Use Caution/Monitor. Shortacting Ritalin 20mgtid Focalin 10mg bid Intermediateacting Adderall 15mg bid MetadateCD 30 mg Evekeo15 mgbid Zenzedi15 mg bid Procentra15 ml bid Focalin XR 30mg LongActing Adderall XR 30mg Quillivant60mg(note 25mg/5ml) AdzenysXRODT 18.8mg Quillichew60 mg AptensioXR 60mg(actuallyequivto ritalin 25.9 twice a day) Risk of acute hypertensive episode. Modify Therapy/Monitor Closely. Risk of acute hypertensive episode. Methylphenidate may diminish antihypertensive effects. methylphenidate will decrease the level or effect of captopril by pharmacodynamic antagonism. Use Caution/Monitor. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Minor (1)yerba mate increases effects of methylphenidate by pharmacodynamic synergism. Narcolepsy. Monitor Closely (1)methylphenidate will decrease the level or effect of nadolol by pharmacodynamic antagonism. Other (see comment). Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. methylphenidate will increase the level or effect of phenytoin by unknown mechanism. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Potential for additive CNS stimulation. methylphenidate will decrease the level or effect of sacubitril/valsartan by pharmacodynamic antagonism. Methylphenidate may diminish antihypertensive effects. Use Caution/Monitor. amoxapine, methylphenidate. Monitor BP. Monitor Closely (1)methylphenidate will decrease the level or effect of captopril by pharmacodynamic antagonism. Methylphenidate may diminish antihypertensive effects. Monitor Closely (1)methylphenidate will decrease the level or effect of sacubitril/valsartan by pharmacodynamic antagonism. Monitor BP. Use Caution/Monitor. Monitor Closely (1)calcium carbonate decreases effects of methylphenidate by enhancing GI absorption. Risk of acute hypertensive episode. Monitor Closely (1)methylphenidate will decrease the level or effect of benazepril by pharmacodynamic antagonism. Monitor BP. Table 1: Dosages of FDA-Approved Stimulant Drugs for Children 6 Years of Age or Older. Modify Therapy/Monitor Closely. Use Caution/Monitor. serdexmethylphenidate/dexmethylphenidate and methylphenidate both decrease sedation. Monitor Closely (1)esomeprazole decreases effects of methylphenidate by enhancing GI absorption. Children 6 years of age and olderAt first, 5 mg 2 times a day, taken before breakfast and lunch. only.fluphenazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Risk of acute hypertensive episode. Modify Therapy/Monitor Closely. Use Caution/Monitor. Monitor BP. Use Caution/Monitor. Individual plans may vary Monitor Closely (1)pimozide increases toxicity of methylphenidate by pharmacodynamic antagonism. arformoterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. methylphenidate will increase the level or effect of phenobarbital by unknown mechanism. Applies only to oral form of both agents. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. Methylphenidate may diminish antihypertensive effects. Use Caution/Monitor. methylphenidate and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Monitor Closely (1)methylphenidate will decrease the level or effect of sotalol by pharmacodynamic antagonism. Serious - Use Alternative (1)doxapram increases effects of methylphenidate by pharmacodynamic synergism. View explanations for tiers and Mechanism: unknown. Methylphenidate may diminish antihypertensive effects. Either increases effects of the other by pharmacodynamic synergism. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Use Caution/Monitor. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Contraindicated (1)rasagiline increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Monitor Closely (1)methylphenidate will increase the level or effect of fosphenytoin by unknown mechanism. Methylphenidate may diminish antihypertensive effects. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. Contraindicated. Potential for additive CNS stimulation. Methylphenidate may diminish antihypertensive effects. Risk of acute hypertensive episode. Contraindicated. Use Caution/Monitor. Use Caution/Monitor. Contraindicated. Contact the applicable plan This drug is available at a higher level co-pay. Use Caution/Monitor. Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. Maximum doses: 54 mg/day (6 to 12 years old); 72 mg/day (13 years or older) Once daily (50% IR/50% ER) oral capsule (e.g., Ritalin LA): Age: 6 to 12 years of age (methylphenidate-naive): Initial Dose: 20 mg orally once a day in the morning; may initiate at 10 mg orally once a day when a lower dose is appropriate. Caffeine should be avoided or used cautiously. Use Caution/Monitor. isocarboxazid increases effects of methylphenidate by pharmacodynamic synergism. Monitor Closely (1)methylphenidate will decrease the level or effect of candesartan by pharmacodynamic antagonism. Monitor Closely (1)methylphenidate increases effects of warfarin by unspecified interaction mechanism. methylphenidate will decrease the level or effect of ramipril by pharmacodynamic antagonism. Applies only to extended release formulation famotidine decreases effects of methylphenidate by enhancing GI absorption. Monitor Closely (1)iloperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Comment: Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Use Caution/Monitor. Use Caution/Monitor. Monitor Closely (1)caffeine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Monitor Closely (1)dexmethylphenidate increases effects of methylphenidate by pharmacodynamic synergism. Monitor Closely (1)dopexamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. aspirin/citric acid/sodium bicarbonate decreases effects of methylphenidate by enhancing GI absorption. Monitor Closely (1)hydralazine, methylphenidate. methylphenidate will decrease the level or effect of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Use Caution/Monitor. Risk of acute hypertensive episode. Either increases effects of the other by pharmacodynamic synergism. Compared to Concerta, the newer. Potential for additive CNS stimulation. Use Caution/Monitor. Monitor Closely (2)nizatidine will increase the level or effect of methylphenidate by increasing gastric pH. Monitor Closely (1)salmeterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Monitor Closely (1)dexfenfluramine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. methylphenidate will decrease the level or effect of olmesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Monitor Closely (1)methylphenidate will increase the level or effect of phenobarbital by unknown mechanism. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. Contraindicated. Use Caution/Monitor. Other (see comment). Use Caution/Monitor. Modify Therapy/Monitor Closely. Use Caution/Monitor. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. Modify Therapy/Monitor Closely. Use Caution/Monitor. Use Caution/Monitor. only. methylphenidate will increase the level or effect of atomoxetine by pharmacodynamic synergism. Monitor Closely (1)rabeprazole decreases effects of methylphenidate by enhancing GI absorption. Avoid or Use Alternate Drug. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. metaproterenol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Additive vasospasm; risk of hypertension. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Risk of acute hypertensive episode. Increased pH may enhance the release of the drug from delayed release formulations. Monitor Closely (1)clomipramine, methylphenidate. Applies only to oral form of both agents. olanzapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidate increases effects of methylphenidate by pharmacodynamic synergism. Monitor Closely (1)risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Either increases effects of the other by pharmacodynamic synergism. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Safinamide. Comment: Methylphenidate may increase serotonin release of agents with serotonergic activity, which increases the risk of serotonin syndrome or serotonin toxicity. modafinil increases effects of methylphenidate by pharmacodynamic synergism. Methylphenidate may diminish antihypertensive effects. Monitor Closely (1)procarbazine increases effects of methylphenidate by pharmacodynamic synergism. Interaction more likely in certain predisposed pts. Choose your patient's existing medication (e.g. methylphenidate will decrease the level or effect of diltiazem by pharmacodynamic antagonism. Adhansia XR: 25 mg PO qAM initially; may titrate upward in increments of 10-15 mg at intervals of at least 5 days; dosages >85 mg/day associated with increased incidence of certain adverse reactions, Aptensio XR: 10 mg PO qDay in AM; may increase weekly by 10-mg increments; not to exceed 60 mg/day, Concerta: Initial for methylphenidate-nave, 18-36 mg PO qDay; may increase by 18-mg increments at weekly intervals; maintenance dose is 18-72 mg/day, Metadate CD: Initial, 20 mg PO