The Metadate CD product contains sucrose. The manufacturer of Metadate CD considers its product contraindicated in patients with hereditary fructose intolerance, glucose-galactose malabsorption, and sucrase-isomaltase insufficiency. The use of inhalational anesthetics during surgery may sensitize the cardiovascular system to the effects of methylphenidate. There may be a risk of sudden blood pressure increases during administration of halogenated anesthetics.
The product labeling for some other formulations of methylphenidate recommends avoiding administration of methylphenidate on the day of surgery in patients receiving halogenated anesthetics; other methylphenidate formulations do not contain a precaution for patients on the day of surgery. Visual disturbance has been reported with the use of methylphenidate and may present as difficulties with accommodation and blurring of vision. If a patient reports ocular discomfort or visual changes, an ophthalmic exam may be necessary to determine the cause.
Acarbose: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Monitor for loss of glycemic control when pseudoephedrine, phenylephrine, and other sympathomimetics are administered to patients taking antidiabetic agents. Epinephrine and other sympathomimetics, through stimulation of alpha- and beta- receptors, increase hepatic glucose production and glycogenolysis and inhibit insulin secretion.
Also, adrenergic medications may decrease glucose uptake by muscle cells. For treatment of cold symptoms, nasal decongestants may be preferable for short term, limited use 1 to 3 days as an alternative to systemic decongestants in patients taking medications for diabetes.
Acebutolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Sympathomimetics, such as amphetamines, phentermine, and decongestants e. Concurrent use increases the risk of unopposed alpha-adrenergic activity. Increased blood pressure, bradycardia, or heart block may occur due to excessive alpha-adrenergic receptor stimulation.
Avoid excessive caffeine intake during use of methylphenidate or its derivatives. Excessive caffeine ingestion via medicines, foods like chocolate, dietary supplements, or beverages including coffee, green tea, other teas, colas may contribute to side effects like nervousness, irritability, nausea, insomnia, or tremor.
Patients should avoid medications and dietary supplements which contain high amounts of caffeine. Acetaminophen; Caffeine: Moderate Caffeine is a CNS stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants. Acetaminophen; Caffeine; Dihydrocodeine: Moderate Caffeine is a CNS stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants.
Moderate If concomitant use of dihydrocodeine and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: Moderate Caffeine is a CNS stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. It is advisable to monitor cardiac function if these medications are coadministered. Vasopressors include medications such as epinephrine, dopamine, midodrine, and non-prescription medications such as pseudoephedrine and phenylephrine.
Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Acetaminophen; Codeine: Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Acetaminophen; Dextromethorphan; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Acetaminophen; Guaifenesin; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Acetaminophen; Hydrocodone: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Acetaminophen; Oxycodone: Moderate If concomitant use of oxycodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Acetaminophen; Tramadol: Moderate If concomitant use of tramadol and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Albiglutide: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Alfentanil: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering alfentanil with methylphenidate derivatives. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose adjustment. Aliskiren: Moderate Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents, including aliskiren.
Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidates and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Aliskiren; Amlodipine: Moderate Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents, including aliskiren.
Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents, including calcium-channel blockers.
Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents, including aliskiren. Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents such as thiazide diuretics. Aliskiren; Hydrochlorothiazide, HCTZ: Moderate Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents, including aliskiren.
Aliskiren; Valsartan: Moderate Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents, including aliskiren. Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate.
Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents such as angiotensin II receptor antagonists.
Alogliptin; Pioglitazone: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Alpha-blockers: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate.
Methylphenidates can reduce the hypotensive effect of antihypertensive agents such as alpha-blockers. Alpha-glucosidase Inhibitors: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Amantadine: Moderate Use of amantadine with methylphenidate derivatives, which are CNS stimulants, requires careful observation.
Coadministration may increase the risk of stimulant effects, such as nervousness, irritability, insomnia, tremor, seizures, or cardiac arrhythmias. Ambrisentan: Moderate Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents.
Amifampridine: Major Carefully consider the need for concomitant treatment with methylphenidate derivatives and amifampridine, as coadministration may increase the risk of seizures. If coadministration occurs, closely monitor patients for seizure activity.
Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses.
