Section 10 · Monograph
Methylphenidate
Reviewed Nov 2026FDA label
Ritalin / ConcertaCNS stimulant
- Forms
- Tab: 5, 10, 20mg | ER tab: 18-72mg
- Dose
- Narcolepsy: 10mg BID-TID (typical 20-60mg/day)
- MOA
- Blocks dopamine/norepinephrine reuptake
Black Box Warning
- Abuse, misuse and addiction: high potential for abuse and misuse that can lead to overdose and death; assess risk before prescribing and monitor throughout treatment
Indications
- Attention-deficit/hyperactivity disorderFDA-labeled
- NarcolepsyFDA-labeled
Mechanism of Action
- CNS stimulant that blocks reuptake of dopamine and norepinephrine, increasing wakefulness and attention
Full Dosing
Adult / usual
- Narcolepsy: 10mg two to three times daily, 30-45 minutes before meals; usual total 20-60mg/day
- Give the last dose early afternoon to avoid insomnia; extended-release forms (e.g., Concerta) are labeled for ADHD
Contraindications
- Concurrent MAOI use or use within 14 days
- Known hypersensitivity
Drug Interactions
- MAOIs: hypertensive crisis
- May reduce the effect of antihypertensives
- May inhibit metabolism of warfarin, phenytoin and phenobarbital
Adverse Effects
- Insomnia, decreased appetite, anxiety, tachycardia, hypertension
- Psychosis, mania, aggression
- Priapism and peripheral vasculopathy
- Growth suppression in children
- Abuse and dependence
Monitoring Parameters
- Blood pressure, heart rate and weight
- Psychiatric symptoms and signs of misuse
- Efficacy; periodic reassessment of need
Pregnancy & Lactation
- Limited human data; use only if benefit justifies risk
- Present in milk; monitor infants