Class: CNS Stimulant. C-II
Dosage Forms. Tablet: 5 mg, 10 mg, 20 mg; Tablet, Chewable: 2.5 mg, 5 mg, 10 mg; Tablet, Extended Release: 10 mg, 20 mg; Capsule, Extended Release: 10 mg, 18 mg, 20 mg, 27 mg, 30 mg, 36 mg, 40 mg, 50 mg, 54 mg, 60 mg; Solution: 5 mg/5 mL, 10 mg/5 mL; Suspension: 25 mg/5 mL
Common FDA Label Indication, Dosing, and Titration.
1. Attention-deficit hyperactivity disorder: Immediate-release tablets, solution, and chewable tablets: Adults, 10-60 mg/d po divided 2-3 times daily, preferably 30-45 min before meals; Children (age 6 y and older) initial, 5 mg po bid; dose adjustments of 5-10 mg at weekly intervals; doses above 60 mg/d not recommended
2. Attention deficit hyperactivity disorder: Extended release, no prior methylphenidate therapy; Adults and Children older than 6 y, 20 mg po daily; may adjust dosage at weekly intervals in 10-mg increments; max 60 mg/d
3. Narcolepsy: Immediate-release tablets, solution, and chewable tablets: Adults and Children older than 6 y, 10-60 mg/d po divided 2-3 times daily
4. Narcolepsy: Sustained-release: Adults and Children >6 y, 20-60 mg/d po divided q8h
1. Fatigue: 5-30 mg po daily
MOA. Amphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. Amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.
Drug Characteristics: Methylphenidate
Medication Safety Issues: Methylphenidate
Drug Interactions: Methylphenidate
Adverse Reactions: Methylphenidate
Efficacy Monitoring Parameters. Resolution of signs of ADHD, patients should have improved attention span and reduced impulsivity.
Toxicity Monitoring Parameters. Blood pressure, heart rate, and weight. Complete blood count. Seek medical attention if chest pain, seizures, heart palpitations, change in behavior or personality, or hostility. Growth in children.
Key Patient Counseling Points. Avoid late evening doses due to resulting insomnia. Swallow the extended-release capsule whole. Do not crush, break, or chew it. If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as pudding, yogurt, or applesauce. Stir this mixture well and swallow it without chewing. Avoid abrupt discontinuation.
Clinical Pearls. Amphetamines have a high potential for abuse, and administration for prolonged periods of time may lead to drug dependence and must be avoided. Misuse of amphetamines may cause sudden death and serious cardiovascular adverse events. Treatment may include drug holidays to assess ongoing need of medication, decrease tolerance, and limit growth suppression. Avoid confusion of multiple different brand names and formulations. Medication guide required at dispensing.