Methylphenidate derivatives may increase the risk of seizures. Amiloride: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents such as potassium-sparing diuretics. Amiloride; Hydrochlorothiazide, HCTZ: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Amitriptyline: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when coadministering drugs that have serotonergic properties such as methylphenidate derivatives and tricyclic antidepressants TCAs.
There are rare reports of serotonin syndrome occurring during use of other serotonergic antidepressants i. Patients receiving this combination should be monitored for the emergence of serotonin syndrome. If serotonin syndrome occurs, all serotonergic agents should be discontinued and appropriate medical management should be implemented.
Additionally, human pharmacologic studies have shown that methylphenidate derivatives may inhibit the metabolism of TCAs. A dose adjustment of the TCA, and monitoring of TCA plasma concentrations when applicable, may be required when initiating or discontinuing methylphenidate derivatives. Amlodipine: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Amlodipine; Atorvastatin: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Amlodipine; Benazepril: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents such as angiotensin-converting enzyme inhibitors.
Amlodipine; Celecoxib: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Amlodipine; Olmesartan: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Amlodipine; Valsartan: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Amoxapine: Moderate Methylphenidate derivatives and amoxapine may lower the seizure threshold; therefore, caution is particularly advisable when this combination is administered to patients susceptible to seizures.
In addition, methylphenidate is thought to exert some of its beneficial effects through dopamine re-uptake blockade while amoxapine has central dopamine antagonist properties.
In theory, the therapeutic effects of either agent may be reduced. Angiotensin II receptor antagonists: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate. Angiotensin-converting enzyme inhibitors: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Apomorphine: Moderate Increased dopaminergic effects may occur during coadministration of methylphenidate derivatives, inhibitors of dopamine reuptake, and dopamine agonists such as pergolide, pramipexole, apomorphine, and ropinirole. Dopaminergic side effects, such as nausea, loss of appetite, weight loss, insomnia, tremor, nervousness, or changes in mood or behavior, are possible.
Armodafinil: Major The use of armodafinil with other psychostimulants, including methylphenidate derivatives, has not been studied. Patients receiving combination therapy of armodafinil with other psychostimulants should be closely observed for signs of nervousness, irritability, insomnia, arrhythmias, or other stimulant-related side effects.
Articaine; Epinephrine: Moderate Methylphenidate derivatives may potentiate the pressor effects of epinephrine. Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Aspirin, ASA; Carisoprodol; Codeine: Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Aspirin, ASA; Oxycodone: Moderate If concomitant use of oxycodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Atenolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Atenolol; Chlorthalidone: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Atomoxetine: Moderate Use atomoxetine and methylphenidate derivatives together with caution and monitor for additive effects.
Monitor heart rate and blood pressure, as well as for any changes in moods or behavior. Pulse and blood pressure should be measured at baseline, following any dose increases, and periodically while on therapy to detect possible clinically important increases. Coadministration of methylphenidate and atomoxetine did not increase the cardiovascular effects seen with administration of methylphenidate alone during clinical trials of atomoxetine. However, methylphenidate and its derivatives have sympathomimetic effects and atomoxetine may increase the blood pressure and heart rate.
Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Moderate Theoretically, concurrent use of methylene blue and methylphenidate derivatives may increase the risk of serotonin syndrome.
Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain MAO-A and methylphenidate increases central serotonin effects.
It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes e. Serotonin syndrome is characterized by the rapid development of various symptoms such as hyperthermia, hypertension, myoclonus, rigidity, hyperhidrosis, incoordination, diarrhea, mental status changes e.
Azilsartan: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate.
Azilsartan; Chlorthalidone: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Psychostimulants, such as methylphenidate derivatives, may lower the seizure threshold, thereby reducing the efficacy of anticonvulsants such as phenobarbital.
Some human pharmacologic studies have shown that methylphenidate may inhibit the metabolism of phenobarbital. More frequent monitoring of phenobarbital concentrations may be required when initiating or discontinuing methylphenidate. The mechanism of the potential effect on phenobarbital concentrations is not clear; methylphenidate is metabolized primarily to ritalinic acid by nonmicrosomal hydrolytic esterases that are widely distributed throughout the body, and appears to have no known inhibitory effect on hepatic enzymes.
