Adult ADHD

Generic Names: Methylphenidate (meth-ill-FEN-eh-date), Methylin (METH-ill-in)

Brand Names: Concerta, Metadate CD, Metadate ER, Methylin ER, Ritalin, Ritalin LA, Ritalin-SR, Daytrana

Manufacturer: The various brand name formulations of the drug methylphindate are produced by several different manufacturers.

What Is Methylphenidate?

Marketed under numerous brand names, the best known of which is Ritalin, methylphenidate and other amphetamines function as central nervous system (CNS) stimulants, and have been FDA approved for the treatment of both adult and childhood attention deficit hyperactivity disorder (ADHD) as well as narcolepsy in adults.

How Does Methylphenidate Work?

Although it is not known exactly how methylphenidate works, it is believed to increase the flow of the neurotransmitters dopamine and norepinephrine, chemicals that carry the signal between neurons (cells of the nervous system). This can result in an increase in a person’s ability to focus over extended periods of time.

How Do I Take Methylphenidate?

There are several brand named drugs that contain methylphenidate, including instant release (IR) formulations and sustained release (SR), also known as extended release (ER) and controlled release (CR), formulations. There is also a methylphenidate trans-dermal patch, which delivers a sustained dose of drug over a long period of time, making it easier to ensure you get the right dose without having to constantly remember to take an oral pill.

Research has shown that the SR formulations of methylphenidate are just as effective, if not more effective, than IR formulas [1-4]. These time-release medications are also less prone to be misused and abused.

Methylphenidate Formulations

Instant Release (IR) Tablets
· Ritalin: 5, 10 or 20mg
· Attenta: 10mg
· Methylin: 5, 10 or 20mg
· Equasym: 5, 10, 20 or 30mg
· Rubifen: 5, 10 or 20mg
Sustained, Controlled or Extended Release (SR, CR or ER)Tablets
· Ritalin SR: 20mg
· Methylin ER: 10 and 20mg
· Metadate ER: 10 and 20mg
· Concerta: 18, 27, 36 and 54mg
Controlled –release Capsules
· Ritalin LA: 10, 20, 30 or 40mg
· Metadate CD: 10, 20, 30, 40 or 60mg
Trans-dermal Patch
· Daytrana 10, 15, 20 or 30mg

Is Methylphenidate Effective for Adult ADHD?

Methylphenidate was the first drug to be used in the treatment of ADHD, originally to treat children in the 1960’s. Since its discovery, methylphenidate has been used to treat ADHD in both children and adults for many years. Recent research has demonstrated the efficacy of this classic ADHD treatment in adults with the disorder [5].

Methylphenidate Minor Side Effects

Common side effects are similar to those typically associated with the use of stimulants, and include:
· Dry mouth
· Upset Stomach
· Diarrhea or Constipation
· Irritability and Restlessness
· Loss of appetite
· Difficulty falling asleep
· Weight loss
Most minor side effects of amphetamines resolve over the first week or two, as your body adjusts to the medication.

Methylphenidate Precautions

Addiction & Abuse
Studies have been done to address concern that use of stimulant medications may lead to later drug dependency and abuse. Although, untreated ADHD has been linked to an increased risk of substance abuse later in life [6], the likelihood of future drug abuse disorder is actually decreased when ADHD is properly treated [7].

Still, because methylphenidate is an amphetamine and stimulant, there is the potential for increasing tolerance to the medication over long-term use as well as the danger of abuse. And this medication is not recommended for people who have a history of drug abuse.

Cardiac Precautions
Methylphenidate and other amphetamines may not be right for you if you have a history of heart problems, such as hardened arteries (arteriosclerosis), heart disease, high blood pressure (hypertension), or any other pre-existing cardiac condition.

Other Precautions
The drug is also not recommended for people with overactive thyroid, glaucoma, epilepsy and seizure disorders, severe anxiety or agitation and those who have taken MAO inhibitors within the past two weeks. Before taking methylphenidate, be sure to tell your doctor if you have any of these problems.

Pregnancy Category C
As a category C medication, methylphenidate may be harmful to an unborn baby. This drug can also pass into breast milk and may be harmful to your baby if you nurse. Be sure to tell your doctor if you are pregnant or plan to become pregnant while you are being treated for ADHD.

Sources

1. Steele, M., et al. (2006). “A randomized, controlled effectiveness trial of OROS-methylphenidate compared to usual care with immediate-release methylphenidate in Attention Deficit-Hyperactivity DisorderPDF (293 KB)”. Can J Clin Pharmacol. 2006 Winter;13(1):e50-62.
2. Pelham, W.E., et al. (2001). “Once-a-day Concerta methylphenidate versus three-times-daily methylphenidate in laboratory and natural settings”. Pediatrics. 2001 Jun;107(6):E105.
3. Keating, G.M., McClellan, K., Jarvis, B. (2001). “Methylphenidate (OROS formulation)”. CNS Drugs. 2001;15(6):495-500; discussion 501-3.
4. Hoare, P., et al. (2005). “12-month efficacy and safety of OROS methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder switched from MPHPDF”. Eur Child Adolesc Psychiatry. 2005 Sep;14(6):305-9.
5. MedScape (2006) New Findings Expand Understanding of Adult ADHD. http://www.medscape.com/viewarticle/537384
6. Richardson. (2005) When Too Much Isn’t Enough, Ending The Destructive Cycle of AD/HD and Addictive Behavior, Piñon Press
7. Wilens, et al. (2003) Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature, Pediatrics Vol. 111 (1).
8. Wikipedia Ritalin http://en.wikipedia.org/wiki/Ritalin
9. Drugs.com http://www.drugs.com/MTM/methylphenidate.html