Facts About Ritalin By Patti Meadows, copyright 1993 Ritalin comes in two versions. The standard tablets (Ritalin) and the long acting, sustained release version (Ritalin-SR) How Does This Drug Have It's Effect? ------------------------------------ It is not fully known how Ritalin works. Current belief is that Ritalin has it's gentle stimulant effect by activating the brain stem arousal system and cortex. Scientific evidence has not established just how Ritalin produces the mental and behavioral effects that it does. Nor is there absolute evidence showing how those effects are related to the central nervous system's state. The time that it takes for the highest levels of a chemical to be active in the body after taking a dose is called the peak rate. The peak rate for the standard version of Ritalin averages 1.9 hours. The times to reach the peak rate for the patients who were tested ranged between a low of .3 hours and a high of 4.4 hours. The sustained release version is absorbed more slowly than the standard version. The average time to reach the peak rate for the SR tablets is 4.7 hours. The range was from 1.3 to 8.2 hours for the sample. Typical Uses of This Drug ------------------------- Ritalin is recommended as part of a total treatment for Attention Deficit Disorder (ADD) and/or Attention Deficit/Hyperactivity Disorder (ADHD). Other parts of the total treatment usually include educational, psychological, and social treatments. The total program should produce a stabilizing effect in children with the behavioral problems characterized by the diagnosis of ADD or ADHD. Symptoms that result in a diagnosis of ADD/ADHD include emotional instability, hyperactivity, impulsivity, moderate to severe distractibility, and short attention span. If the symptoms are of recent origin, the diagnosis should not be finalized. Other symptoms that might be present include learning disability, and an abnormal EEG. Learning may or may not be impaired to an extent to be noticed by observers. Note: The specific cause of ADD/ADHD is unknown. Adequate diagnosis requires medical, psychological, educational, and social sources. The diagnosis must be based on a complete history of the patient. The presence of isolated symptoms is not cause for diagnosis. Drug treatment is not required for all children with this disorder. Medication should not be prescribed for children who develop symptoms as a result of environmental factors and/or psychiatric disorders, including psychosis. It is essential that educational, psychological and social treatments are used first. The physician should then determine whether a course of medication should be Attention Deficit Disorders and Narcolepsy (the uncontrollable desire to sleep) are the two main uses for Ritalin. Reasons to Avoid Taking This Drug --------------------------------- Agitation, anxiety, and tension can be aggravated by Ritalin If a patient is known to be hypersensitive to Ritalin, it should not be prescribed. Ritalin should not be prescribed for patients with glaucoma, patients with motor tics, patients diagnosed with Tourette's syndrome, or if there is a family history of Tourette's syndrome. Other Warnings -------------- Ritalin has not been proven for safety and effectiveness in children under six years of age. It should not be prescribed for this age group. There is not yet proven data on the safety and effectiveness of long term use in children. There have been reports of growth suppression associated with the long term use of stimulants in children (both in weight gain and in height); however, a cause/effect relationship has not been shown. Therefore, patients needing long term medication should be especially monitored. Studies have shown that Ritalin may aggravate behavior and thought disorders in psychotic children. Ritalin is not meant as a treatment for severe depression and should not be used for treatment of such. Ritalin should not be used to treat or prevent normal levels of tiredness in individuals. There has been some evidence that Ritalin can lower the convulsive threshold in patients. This includes patients with a history of seizures, also patients with no history of seizures but showing earlier EEG abnormalities, and to a far less extent patients with normal EEGs and no history of seizures. The safety of using anticonvulsants and Ritalin together has not been shown. If seizures occur while on Ritalin, the Ritalin should be stopped. Blood pressure should be monitored for all patients taking Ritalin, especially those with a history of high blood pressure. There have been rare reports of visual disturbances, blurring of vision, and difficulties with accommodation for patients using Ritalin. Use During Pregnancy or Breast Feeding -------------------------------------- There have not been adequate studies done to determine the safety of Ritalin during pregnancy. It is unknown whether Ritalin is passed into the breast milk. Ritalin should not be prescribed for women of childbearing age unless the physician determines that the benefits outweigh the possible risks. Interactions With Other Drugs ----------------------------- Ritalin could decrease the effect of Guanethidine (used to reduce high blood pressure). Caution should be used when Ritalin is used with MAO inhibitors (antidepressants). Studies on humans indicate that Ritalin may increase the effect of some drugs. The following drugs may need to have their doses adjusted when Ritalin is prescribed: coumarin anticoagulants (blood thinners) anticonvulsants such as Phenobarbital, Dilantin, Tegretol, and Primadone (Mysoline) Phenylbutazone (anti-inflammatory drug) Tricyclic antidepressants such as Impramine and Desipramine (Tofranil and Norpramin) Drug Dependence --------------- Caution should be used in prescribing Ritalin to patients with a history of drug dependence or alcohol, or emotionally unstable patients. These patients may increase the dosage on their own. Long term abuse of Ritalin can lead to increased tolerance and psychic dependence with a range of abnormal behavior. Psychotic behavior can occur. Drug withdrawal requires careful supervision. Severe depression can occur during the withdrawal process and the effects of the previous over activity can be unmasked. The personality problems that lead to the abuse will require long term follow-up. Adverse Reactions ----------------- The most common side effects are insomnia and nervousness. These can often be controlled by lowering the dosage and/or discontinuing the evening doses. The most common side effects in children include abdominal pain, insomnia, loss of appetite, rapid heartbeat, and weight loss during long term therapy. Less common reactions include: abdominal pain, abnormal muscle movements, angina, anorexia, blood pressure changes, dizziness, drowsiness, headache, hypersensitivity, nausea, palpitations, pulse changes, rapid or irregular heartbeat, and weight loss. Rare reports of Tourette's syndrome exist. Toxic psychosis has also been reported; as have anemia, leukopenia, transient depressed mood, and scalp hair loss. Dosage-Adults ------------- Standard Ritalin tablet doses should be given 2 or three times daily, 30-45 minutes before meals. Average dosage is 20 to 30 mg daily. The highest daily doses may be as much as 40 to 60 mg, and the lower daily doses may be from 10 to 15 mg daily. If insomnia occurs, the last dose should be taken before 6 PM. Ritalin-SR lasts 8 hours and the physician shall adjust for the difference in the length of the drug being active when prescribing. The SR tablets must be swallowed whole. They must not be chewed or crushed. Dosage-Children --------------- Ritalin should be started in small doses. Increases should be made in gradual weekly increments. A full day's dose above 60 mg is not recommended. Standard Ritalin tablets should be started with 5 mg twice daily with gradual weekly increases of 5 to 10 mg. After the correct dose is determined, Ritalin SR may be given after the physician adjusts for the difference in the length of the drug being active. The SR tablets must be swallowed whole. They must not be chewed or crushed. If the symptoms which lead to Ritalin being prescribed should become worse, or if any side effects are observed, stop taking the drug. If improvement of the symptoms is not noticed after one month of correct dosage adjustments, the use of Ritalin should be stopped. The patient should stop using Ritalin periodically to assess the condition of the symptoms. Sometimes the improvement in symptoms remains even when the drug is discontinued permanently. Ritalin treatment need not be indefinite. In many cases Ritalin can be discontinued after puberty. Overdosage Symptoms ------------------- Agitation, confusion, convulsions which can be followed by coma, delirium, dryness of mucous membranes, enlarged pupils, euphoria, flushing, hallucinations, headache, high fever, hypertension, muscle twitching, rapid or irregular heartbeat, sweating, tremors, and vomiting. Treatment of overdose may need to consist of hospitalization where supportive measures can be provided. Intensive care must be provided to support the circulation and respiration of the patient. Other measures such as protecting the patient against self injury and against external stimuli which can further agitate the patient are given as needed. Chemical Overview of This Drug ------------------------------ Ritalin hydrochloride, (generic name is methylphenidate hydrochloride) is a mild stimulant of the central nervous system. It is available by tablet, in doses of 5 mg, 10 mg, and 20 mg to take by mouth. The sustained release version is called Ritalin-SR, and comes in 20 mg tablets to take by mouth. The full chemical name is methyl a-phenyl-2-piperidineacetate hydrochloride. The chemical is an odorless, white powder, and made up of very small crystals. When dissolved in liquids, it is acidic. The chemical dissolves easily in water and in methanol. It will also dissolve in alcohol. and will somewhat dissolve in acetone and in chloroform. 269.77 is the molecular weight. The inactive ingredients of Ritalin tablets are as follows: 5 mg tablets D&C Yellow No. 10, lactose, magnesium stearate, polyethylene glycol, starch, sucrose, and talc. 10 mg tablets FD&C Green No. 3, lactose, magnesium stearate, polyethylene glycol, starch, sucrose, and talc. 20 mg tablets D&C Yellow No. 10, lactose, magnesium stearate, polyethylene glycol, sucrose, talc and tragacanth. Ritalin-SR (20 mg) Cellulose compounds, cetostearyl alcohol, lactose, magnesium stearate, mineral oil, povidone, titanium dioxide, and zein. Sources ------- The Physicians' Desk Reference The PDR Family Guide to Prescription Drugs __________________________________________________________________________ AUTHOR'S NOTE: Although I retain copyright, I give permission for non-commercial reproduction of this article provided that my authorship is properly credited. 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