Benazepril: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Benazepril; Hydrochlorothiazide, HCTZ: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Bendroflumethiazide; Nadolol: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Moderate Theoretically, concurrent use of methylene blue and methylphenidate derivatives may increase the risk of serotonin syndrome.
Beta-blockers: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Betaxolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Bethanechol: Moderate Bethanechol offsets the effects of sympathomimetics at sites where sympathomimetic and cholinergic receptors have opposite effects. Bisoprolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Bosentan: Major Avoid use of sympathomimetic agents with bosentan. Sympathomimetics counteract the medications used to stabilize pulmonary hypertension, including bosentan. Sympathomimetics can increase blood pressure, increase heart rate, and may cause vasoconstriction resulting in chest pain and shortness of breath in these patients.
Patients should be advised to avoid amphetamine drugs, decongestants including nasal decongestants and sympathomimetic anorexiants for weight loss, including dietary supplements.
Intravenous vasopressors may be used in the emergency management of pulmonary hypertension patients when needed, but hemodynamic monitoring and careful monitoring of cardiac status are needed to avoid ischemia and other complications. Bretylium: Moderate Monitor blood pressure and heart rate closely when sympathomimetics are administered with bretylium. The pressor and arrhythmogenic effects of catecholamines are enhanced by bretylium.
Brimonidine; Timolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Bromocriptine: Moderate Increased dopaminergic effects may occur during coadministration of methylphenidate derivatives, inhibitors of dopamine reuptake, and dopamine agonists such as bromocriptine.
Brompheniramine; Carbetapentane; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Brompheniramine; Dextromethorphan; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Brompheniramine; Guaifenesin; Hydrocodone: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Brompheniramine; Hydrocodone; Pseudoephedrine: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Brompheniramine; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Bumetanide: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents such as loop diuretics. Buprenorphine: Contraindicated If concomitant use of buprenorphine and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Buprenorphine; Naloxone: Contraindicated If concomitant use of buprenorphine and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Bupropion: Major Medications which may lower the seizure threshold, such as methylphenidates, should be used with great caution or avoided in patients taking bupropion. The manufacturer recommends low initial dosing and slow dosage titration of bupropion if this combination must be used concurrently; the patient should be closely monitored. Bupropion; Naltrexone: Major Medications which may lower the seizure threshold, such as methylphenidates, should be used with great caution or avoided in patients taking bupropion.
Butalbital; Acetaminophen; Caffeine: Moderate Caffeine is a CNS stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants. Caffeine: Moderate Caffeine is a CNS stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants. Avoid excessive caffeine intake during use of methylphenidate derivatives. Moderate Caffeine is a CNS stimulant and such actions are expected to be additive when coadministered with other CNS stimulants or psychostimulants.
Calcium, Magnesium, Potassium, Sodium Oxybates: Moderate The stimulant effects of methylphenidate derivatives can be additive when used concurrently with other psychostimulants, such as sodium oxybate. The combination may increase the incidence of side effects; if these combinations cannot be avoided the patient should be closely observed for signs of nervousness, irritability, insomnia, arrhythmias, or other stimulant-related problems.
Sodium oxybate has the potential to induce seizures; it has been speculated that this effect may be mediated through the action of sodium oxybate at GABA receptors. Although convulsant effects occur primarily at high dosages, sodium oxybate should be used cautiously with psychostimulants that are known to lower seizure threshold.
Note that CNS stimulants, including methylphenidate, are frequently used in the treatment of narcolepsy, and clinical trials involving the use of psychostimulants with sodium oxybate have not found the combinations to be unsafe. Pharmacodynamic interactions cannot be ruled out, however. Calcium-channel blockers: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Canagliflozin: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Canagliflozin; Metformin: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Candesartan: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate. Candesartan; Hydrochlorothiazide, HCTZ: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Captopril: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Captopril; Hydrochlorothiazide, HCTZ: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Carbamazepine: Minor Psychostimulants, such as methylphenidate and its derivatives, may lower the seizure threshold, thereby reducing the efficacy of anticonvulsants such as carbamazepine. There are rare case reports of reduced methylphenidate concentrations occurring during the use of carbamazepine concurrently. The mechanism of the interaction is not clear as methylphenidate is metabolized primarily to ritalinic acid by nonmicrosomal hydrolytic esterases that are widely distributed throughout the body.
