Methylphenidate for attention deficit hyperactivity disorder (ADHD)
Methylphenidate for attention deficit hyperactivity disorder (ADHD)
This leaflet is about the use of methylphenidate for attention-deficit hyperactivity disorder, which is often known as ADHD. Treatment with medicines is part of a comprehensive treatment programme for ADHD that includes behavioural therapy. The diagnosis of ADHD must have been confirmed by a specialist.
This leaflet has been written specifically about the use of this medicine in children. The information may differ from that provided by the manufacturer. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.
Do not stop giving methylphenidate suddenly without first speaking to your doctor.
Name of drug
Methylphenidate (sometimes known as methylphenidate hydrochloride)
Brand names: Medikinet®, Ritalin®
Modified-release brands: Concerta XL®, Equasym XL®, Matoride XL®, Medikinet XL®
Why is it important for my child to take this medicine?
This medicine will help to reduce the symptoms of hyperactivity and impulsive behaviour. It will also help to increase attention and concentration span. Methylphenidate is used as part of a comprehensive treatment programme for ADHD.
What is methylphenidate available as?
- Tablets: 5 mg, 10 mg, 20 mg; these contain small amounts of lactose. Ritalin® contains gelatin.
- Modified-release tablets: 18 mg , 27 mg , 36 mg, 54 mg; these may contain lactose.
- Modified-release capsules: 5mg, 10 mg, 20 mg, 30 mg, 40 mg; these contain gelatin and a small amount of sugar.
If you have any concerns or questions, speak with your child’s doctor or pharmacist.
When should I give methylphenidate?
Modified-release tablets/capsules (Concerta XL, Equasym XL, Matoride XL, Medikinet XL) are usually given once each day. This is usually in the morning. These gradually release the medicine over the day.
- Equasym XL is best given before breakfast.
- Medikinet XL is best given with or after breakfast.
Medikinet and Ritalin tablets are usually given two or three times each day. This should be in the morning, then around midday and, where necessary, late afternoon. Ideally, these times are about 4 hours apart.
Give the medicine at about the same time(s) each day so that this becomes part of your child’s daily routine, which will help you to remember.
How much should I give?
Your doctor will work out the amount of methylphenidate (the dose) that is right for your child. The dose will be shown on the medicine label.
You will probably give your child a low dose to start with, then increase it gradually. Your doctor will explain what to do.
It is important that you follow your doctor’s instructions about how much to give.
How should I give it?
Tablets should be swallowed with a glass of water, milk or juice. Your child should not chew the tablet.
Medikinet® and Ritalin® tablets can be crushed and mixed with a small amount of soft food such as yogurt, honey or jam. Make sure your child swallows it all straight away, without chewing.
You must not crush any of the XL (modified-release) tablets, as they will not work properly.
Capsules should be swallowed with a glass of water, milk or juice. Your child should not chew the capsule. You can open the capsule and mix the contents with a small amount of soft food such as yogurt, honey or jam. Make sure your child swallows it all straight away, without chewing.
When should the medicine start working?
The medicine will start to work within 30–60 minutes, depending on which type of tablet or capsule your child has.
What if my child is sick (vomits)?
- If your child is sick less than 30 minutes after having a dose of methylphenidate, give them the same dose again.
- If your child is sick more than 30 minutes after having a dose of methylphenidate, you do not need to give them another dose. Wait until the next normal dose.
If your child is sick again, seek advice from your GP, pharmacist or hospital. They will decide what to do based on your child’s condition and the specific medicine involved.
What if I forget to give it?
Do not give the missed dose. Give the next dose as usual.
Never give a double dose of methylphenidate.
What if I give too much?
It may be dangerous to give too much methylphenidate.
If you think you may have given your child too much methylphenidate, contact your doctor or local NHS services (111 England and Scotland; 0845 4647 in Wales) or take your child to hospital.
Take the medicine container or packaging with you, even if it is empty. This will be useful to the doctor. Have the medicine or packaging with you if you telephone for advice.
Are there any possible side-effects?
We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).
Side-effects you must do something about
Your child may become irritable, aggressive, tearful or depressed. These effects are temporary and completely reversible on stopping treatment. You should contact your specialist or doctor as soon as possible. If you are worried, do not give any more doses of methylphenidate until you have talked to your doctor.
If your child can feel their heart beating much faster than normal (they may say it is racing), contact your doctor straight away.
If your child starts being sick every few hours or has stomach pains, take them to your doctor or hospital straight away.
- Your child may have less of an appetite so they may not want to eat much. It may help to give each dose of methylphenidate with or after a meal.
- Your child may lose some weight during the first few months of treatment although they will probably put the weight back on. If you notice your child is losing a lot of weight contact your doctor.
- Your child may feel dizzy or light-headed when they stand up, or may faint. Encourage them to stand up slowly, and to sit or lie down if they feel dizzy or light-headed. If this happens often, contact your doctor who may need to check your child’s blood pressure.
- If your child is prone to tics (sudden muscle twitches of the face or body), methylphenidate may make these worse.
Other side-effects you need to know about
- Your child may get indigestion, stomach ache, feel sick (nausea) or be sick (vomit). Giving the medicine with some food or milk may help.
- Some children may get a dry mouth. Eating citrus fruits (e.g. oranges) and taking sips of water may help. This effect usually settles down quite quickly
- Your child may have a blocked nose more often whilst taking methylphenidate. Usually this does not need treatment and will get better on its own.
- Your child may have problems sleeping. This can be helped by taking the last dose at least 6 hours before bedtime.
- They may get a mild headache or pain in their muscles or joints.
If you are concerned about any of these side-effects contact your doctor.
Can other medicines be given at the same time as methylphenidate?
You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.
Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines.
Is there anything else I need to know about this medicine?
- Methylphenidate may affect the growth of some children. Your doctor will monitor your child’s growth.
- Your doctor will check your child’s blood pressure regularly.
It is important that your child always has the same brand of methylphenidate if they have been prescribed a modified-release tablet or capsule (Concerta XL, Equasym XL, Matoride XL, Medikinet XL) as there may be differences between brands. Keep a record of which medicines your child has.
General advice about medicines
- Try to give medicines at about the same times each day, to help you remember.
- Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
- If you are not sure a medicine is working, contact your doctor but continue to give the medicine as usual in the meantime. Do not give extra doses as you may do harm.
If you think someone else may have taken the medicine by accident, contact your doctor straight away.
- Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
- Make sure that the medicine you have at home has not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.
Where I should keep this medicine?
- Keep the medicine in a cupboard, away from heat and direct sunlight.
- Make sure that children cannot see or reach the medicine.
- Keep the medicine in the container it came in.
Who to contact for more information
Your child’s doctor, pharmacist or specialist will be able to give you more information about methylphenidate and about other medicines used to treat ADHD.
Version 2, January 2015. © NPPG, RCPCH and WellChild 2011, all rights reserved. Reviewed by: January 2018.
The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk
We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.