Overview
Ritalin is the brand name for Methylphenidate hydrochloride. It contains an amphetamine and is a central nervous system stimulant. Ritalin is most commonly used to treat ADHD: Attention-Deficit Hyperactivity Disorder, also known as ADD: Attention-Deficit Disorder. Ritalin is also used to treat narcolepsy.

When it is used to treat ADHD, Ritalin should be part of a psychological, educational, and social program of therapy. This drug is used to:

1. increase attention span
2. improve a person’s ability to focus
3. decrease restlessness
4. control overactivity

Why is this drug prescribed?
Ritalin is used to treat ADHD. It is prescribed for the following symptoms:

1. inability to pay attention (e.g. to class work)
2. hyperactivity
3. impulsiveness
4. disruptive behavior
5. peer relationship problems
6. unstable mood/mood swings

The presence of these symptoms alone does not indicate a need for Ritalin therapy. ADHD may be difficult to diagnose, and not all cases require medication.

Ritalin is also used to treat narcolepsy. Symptoms of narcolepsy include an uncontrollable desire to sleep and sudden deep sleep.

Warnings and Precautions
Ritalin’s effects on children under six years old have not been established. The long-term effects on children older than this have not been established.

Ritalin may raise blood pressure, and patients with high blood pressure should be closely monitored while taking Ritalin.

Ritalin may lead to psychological and physical dependence and patients may require supervision during drug withdrawal. The habit-forming potential is high. Addiction is rare in children but a problem with adults. When Ritalin is discontinued after long-term use, dosages should be gradually reduced.

Use of Ritalin may lead to dizziness or sleepiness. It may also hide signs of tiredness and affect concentration. Patients should not drive or operate heavy machinery until the effects of Ritalin are known.

For Pregnant or Nursing Mothers: The effects of Ritalin during pregnancy are not known, but it is not recommended for pregnant women. It is not known whether Ritalin passes into breast milk, but Ritalin is not recommended for pregnant women due to the possible risk to the infant.

Contraindications
Ritalin should not be used for people with the following medical conditions:

1. anxiety or agitation
2. tension
3. agitation
4. thyrotoxicosis
5. tachyarrhythmias
6. severe angina pectoris
7. glaucoma
8. hypersensitivity to methylphenidate or another amphetamine
9. motor tics or a family history or diagnosis of Tourette's syndrome
10. a history of drug or alcohol dependence or abuse
11. epilepsy or a history of seizures
12. high blood pressure
13. psychosis

Adverse Reactions
Ritalin may cause the following reactions:

1. minor suppression of growth (weight gain and height) with long term use
2. insomnia
3. nervousness
4. irritability
5. decreased appetite
6. nausea
7. stomach pain
8. weakness
9. dizziness
10. drowsiness
11. tremor
12. hyperactive reflexes
13. confusion, delirium
14. panic attacks
15. suicidal tendencies
16. irregular heat beat
17. cardiac arrhythmias
18. high blood pressure
19. chest pain
20. circulatory collapse
21. lack or coordination
22. uncontrolled movements
23. muscle cramps
24. fever
25. skin rash, itching
26. joint pain
27. weight loss (with long term use)

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Ritalin are:

1. MAO Inhibitors: Ritalin should only be used very cautiously when combined with MAO Inhibitors as it may cause sudden extremely high blood pressure and severe convulsions
2. guanethidine’s hypotensive effect may be decreased by Ritalin
3. coumarin anticoagulants, anticonvulsants (phenobarbital, diphenylhydantoin, primidone), phenylbutazone and tricyclic antidepressants (imipramine, desipramine): the dosages of these drugs may need to be reduced when taken with Ritalin.
4. Amantadine (e.g., Symmetrel), amphetamines, appetite suppressants (diet pills), Bupropion (e.g., Wellbutrin, Zyban), caffeine (e.g., NoDoz), Chlophedianol (e.g., Ulone), cocaine, medicine for asthma or other breathing problems, medicine for colds, sinus problems, hay fever or other allergies (including nose drops or sprays), Nabilone (e.g., Cesamet), Pemoline (e.g., Cylert)—taking these while on Ritalin therapy may lead to severe nervousness, irritability, trouble in sleeping, or possibly irregular heartbeat or seizures
5. epinephrine
6. dopamine
7. warfarin
8. phenytoin
9. bretylium

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