Interactions with other potent enzyme inducers have not been reported. Monitor for any changes in therapeutic effectiveness of either drug. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Carbetapentane; Diphenhydramine; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Carbetapentane; Guaifenesin; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Carbetapentane; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Carbetapentane; Phenylephrine; Pyrilamine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Carbidopa; Levodopa: Moderate Increased dopaminergic effects may occur during coadministration of methylphenidate or its derivatives, which inhibit dopamine reuptake, and medications that increase dopaminergic activity such as levodopa.
Carbidopa; Levodopa; Entacapone: Moderate Increased dopaminergic effects may occur during coadministration of methylphenidate or its derivatives, which inhibit dopamine reuptake, and medications that increase dopaminergic activity such as levodopa.
Minor Due to their pharmacologic actions, it is thought that increased dopaminergic effects may occur during coadministration of methylphenidate derivatives, inhibitors of dopamine reuptake, and COMT inhibitors. Be alert for any dopamine-related side effects such as nausea, reduced appetite, tremor, or changes in moods or behaviors.
Carbinoxamine; Hydrocodone; Phenylephrine: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Carbinoxamine; Hydrocodone; Pseudoephedrine: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Carbinoxamine; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Cardiac glycosides: Major Concomitant use of cardiac glycosides with sympathomimetics can cause arrhythmias because sympathomimetics enhance ectopic pacemaker activity.
Caution is warranted during co-administration of digoxin and sympathomimetics. Carteolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Carvedilol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Chlophedianol; Guaifenesin; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors. Chlordiazepoxide; Amitriptyline: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when coadministering drugs that have serotonergic properties such as methylphenidate derivatives and tricyclic antidepressants TCAs.
Chlorothiazide: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Chlorpheniramine; Codeine: Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate If concomitant use of dihydrocodeine and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: Moderate If concomitant use of dihydrocodeine and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Chlorpheniramine; Hydrocodone: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Chlorpheniramine; Hydrocodone; Phenylephrine: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Chlorpheniramine; Hydrocodone; Pseudoephedrine: Moderate If concomitant use of hydrocodone and methylphenidate derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Chlorpheniramine; Phenylephrine: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
Chlorthalidone: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Chlorthalidone; Clonidine: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and clonidine, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. Methylphenidate derivatives can reduce the hypotensive effect of antihypertensive agents, including clonidine. Citalopram: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when coadministering drugs that have serotonergic properties such as methylphenidate derivatives and selective serotonin reuptake inhibitors SSRIs.
There are rare reports of serotonin syndrome occurring during use of an SSRI and methylphenidate derivatives. Additionally, human pharmacologic studies have shown that methylphenidate derivatives may inhibit the metabolism of SSRIs. A dose adjustment of the SSRI may be required when initiating or discontinuing methylphenidate derivatives. Clevidipine: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Clomipramine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when coadministering drugs that have serotonergic properties such as methylphenidate derivatives and tricyclic antidepressants TCAs.
Clonidine: Moderate Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and clonidine, particularly during initial coadministration and after dosage increases of methylphenidate derivatives.
Cocaine: Major Avoid concomitant use of additional vasoconstrictor agents with cocaine. If unavoidable, prolonged vital sign and ECG monitoring may be required.
Myocardial ischemia, myocardial infarction, and ventricular arrhythmias have been reported after concomitant administration of topical intranasal cocaine and vasoconstrictor agents during nasal and sinus surgery. The risk for nervousness, irritability, convulsions, and other cardiac arrhythmias may increase during coadministration. Codeine: Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Codeine; Guaifenesin: Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Codeine; Guaifenesin; Pseudoephedrine: Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Codeine; Phenylephrine; Promethazine: Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome.
Codeine; Promethazine: Moderate If concomitant use of codeine and methylphenidate or its derivatives is warranted, monitor patients for the emergence of serotonin syndrome. Colchicine: Minor The response to sympathomimetics may be enhanced by colchicine. COMT inhibitors: Minor Due to their pharmacologic actions, it is thought that increased dopaminergic effects may occur during coadministration of methylphenidate derivatives, inhibitors of dopamine reuptake, and COMT inhibitors.
Dapagliflozin: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Dapagliflozin; Metformin: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Dapagliflozin; Saxagliptin: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Desflurane: Major Avoid the use of methylphenidate or its derivatives in patients being treated with halogenated anesthetics e.
The use of Metadate CD is contraindicated on the day of surgery. A doctor may slowly increase this dosage until it is effective. All dosages must stay within the maximum daily dose MDD of 54 mg per day for children aged 6—12 years and 72 mg per day for adolescents and adults.
For adults who are new to Concerta or Ritalin, a doctor will usually recommend a starting dosage of either 18 mg or 36 mg per day. They may increase this by 18 mg each week, up to the MDD of 72 mg. When taking IR Ritalin, a person must divide their overall daily dosage into two or three smaller doses. Taking small doses throughout the day helps maintain adequate levels of dopamine and norepinephrine.
Ritalin is not suitable for children under 6 years of age. A doctor may gradually increase this dosage by 5 mg or 10 mg each week. Children should not exceed the MDD of 60 mg of Ritalin per day. The usual dosage for adults is around 20—30 mg of Ritalin per day.
Some people may need more or less than this, so a doctor will determine the most appropriate dosage of Ritalin for each person. These slow release drugs require a person to take fewer doses throughout the day. IR Ritalin may be a better option for people who require immediate symptom relief. However, some people may notice that their symptoms return before they are due to take the next dose.
For people looking to take fewer tablets throughout the day, Ritalin LA or Concerta may be more suitable. Concerta provides the longest lasting effects. It is best to speak with a doctor about the advantages and disadvantages of each type of medication. Sometimes, long-term use of prescription stimulants such as methylphenidate hydrochloride can lead to tolerance.
If a person develops a tolerance, they may need to increase the amounts of a drug they take in order for it to remain effective. People who take large dosages of a drug for an extended period of time may also develop a drug dependence.
Abruptly stopping a drug or rapidly decreasing the dosage can result in withdrawal. People in withdrawal may experience a relapse in the condition or symptoms they were taking the drug to treat. Some common symptoms of withdrawal from stimulant drugs include:.
It is important to take care when using Concerta and Ritalin. Always stay within the doctor-recommended dosage and keep medications out of reach of children. It is possible to overdose on methylphenidate hydrochloride. An overdose is a life-threatening emergency, so anyone who has taken too much Concerta or Ritalin requires urgent medical attention.
Concerta and Ritalin are stimulant medications containing an active ingredient called methylphenidate hydrochloride. The main differences between the medications are how quickly they work to relieve symptoms and how long their effects last. Concerta has a long, steady release pattern, while the short-acting Ritalin releases more quickly and the level drops between doses. This creates more hills and valleys in your blood level.
Some people do better with the long release of Concerta while others may need the quicker action of Ritalin. Other versions of Ritalin may work similarly to the long-acting benefits of Concerta. But Ritalin LA does not last as long as Concerta. Recall that Concerta can act for up to hours. The Cleveland Clinic estimates that long-acting Ritalin works for six to eight hours.
There is a cost difference between the once-daily dosage of Concerta and the several doses per day you take of immediate-release Ritalin. In general, Ritalin costs more because you need to take it more often. Both medications are available as generic drugs. Generic forms tend to cost less than brand-name versions of the same medications. Generic forms of Ritalin tend to cost less than generic forms of Concerta.
The cost to you depends on your health insurance plan. Your plan likely covers generic forms of both drugs. Also, Concerta and Ritalin are both usually stocked at most pharmacies. Stimulants like Concerta and Ritalin carry the risk of side effects. Both drugs may affect growth in children or cause weight loss.
Because they contain the same drug, Concerta and Ritalin share the same side effects. Common side effects can include:. These drugs are not right for everyone. People with some health problems should not take Concerta or Ritalin. You may also need to avoid the drugs if you take certain medications. Concerta and Ritalin can be abused. Even if you take the drugs as prescribed, they can cause dependence. The risk of dependence is greater in people with a history of substance abuse. If you have a history of drug or alcohol abuse, you should discuss your risk of dependence with your doctor before taking Concerta or Ritalin.
Both medications are category C pregnancy drugs.
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