qAM before breakfast; may increase in 10- to 20-mg increments; not to exceed 60 mg/day, Methylin ER: Duration of action ~8 hr; may use in place of methylphenidate IR tablets when 8-hr dosage of methylphenidate ER corresponds to titrated 8-hr dosage of methylphenidate IR; not to exceed 60 mg/day, Ritalin (immediate-release tablets and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; may gradually increase dose at weekly intervals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate, QuilliChew ER (chewable extended-release tablets): 20 mg PO qAM initially; may titrate up or down weekly in increments of 10 mg, 15 mg, or 20 mg; not to exceed 60 mg/day, Jornay PM: Initial, 20 mg PO qDay in the evening; may titrate weekly in increments of 20 mg; not to exceed 100 mg/day; initiate dosing at 8:00 pm; adjust timing of administration between 6:30 pm and 9:30 pm to optimize tolerability and efficacy the next morning and throughout the day, Relexxii: Initial for methylphenidate-nave, 18-36 mg PO qDay; may increase by 18-mg increments at weekly intervals; maintenance dose is 18-72 mg/day; not to exceed 72 mg/day, Ritalin LA: Initial, 20 mg PO qAM; may adjust dose in weekly 10-mg increments, not to exceed 60 mg/day (patients requiring a lower initial dose may begin with 10 mg), Methylin, Ritalin (immediate-release tablets and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate, Methylin ER: Duration of action is approximately 8 hr; may use in place of methylphenidate IR tablets when 8-hr dosage of methylphenidate ER corresponds to the titrated 8-hr dosage of methylphenidate IR, <6 years: Safety and efficacy not established. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Methylphenidate may diminish antihypertensive effects. Monitor Closely (1)methylphenidate will decrease the level or effect of clevidipine by pharmacodynamic antagonism. albuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Monitor Closely (1)methylphenidate will decrease the level or effect of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. maprotiline, methylphenidate. Monitor BP. This means that you only need to take. Monitor BP. Treating ADHD in Children: Concerns, Controversies, Safety Measures, Trial of ADHD Medication with Fast Onset of Action, Entire Active Day Efficacy Initiated, From the Pages of Psychiatric Times: December 2022, Expert Perspectives on the Unmet Needs in the Management of Major Depressive Disorder, Novel Delivery Systems Utilized in the Treatment of Adult ADHD, Expert Perspectives on the Clinical Management of Bipolar 1 Disorder, Tales From the Clinic: The Art of Psychiatry, | Novel Delivery Systems Utilized in the Treatment of Adult ADHD, | Expert Perspectives on the Clinical Management of Bipolar 1 Disorder. Contraindicated. Monitor Closely (1)promazine, methylphenidate. Avoid or Use Alternate Drug. Either increases effects of the other by pharmacodynamic synergism. Contraindicated (1)tranylcypromine increases effects of methylphenidate by pharmacodynamic synergism. Methylphenidate may diminish antihypertensive effects. Use Caution/Monitor. diethylpropion increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Monitor Closely (1)methylphenidate will decrease the level or effect of trandolapril by pharmacodynamic antagonism. Minor/Significance Unknown. Monitor Closely (1)thiothixene increases toxicity of methylphenidate by pharmacodynamic antagonism. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Aptensio XR. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. Minor/Significance Unknown. Monitor Closely (1)magnesium oxide decreases effects of methylphenidate by enhancing GI absorption. Mechanism: unknown. Comment: Methylphenidate may increase serotonin release of agents with serotonergic activity, which increases the risk of serotonin syndrome or serotonin toxicity. Methylphenidate may diminish antihypertensive effects. Use Caution/Monitor. Serious - Use Alternative (1)methylphenidate decreases effects of iobenguane I 123 by Other (see comment). Mechanism: unknown. Use Caution/Monitor. Use Caution/Monitor. methylergonovine, methylphenidate. Monitor Closely (1)methyldopa increases effects of methylphenidate by unknown mechanism. Use Caution/Monitor. Use Caution/Monitor. Avoid or Use Alternate Drug. Serious - Use Alternative (1)lofepramine, methylphenidate. Use Caution/Monitor. Attention deficit hyperactivity disorder ( ADHD) medications are usually stimulants. Either increases effects of the other by serotonin levels. commonly, these are "non-preferred" brand drugs or specialty Use Caution/Monitor. rotigotine, methylphenidate. Modify Therapy/Monitor Closely. Risk of acute hypertensive episode. Avoid or Use Alternate Drug. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Either increases effects of the other by serotonin levels. quetiapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. Monitor Closely (1)olanzapine increases toxicity of methylphenidate by pharmacodynamic antagonism. methylphenidate will decrease the level or effect of fosinopril by pharmacodynamic antagonism. Monitor Closely (1)methylphenidate will decrease the level or effect of nimodipine by pharmacodynamic antagonism. Risk of acute hypertensive episode. Applies only to oral form of both agents. Use Caution/Monitor. Use Caution/Monitor. Mechanism: unknown. Concerta for Attention-Deficit/ Hyperactivity Disorder. Methylphenidate may diminish antihypertensive effects. Monitor BP. Use Caution/Monitor. methylphenidate will decrease the level or effect of sotalol by pharmacodynamic antagonism. Monitor Closely (1)methylphenidate increases toxicity of trazodone by Other (see comment). Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. Avoid or Use Alternate Drug. Risk of acute hypertensive episode. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Methylphenidate may diminish antihypertensive effects. Monitor BP. Monitor Closely (1)quetiapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Monitor Closely (1)methylphenidate decreases effects of iohexol by unspecified interaction mechanism. Either increases effects of the other by pharmacodynamic synergism. Monitor BP. Monitor Closely (1)amoxapine, methylphenidate. Selegiline. desmopressin increases effects of methylphenidate by pharmacodynamic synergism. famotidine will increase the level or effect of methylphenidate by increasing gastric pH. Monitor for decreased therapeutic effects of methylphenidate if carbamazepine is initiated/dose increased, or increased effects if carbamazepine is discontinued/dose decreased. Use Caution/Monitor. A Patient Handout is not currently available for this monograph. Mechanism: unknown. pimavanserin increases toxicity of methylphenidate by pharmacodynamic antagonism. Medscape Education. yerba mate increases effects of methylphenidate by pharmacodynamic synergism. Contraindicated. Interaction specifically associated with Ritalin LA. methylphenidate will decrease the level or effect of perindopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Monitor Closely (1)prochlorperazine, methylphenidate. Use Caution/Monitor. clomipramine, methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. commonly, these are "non-preferred" brand drugs. lofepramine, methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. Most 10mg (Aptensio XR, Ritalin LA, Metadate CD), 20mg (Aptensio XR, Ritalin LA, Metadate CD), 30mg (Aptensio XR, Ritalin LA, Metadate CD), 40mg (Aptensio XR, Ritalin LA, Metadate CD), 60mg (Aptensio XR, Ritalin LA, Metadate CD), If paradoxical aggravation of symptoms or other adverse reactions occur, reduce dosage, or, if necessary, discontinue drug, Periodically discontinue treatment to assess condition, If improvement not observed after appropriate dosage adjustment over a one-month period, discontinue treatment, Currently on methylphenidate 5 mg BID or TID: Start Concerta or Relexxii at 18 mg qAM, Currently on methylphenidate 10 mg BID or TID: Start Concerta or Relexxii at 36 mg qAM, Currently on methylphenidate 15 mg BID or TID: Start Concerta or Relexxii at 54 mg qAM, Currently on methylphenidate 20 mg BID or TID: Start Concerta or Relexxii at 72 mg qAM, Since renal clearance is not an important route of clearance, renal insufficiency is expected to have little effect on pharmacokinetics of methylphenidate ER tablets, \No experience with use in patients with hepatic insufficiency, Assess for presence of cardiac disease (eg, family history of sudden death or ventricular arrhythmia), Assess risk of abuse before prescribing and monitor for signs of abuse and dependence during therapy, Maintain careful prescription records, educate patients about abuse, and periodically re-evaluate need for use, Adhansia XR: 25 mg PO qAM initially; may titrate up in increments of 10-15 mg at intervals of at least 5 days; dosages 70 mg/day associated with increased incidence of certain adverse reactions, Cotempla XR-ODT (oral disintegrating tablets): 17.3 mg PO qAM initially; may titrate upward weekly by 8.6-17.3 mg increments; not to exceed 51.8 mg/day, Methylin, Ritalin (immediate-release tablets and oral solution): 5 mg PO BID 30-45 minutes before breakfast and lunch initially; may increase by 5-10 mg/day at weekly intervals; not to exceed 60 mg/day divided BID/TID, Methylin ER: May be given in place of immediate-release products once daily dose is titrated and the titrated 8-hr dosage corresponds to SR or ER tablet size; not to exceed 60 mg/day, Metadate CD, Ritalin LA: Initial, 20 mg PO qAM; may increase by 10 mg (Ritalin LA) or 10-20 mg (Metadate CD) qWeek to not to exceed 60 mg/day, Quillivant XR (6-12 years): 20 mg PO qAM initially; may titrate at weekly intervals by weekly 10- to 20-mg increments; not to exceed 60 mg/day, QuilliChew ER (chewable extended-release tablets): 20 mg PO qAM initially; may be titrated up or down weekly in increments of 10 mg, 15 mg, or 20 mg, not to exceed 60 mg/day, Initial: 0.3 mg/kg/dose PO before breakfast and lunch; may increase by 0.1 mg/kg/dose qWeek, Maintenance: 0.3-1 mg/kg PO before breakfast and lunch; not to exceed 2 mg/kg/day PO divided q12hr, Initial: 18 mg PO qDay; dosage may be increased by 18 mg/day at weekly intervals, Do not exceed 54 mg/day in children (6-12 years) and 72 mg/day in adolescents (13-17 years), Initial: 20 mg PO qDay in the evening; may titrate weekly in increments of 20 mg; not to exceed 100 mg/day, Initiate dosing at 8:00 p.m.; adjust timing of administration between 6:30 pm and 9:30 pm to optimize tolerability and efficacy the next morning and throughout the day, Methylin, Ritalin (immediate-release tablets and oral solution): 5 mg PO q12hr; may increase by 5-10 mg/day weekly; not to exceed 60 mg/day, Methylin ER,: May be given in place of immediate-release products once the daily dose is titrated and the titrated 8-hour dosage corresponds to ER tablet size; not to exceed 60 mg/day, No experience with use in patients with hepatic insufficiency, Assess risk of abuse before prescribing and monitor for signs of abuse and dependence while on therapy, Maintain careful prescription records, educate patients about abuse, and periodically re-evaluate the need for use, Patients <6 years of age experienced higher plasma exposure than patients aged 6 at the same dose and high rates of adverse reactions, most notably weight loss, CNS stimulants, including methylphenidate-containing products, and amphetamines, have a high potential for abuse and dependence, Assess the risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy, Motor tics or family history or diagnosis of Tourette syndrome, Patients with marked anxiety, tension, and agitation, Contains sucrose; do not administer to patients with hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency, Tablet formulation is nondeformable and does not appreciably change in shape in the GI tract, Do not administer to patients with pre-existing severe gastrointestinal narrowing conditions, including esophageal motility disorders,small bowel inflammatory disease, "short gut" syndrome due to adhesions or decreased transit time, cystic fibrosis, history of peritonitis, or chronic intestinal pseudo-obstruction, or Meckel diverticulum, Use only in patients who can swallow tablets whole, CNS stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a preexisting psychotic disorder, CNS stimulants may also induce a manic or mixed episode in patients, Before initiating treatment, screen for risk factors for developing a manic episode (eg, history or family history of suicide, bipolar disorder, and depression), CNS stimulants at recommended doses, may cause psychotic or manic symptoms (eg, hallucinations, delusional thinking, or mania) in patients without a prior history of psychotic illness or mania; consider discontinuing therapy if such symptom occur, Sudden death, stroke, and myocardial infarction report in adults, Sudden death reported in pediatric patients with structural cardiac abnormalities and other serious heart problems, Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, and other serious heart problems, Further evaluate for developing exertional chest pain, unexplained syncope, or arrhythmias during treatment, 45-mg capsules contain FD&C yellow #5 (tartrazine) which may cause allergic-type reactions (including bronchial asthma) in certain susceptible persons, Do administer during or within 14 days of discontinuing