suddenly can cause problems and your doctor may recommend that the dose is reduced gradually.
• If the person taking this medicine is also a driver, please be aware that methylphenidate is likely to affect your reactions and ability to drive. It is an offence to drive while your reactions are impaired. Even if your driving ability is not impaired, should you drive, you are advised to carry with you some evidence that the medicine has been prescribed for you - a repeat prescription form or a patient information leaflet from the pack is generally considered suitable.
• If you are planning a trip abroad, you are advised to carry a letter with you from your doctor to explain that you (or your child) have been prescribed methylphenidate. This is because methylphenidate is classed as a 'controlled drug' and is subject to certain restrictions.

Can methylphenidate cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with methylphenidate. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Your doctor will have discussed with you the possibility that methylphenidate treatment may be associated with suicidal thoughts and thoughts about self-harm. Although this is very rare, if you think your child is having such thoughts, you must tell your doctor about it straightaway.

If your child experiences any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store methylphenidate

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines