Methylphenidate

About methylphenidate

Please note

This page will give you general information about methylphenidate. It is not medical advice.

Always talk to your doctor about your situation and whether this medication is for you.
Methylphenidate is a 'controlled drug'

This means that the pharmacy must store the tablets extra securely by locking them in a cupboard. The doctor must also write extra things on the prescription, like the total amount needed in words and figures to make it harder for a genuine prescription to be altered.

A prescription for methylphenidate must be dispensed by the pharmacy within 28 days of the prescription being written (you can keep most other prescriptions for six months).

You cannot get an emergency supply of methylphenidate without a prescription.

This is all because methylphenidate can make people without ADHD feel high, and it might be sold as a street drug.

If you must take it to school, it might have to be locked in a safe place.

Thinking about trying medication? Read our guide

How methylphenidate works

Methylphenidate is a central nervous stimulant, sometimes called a CNS stimulant, which makes more noradrenaline and dopamine available in your brain.

It might seem odd that you would use a stimulant as a treatment for hyperactivity, but in people with ADHD, stimulant medicines do not make them more active (as they do in other people). Instead these medicines make them better able to focus.

Methylphenidate stimulates centres in the brain that are underactive in people with ADHD, such as the bits of the brain involved with concentration.

Methylphenidate helps people with ADHD to increase their attention span and concentration. It also helps them to stop acting on impulse without thinking.

Methylphenidate works by blocking noradrenaline and dopamine (two chemicals in the brain that carry messages between nerve cells) from being taken back up into the nerve cells in the brain after being released. This results in higher levels of noradrenaline and dopamine between the nerve cells and allows these chemicals to hang around for longer.

Having higher levels of noradrenaline and dopamine in the brain affects different parts of the body, including the heart, the gut, and the lungs. Overall, this leads to the good effects of the medicine, but it can also produce unwanted side effects. It is hard to control how much of each effect someone will experience, as every person is different.

In people with narcolepsy, the action of methylphenidate (as explained above) helps them to stay awake and alert.

ADHD and mental health

Methylphenidate and everyday life

Frequently asked questions

It can take a few weeks for methylphenidate to show its full effect.

You should see improvements in your concentration and other symptoms within one month of starting the medicine.

Your doctor might start you on a low dose and then increase it slowly over two to four weeks to your full dose.

Methylphenidate can sometimes affect your growth.

Your doctor will check your height and weight at least every six months when you are on methylphenidate.

Up to one in ten children and young people who take methylphenidate might not grow as fast as their friends.

If this happens to you, your doctor might stop the methylphenidate for a while.

Methylphenidate can also affect your weight.

Methylphenidate makes some people want to eat less, and this might result in weight loss. It is very difficult to know how this will affect each person who takes it.

Talk to your doctor about this if it worries you.

You may want to let your family and friends know you are taking methylphenidate so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Methylphenidate is a stimulant and can therefore affect your sleep by keeping you awake.

You should take your tablets early in the day, and no later than lunchtime, to get the best chance of sleeping normally.

For some people, it can make you feel more drowsy than normal.

Talk to your doctor about this if it worries you.

Alcohol

If you drink alcohol when you are taking methylphenidate, it can make the effect of the methylphenidate greater and you could experience side effects as if you have taken too much of it.

If you decide to drink alcohol, see how it affects you and make sure you are with friends to help you if you need it.

Street drugs

Methylphenidate is dangerous to take with cocaine, ecstasy or amfetamines. This is because they are all stimulants and may together put too much pressure on your heart and the blood vessels in your brain.

We have found no information about mixing methylphenidate with cannabis, methadone, heroin or other street drugs or legal highs.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis. For more information, have a look at our drugs and alcohol page.

Methylphenidate is a stimulant, so some people want to use it as a drug to get high.

There are also a growing number of people who are using methylphenidate as a ‘performance-enhancer’ to help them work harder or revise for exams.

People taking methylphenidate from their doctor can be targeted at school and bullied to give away or sell their medicine.

If someone is asking you to give away or sell your medicine, please ask your parent, teacher or doctor to help you.

Remember that methylphenidate has serious side effects. Do not give or sell your tablets to anyone else – they may become very ill.

Methylphenidate can produce a false positive test for amfetamines and LSD on a urine drug screen.

Talk to your doctor about this if it is a problem for you.

Methylphenidate can interact with some other medicines and drugs.

Do not take methylphenidate if you are taking a medicine called a monoamine oxidase inhibitor (MAOI) used for depression, or if you have taken a MAOI in the last 14 days. MAOIs include isocarboxazid, phenelzine, tranylcypromine and moclobemide. Taking a MAOI with methylphenidate may cause a sudden dangerous increase in your blood pressure.

If you are taking other medicines, check with your doctor or pharmacist before taking methylphenidate, as it may affect how well they work or cause side effects.

Tell the doctor if you are going to have an operation; you may need to stop methylphenidate for that day as it does not mix well with some anaesthetics used in surgery.

You also need to tell the team doing your operation if you are taking methylphenidate well in advance of it taking place.

Different brands of methylphenidate contain lactose, wheat starch and gelatin – check your type if any of these are a problem for you.

Ritalin®, Delmosart®, Matoride XL®,Xaggitin XL® and Concerta XL® tablets may not be suitable for you if you have problems eating some sugars or dairy (milk-based) foods, as they contain lactose. Xenidate XL contains sucrose. An unbranded plain tablet that contains neither lactose nor sucrose is available. Ask your pharmacist.

Ritalin® tablets contain wheat starch. This is still OK to take if you have coeliac disease, but not if you have wheat intolerance leading to chronic diarrhoea (fatty loose poo).

Ritalin® tablets, Equasym XL® capsules and Medikinet XL® capsules contain gelatin.

Taking methylphenidate may give you blurred vision, make you feel dizzy, or affect your focus when you start taking it.

It may be best to stop doing things like driving a car, riding a bike, or anything else that needs a lot of focus for the first few days, until you know how it affects you.

Don't worry - most people drive as normal while taking methylphenidate.

There is a new ‘drug driving’ offence that come into force in March 2015, which means someone driving dangerously who has taken methylphenidate could be arrested.

If you take methylphenidate as prescribed by the doctor and you are sure that it doesn’t affect your driving, then you will be allowed to drive. It may be worth having some evidence that you are taking methylphenidate (like a doctor’s letter) when driving.

It is important to stick to the dose on the prescription, and to check that you can drive safely while taking it. If you think you driving might be affected, don’t drive and speak to your doctor.

Pregnancy

Do not take methylphenidate if you are trying to get pregnant and use a good method of contraception while taking the drug.

Methylphenidate may double the risk of miscarriage.

If you and your partner are trying to have a baby, you should go back to the doctor to discuss your options.

There is a small increase in risk of heart problems when methylphenidate is taken during the first three months of pregnancy. One in 53 babies whose mums took methylphenidate experienced heart problems compared to one in 79 whose mums didn’t take methylphenidate.

If you do become pregnant while you are on methylphenidate, you should carry on taking the medicine and go back to your doctor as soon as possible to discuss whether you should change or stop your medicine.

If you agree with your doctor to carry on taking methylphenidate, you should tell your midwife that you are taking it.

Breastfeeding

Methylphenidate can be passed to the baby in breastmilk.

Talk to your doctor or midwife about your feeding options.

Limited evidence suggests it is safe to breastfeed if you have a healthy full-term baby.

Sex

Methylphenidate can have side effects that may affect your sex life. These include:

having a lower sex drive or finding it harder to get aroused
losing weight
other side effects like mild hair loss that can affect your body confidence

These effects should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to the doctor and see what other treatment you could try.

Fertility

There is nothing to suggest that methylphenidate has any effect on fertility.

Women who are trying to get pregnant, however, should talk about it with their doctor.

Methylphenidate is a stimulant, and this makes it a banned substance in sport.

If you play sport to a high level, and want to compete where testing will happen, you will need to go back to your doctor to discuss other ways of managing your ADHD.

Taking methylphenidate may give you blurred vision, make you feel dizzy, or affect your focus when you start taking it.

It may be best to stop doing things like driving a car, riding a bike, or anything else that needs a lot of focus for the first few days, until you know how it affects you.

Don't worry - most people drive as normal while taking methylphenidate.

There is a new ‘drug driving’ offence that come into force in March 2015, which means someone driving dangerously who has taken methylphenidate could be arrested.

It is important to stick to the dose on the prescription, and to check that you can drive safely while taking it. If you think you driving might be affected, don’t drive and speak to your doctor.

Your doctor should know

You need to talk to your doctor or pharmacist before starting treatment with methylphenidate if you have or have had any of the following conditions:
- heart or blood circulation problems
- tics (movements you cannot control), or if someone in your family has Tourette’s syndrome
- dependence on drugs or alcohol in the past
- other mental health conditions, like depression, personality disorders, mania or anorexia nervosa
- thoughts of taking your own life
- an overactive thyroid
- increased pressure in the eye (glaucoma)
- a tumour in the adrenal gland (phaeochromocytoma)
- an allergy to methylphenidate or the other ingredients of the medicine

Uses, warnings, safety and side effects of methylphenidate

Taking methylphenidate

How long will I need to take methylphenidate for?

Many people take methylphenidate for a year, and then check to see if they still need it. You and your doctor should talk about how long you need to take methylphenidate.

After a year, the doctor may stop the medicine (this is known as a drug ‘holiday’) to see if you still need it. They will probably do this during a holiday if you are at school.

Some people find that they need to take methylphenidate for several years.

Medication is just one part of treatment for ADHD. Methylphenidate is prescribed as part of a wider treatment plan including educational, social and psychological counselling.

You should only take methylphenidate as agreed with your doctor

You will get the best effect from your methylphenidate if you do not miss any doses.

Try to get into a routine to help you remember to take your medicine, such as taking it with meals or when you brush your teeth.

Make sure that you know your dose. If it is not written on the label, check with your pharmacist or doctor.

Taking methylphenidate with food can help you to avoid side effects of feeling sick, being sick, or having stomach pains (but see below if you take the Equasym XL® brand of methylphenidate).

Avoid taking your methylphenidate doses after 4pm. If you take methylphenidate after 4pm, it could make it harder for you to get to sleep.

The ‘plain’ methylphenidate tablets need to be taken two or three times a day. Plain methylphenidate tablets can be taken with or without food, but taking them with meals might help you to remember to take them.

The plain methylphenidate tablets can be broken in half or crushed and mixed with a small amount of soft food such as yogurt, honey or jam to make them easier to swallow.

There are several brands of ‘slow-release’ methylphenidate tablets or capsules (they may also be referred to as ‘modified-release’ or ‘XL’). These release some of the methylphenidate straight away but release the rest slowly throughout the day. For this reason, they can be taken less often.

The Equasym XL® brand of methylphenidate needs to be taken in the morning before breakfast. Some people who take this brand may find that it wears off in the late afternoon or early evening, in which case the doctor may prescribe a dose of the plain methylphenidate tablet for you to take at this time.

The Medikinet XL® brand of methylphenidate should be taken in the morning, with or after breakfast.

The Concerta XL®, Xenidate XL®, and Matoride XL® brands of methylphenidate should be taken in the morning, but this can be before, with, or after breakfast.

It is important not to break or chew the slow-release methylphenidate tablets or capsules. This is because they have a special system in them to deliver the medicine into your body over a few hours, which could be damaged if you chew or break them.

However, you can empty out the contents of Equasym XL®, Ritalin XL® and Medikinet XL® capsules on to a tablespoon of apple sauce and swallow it without chewing. Ritalin XL® and Medikinet XL® can also be added to yogurt.

What should I do if I miss a dose of methylphenidate?

If you remember later during the morning, take it as soon as possible.

If you forget to take it by lunchtime, just start again on the next day.

Do not take a double dose.

There are tablets and capsules that you can take once a day. If this would help you to remember, ask your doctor about them.

What will happen if I forget to take my methylphenidate?

If you forget to take methylphenidate for a few days, your symptoms may come back.

Stopping the use of methylphenidate

Once you start taking methylphenidate, the brain adjusts to having a new level of noradrenaline and dopamine around. If you stop taking methylphenidate all at once, the balance of these chemicals starts to change again. You could get some unwanted symptoms from the change.

Your ADHD symptoms could also return, or the sudden drop in noradrenaline and dopamine in your brain could bring on symptoms of depression.

You can stop taking it safely with your doctor’s help.

Go and speak to your doctor if you have missed a few doses or have decided to stop taking your medication.

Warnings and safety

Safety headlines

If you have taken more methylphenidate than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

Methylphenidate can sometimes cause serious side effects: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), and other symptoms that can be found here. Go to a hospital with your medicine if you get any of these symptoms.

Do not take methylphenidate if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Stopping methylphenidate suddenly can cause serious side effects. If you are thinking of stopping or want to stop, talk to your doctor first.

You might feel sleepy in the first few days after taking methylphenidate. Do not drive a car, ride a bike or operate machines until you see how this affects you.

Use good contraception while you are taking methylphenidate. If you take methylphenidate while you are pregnant, it may affect the developing baby. Talk to your doctor or midwife about this and get their help.

When to go to the hospital

If you have taken more methylphenidate than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Go to A&E. Take your medicine with you to show to the doctors. Tell them how much you have taken. Get a friend or family member to go with you, if you can, just in case you feel ill on the way.

You might get any of the following signs:

being sick
feeling very happy, agitated or confused
shaking or muscle movements that you cannot control
having a seizure (fit), which can lead to a coma
hallucinations (seeing, feeling or hearing things that are not real)
sweating, flushing or high fever
headache
changes in your heartbeat (slow, fast or uneven)
high blood pressure
your pupils dilating (getting bigger)
dry nose and mouth

Monitoring

Before you start taking methylphenidate, and at least every six months after you start, the doctor will do some tests to check that methylphenidate is (still) right for you.

They will check your appetite, as methylphenidate can make you want to eat less.

They will check your weight and height, as methylphenidate can make you grow more slowly.

They will check your heart rate and blood pressure, as this is a stimulant that can have side effects on the heart and blood vessels.

They will ask you about your mood and how you are feeling, to check that the medicine is working but also whether you are having any side effects.

Side effects of methylphenidate

Please do not be worried by the side effects listed on this page. Many people take methylphenidate without any side effects or with only a few mild side effects. If you think you might be getting a side effect from methylphenidate, then you should discuss this with your doctor, nurse, or pharmacist.

Some side effects that appear should get better after a few days. If they do not, you should go back to your doctor.

If you get any side effects not listed here please look at the patient leaflet in the medicine pack or speak to your pharmacist or doctor.

Very common side effects of taking methylphenidate (affecting more than one in ten people) include:

headache – try paracetamol or talk to your pharmacist about options to help
feeling nervous
not being able to sleep

Common side effects of methylphenidate (affecting up to one in ten people) include:

dry mouth
feeling unusually sleepy or drowsy
loss of appetite or decreased appetite
itching, rash or raised red itchy rashes (hives)
hair loss
high blood pressure, fast heartbeat (tachycardia)
feeling dizzy, experiencing movements which you cannot control, being unusually active
feeling aggressive, agitated, anxious, depressed, irritable and generally behaving unusually
stomach pain, diarrhoea, or feeling sick or being sick. These usually occur at the beginning of treatment and may be reduced by taking the medicine with food
irritation of the nose and throat areas
joint pains

There are other side effects that you can get when taking this medicine – we have only included the most common ones here.

Please look at the leaflet inside your medicine box, or ask a doctor or pharmacist, if you want to know whether you are getting a side effect from your medicine.

If you want to stop taking methylphenidate, speak to your doctor to talk through the options available to you.

If you do get a side effect, please think about reporting it via the Yellow Card Scheme.