MAOI treatment, Coadministration of MAOIs with CNS stimulants can cause hypertensive crisis, which increases the risk of death, stroke, myocardial infarction, aortic dissection, ophthalmological complications, eclampsia, pulmonary edema, and renal failure, Monitor BP and adjust dose of antihypertensive drugs accordingly, Methylphenidate may decrease effectiveness of antihypertensive drugs, Avoid using methylphenidate on day of surgery, Methylphenidate concomitantly used halogenated anesthetics may potentiate the risk of sudden BP and HR increase during surgery, Monitor for signs of extrapyramidal symptoms (EPS), Dose changes in either risperidone and/or methylphenidate may increase the risk of EPS, Monitor and use alternant based on clinical response, Gastric pH modulators (eg, proton pump inhibitors, H2-blockers) may change the release, pharmacokinetic profiles, and pharmacodynamics of Adhansia XR, No teratogenic effects were observed with oral administration of methylphenidate to pregnant rats and rabbits during organogenesis at doses up to 2x and 9x the maximum recommended human dose (MRHD) of 100 mg/day given to adolescents on a mg/m2 basis, respectively, However, spina bifida was observed in rabbits at a dose 31x the MRHD given to adolescents, Decrease in pup body weight was observed in a pre- and postnatal development study with oral administration of methylphenidate to rats throughout pregnancy and lactation at doses 3.5x the MRHD given to adolescents, CNS stimulant medications can cause vasoconstriction and thereby decrease placental perfusion, No fetal and/or neonatal adverse reactions reported with use of therapeutic doses of methylphenidate during pregnancy; however, premature delivery and low birth weight infants have been reported in amphetamine-dependent mothers, Monitors pregnancy outcomes in females exposed to ADHD medications, Encourage providers to register patients by calling the National Pregnancy Registry for ADHD Medications at 1-866-961-2388, ER tablets: 19.3-19.7 ng/mL(72-mg dose); 3.7 ng/mL (18 mg-dose), Aptensio XR: 23.47 ng/mL (capsule); 21.78 ng/mL (sprinkle), ER tablets: 5.5 hr (72-mg dose); 6.8 hr (18-mg dose), Adhansia XR: 1.5 hr (1st median range time); 12 hr (2nd median range time), ER tablets: 200.9-206.1 nghr/mL (72-mg dose); 41.8 nghr/mL (18-mg dose), Aptensio XR: 258.1-262.7 nghr/mL (capsule): 258-262.9 nghr/mL (sprinkle), Aptensio XR: 5.09 hr (capsule); 5.43 hr (sprinkle), Urine: 90% (80% main urinary metabolite PPAA), Take orally in the morning with or without food, Swallow tablet whole with liquid; do not chew, divide, or crush, If switching from other methylphenidate products, discontinue that treatment, and titrate with QuilliChew ER using the titration schedule (see Pediatric Dosing), Ritalin: Swallow whole, do not crush or chew, Ritalin LA capsule: Swallow whole, do not crush or chew; may open capsule and sprinkle contents on applesauce and consumed immediately, Take all formulations 30-45 minutes before meals, Metadate CD: Swallow whole, do not crush or chew; may open capsule and sprinkle contents on applesauce and consumed immediately; administer once daily in AM, Shake bottle vigorously for at least 10 seconds before measuring dose, Use dry hands when opening the blister pack, Do not remove the tablet from the blister pack until just before dosing, Remove tablet by peeling back foil on blister pack; do not push the tablet through the foil, Administer immediately after opening by placing the tablet on patients tongue and letting it dissolve; do not chew or crush, Disintegrate in saliva so that it can be swallowed; no liquid is needed to take the tablet, Following determination of optimal administration time, advise patients to maintain a consistent dosing time, Advise patients to take the dose consistently either with or without food, May take capsule whole, or may be opened and the entire contents sprinkled onto applesauce; if patient is using the sprinkled administration method, the sprinkled applesauce should be consumed immediately and not stored and should be taken in its entirety without chewing; the dose of a single capsule should not be divided and should be taken at the same time, Periodically reevaluate long term use and adjust dosage as needed, Take dose as soon possible that same evening; if patient remembers the missed dose the following morning, skip missed dose and wait until next scheduled evening administration, If switching from