Methylin

Forms/Strengths

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

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

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

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.

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

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.

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.

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).