# Methylin ### (methylphenidate)
[**Full Prescribing Information**](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=9e3c22d9-71d9-46a7-b315-8021c94c4bec&type=display)[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e3c22d9-71d9-46a7-b315-8021c94c4bec)
--- **Forms/Strengths** - **Liquid (grape flavored):** 5 mg/5 mL, 10 mg/5 mL - **Chewable:** 2.5 mg, 5 mg, 10 mg --- ### **Dosing** - **Age:** ≥ 6 y/o - **Onset:** ~20-60 min - **Duration:** 3-4 hours - **Considerations:** Typically dosed multiple times per day. May be taken with or without food. - **Liquid:** Colorless, grape-flavored liquid; store at room temperature. - **Chewable:** Grape-flavored chewable tablet. - **Initial Dose:** 5 mg twice daily (before breakfast and lunch) - **Titration:** 5-10 mg weekly - **Max Dose:** 2mg/kg/day up to 60 mg/day --- ### **Quick Facts** - Blocks dopamine/norepinephrine reuptake; enhances focus, attention, and impulse control - Immediate-release formulation provides rapid onset - Available as tablets and oral solution - Common side effects: decreased appetite, insomnia, headache, stomach upset --- ### **Indications** - ADHD** (ICD-10: F90.0) - **Narcolepsy:** G47.419 --- ### **Off-Label Uses** - **Binge Eating Disorder (F50.2)** – Sometimes used to help curb compulsive overeating - **Treatment-Resistant Depression (F33.9)** – May improve motivation and energy in certain cases - **Cancer-related Fatigue (R53.0)** – Can enhance alertness and reduce severe fatigue - **Other Fatigue Syndromes (R53.83)** – May help improve wakefulness in chronic fatigue --- ### **How to Take** - Administer orally, **preferably 30 to 45 minutes before meals**. - Take **two to three times daily**, as directed, with doses **at least 4 hours apart**. - Can be taken **with or without food**; high-fat meals may delay absorption. - **Swallow the tablet whole**; do not crush or chew. - If using the **oral solution**, **measure dose carefully** with a provided dosing syringe or cup—do not use household spoons. - Avoid taking **late in the day** to prevent insomnia. --- ### **Side Effects** - Common: Insomnia, decreased appetite, headache, abdominal pain, tachycardia, dry mouth - Serious: Cardiovascular events (e.g., sudden death in patients with cardiac abnormalities), psychiatric events (e.g., psychosis, mania), priapism, growth suppression in children --- ### **Monitoring / Labs** - **Cardiovascular**: Baseline and routine monitoring of heart rate and blood pressure. - **Growth in Pediatrics**: Regular monitoring of height and weight to detect growth suppression. - **Psychiatric Symptoms**: Observe for mood changes, anxiety, or psychosis. - **Abuse Potential**: Monitor for misuse or diversion. --- ### **Education** - **When to Call the Doctor:** - Severe **mood changes, aggression, or suicidal thoughts**. - Chest pain, rapid heartbeat, shortness of breath (**cardiovascular concerns**). - Uncontrolled movements, tics, or worsening anxiety. - Numbness, coldness, or color changes in fingers or toes (**circulatory issues**). - Unexplained weight loss or **delayed growth in pediatric patients**. - **Safety Tips:** - **Monitor blood pressure and heart rate**, especially in patients with cardiovascular risk. - Use caution in patients with **anxiety, bipolar disorder, or psychosis**, as symptoms may worsen. - Avoid **caffeine and other stimulants**, which may amplify side effects. - Ensure **adequate hydration and nutrition**, as appetite suppression is common. - **Tapering may be required** if discontinuing after long-term use. - **Parent Tips for Pediatric Patients:** - **Encourage a nutrient-dense diet** to counteract appetite suppression. - Administer in the **morning before school** for optimal effect. - Monitor **school performance and behavioral changes**. - Observe for **sleep disturbances**; adjust timing if necessary. - Communicate regularly with **teachers and caregivers** about medication effects. --- ### **Additional Information** - **Contraindications:** - **Hypersensitivity** to methylphenidate or formulation components. - **Use within 14 days of MAOI therapy** (risk of hypertensive crisis). - Symptomatic **cardiovascular disease, moderate-to-severe hypertension, hyperthyroidism, glaucoma**. - **History of substance use disorder**, unless benefits outweigh risks. - **Pregnancy:** - **Category C**; use only if benefits outweigh risks. - May cause **neonatal withdrawal symptoms** or **low birth weight**. - **Lactation:** - **Excreted in breast milk**; **not recommended** due to potential infant exposure. - **Drug Interactions:** - **Serotonergic drugs** (e.g., SSRIs, SNRIs, MAOIs) increase **serotonin syndrome risk**. - **Acidifying agents** (e.g., ascorbic acid) may reduce drug absorption. - **Alkalinizing agents** (e.g., sodium bicarbonate) may increase methylphenidate levels. - May potentiate **hypertensive effects** of certain medications (e.g., decongestants, beta-agonists).