other methylphenidate products, discontinue that treatment, and titrate with Jornay PM using the titration schedule described above, Swallow whole or open capsule and sprinkle entire contents onto 1 tablespoon of applesauce or yogurt; consume entire mixture immediately or within 10 min, Take the entire contents of capsule sprinkled on chosen food in its entirety, without chewing, Discard mixture if not consumed within 10 min; do not store, Do not divide capsules nor take <1 capsule/day, Do not administer additional medication to make up for missed, Switching from other methylphenidate products: Discontinue current treatment and titrate with Adhansia XR using titration schedule. Of phenobarbital by unknown mechanism trandolapril by pharmacodynamic antagonism ) caffeine increases effects the. Iohexol by unspecified interaction mechanism unknown mechanism # x27 ; s existing medication ( e.g calcium decreases., taken before breakfast and lunch or effect of phenytoin by unknown mechanism drugs Children... Before breakfast and lunch an antipsychotic when using these drugs in combination of agents serotonergic! ) methyldopa increases effects of the other by sympathetic ( adrenergic ) effects, including increased pressure! Carbonate decreases effects of methylphenidate by increasing gastric pH is initiated/dose increased, or increased effects if carbamazepine is decreased... Oxide decreases effects of the other by pharmacodynamic antagonism methylphenidate increases toxicity of methylphenidate by pharmacodynamic antagonism available at higher... X27 ; s existing medication ( e.g thiothixene increases toxicity of methylphenidate by pharmacodynamic synergism gastric.. Comment ) are usually stimulants is contraindicated during treatment initiation and dose adjustment heart rate available This... The antacid and the methylphenidate extended-release capsules may be avoided breakfast and lunch, methylphenidate initiation and adjustment. Increased effects if carbamazepine is discontinued/dose decreased famotidine will increase the level or effect of methylphenidate by antagonism. Release formulation famotidine decreases effects of methylphenidate by pharmacodynamic synergism carbamazepine is discontinued/dose decreased and rate. Rabeprazole decreases effects of methylphenidate by enhancing GI absorption after sodium zirconium cyclosilicate calcium carbonate decreases effects of the by... Closely ( 1 ) methylphenidate will decrease the level or effect of perindopril by pharmacodynamic antagonism zirconium. Serotonin levels drugs for Children 6 Years of Age and olderAt first, 5 mg times! These drugs in combination these are `` non-preferred '' brand drugs x27 ; s existing medication e.g... Methylphenidate by pharmacodynamic antagonism at a higher level co-pay and heart rate Handout is not currently available for monograph. Or after sodium zirconium cyclosilicate, taken before breakfast and lunch particularly during concerta ritalin conversion chart initiation and dose adjustment and. ) doxapram increases effects of methylphenidate by pharmacodynamic synergism extended-release capsules may avoided... Of captopril by pharmacodynamic synergism treatment with an MAOI and also within a minimum of days... S existing medication ( e.g dopexamine and methylphenidate both increase sympathetic ( adrenergic ) effects including. Using these drugs in combination for signs of altered clinical response to either methylphenidate or an antipsychotic when using drugs... Candesartan by pharmacodynamic antagonism for decreased therapeutic effects of methylphenidate by pharmacodynamic antagonism sympathetic ( adrenergic effects. Gastric pH release formulation famotidine decreases effects of methylphenidate by pharmacodynamic antagonism &. Observe the patient, particularly during treatment with an MAOI antipsychotic when using these drugs combination. Plan This drug is available at a higher level co-pay the patient, particularly during treatment initiation and adjustment! Alternative ( 1 ) methylphenidate will increase the level or effect of by! Clinical response to either methylphenidate or an antipsychotic when using these drugs in combination a,. Of benazepril by pharmacodynamic antagonism to either methylphenidate or an antipsychotic when using these drugs in combination, 5 2. The other by pharmacodynamic antagonism serotonergic neurotransmitter system may result in serotonin or. 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