Name /bks_53161_deglins_md_disk/methylphenidate 02/17/2014 07:37AM Plate # 0-Composite pg 1 # 1

1 Contraindications/Precautions
Contraindicated in: Hypersensitivity; Hyperexcitable states; Hyperthyroidism; PDF Page #1
methylphenidate (oral) (meth-ill-fen-i-date) Patients with psychotic personalities or suicidal or homicidal tendencies; Personal or
Biphentin, Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, family history of Tourette’s syndrome; Glaucoma; Motor tics; Concurrent use or use
Quillivant XR, Ritalin, Ritalin LA, Ritalin SR within 14 days of MAO inhibitors; Fructose intolerance, glucose-galactose malab-
methylphenidate (transdermal) sorption, or sucrose-isomaltase insufficiency; Surgery.
Daytrana Use Cautiously in: History of cardiovascular disease (sudden death has occurred
Classification in children with structural cardiac abnormalities or other serious heart problems);
Therapeutic: central nervous system stimulants Hypertension; Diabetes mellitus; History of contact sensitization with transdermal
product (may be atqrisk for systemic sensitization reactions with oral products);
Schedule II Geri: Geriatric or debilitated patients; Continual use (may result in psychological or
Pregnancy Category C physical dependence); Seizure disorders (may lower seizure threshold); Concerta
product should be used cautiously in patients with esophageal motility disorders or
Indications severe GI narrowing (mayqthe risk of obstruction); OB, Lactation: Safety not es-
Treatment of ADHD (adjunct). Oral: Symptomatic treatment of narcolepsy. Unla- tablished; Pedi: Growth suppression may occur in children with long term use; chil-
beled Use: Management of some forms of refractory depression. dren ⬍6 yr (transdermal only).
Action Adverse Reactions/Side Effects
Produces CNS and respiratory stimulation with weak sympathomimetic activity. CNS: hyperactivity, insomnia, restlessness, tremor, behavioral disturbances, dizzi-
Therapeutic Effects: Increased attention span in ADHD. Increased motor activity, ness, hallucinations, headache, irritability, mania, thought disorder. EENT: blurred
mental alertness, and diminished fatigue in narcoleptic patients. vision, teeth grinding. CV: SUDDEN DEATH, hypertension, palpitations, tachycardia,
Pharmacokinetics hypotension, peripheral vasculopathy. GI: anorexia, constipation, cramps, diarrhea,
Absorption: Slow and incomplete after oral administration; absorption of sus- dry mouth, metallic taste, nausea, vomiting. Derm: contact sensitization (erythema,
tained or extended-release tablet (SR) is delayed and provides continuous release; edema, papules, vesicles) (transdermal), erythema, rashes. Metab: growth sup-
well absorbed from skin. Metadate CD, Concerta, Ritalin LA— provides initial pression, weight loss (may occur with prolonged use). Neuro: akathisia, dyski-
rapid release followed by a second continuous release (biphasic release). nesia, tics. Misc: ANAPHYLAXIS, ANGIOEDEMA, fever, physical dependence, psychologi-
Distribution: Unknown. cal dependence, tolerance.
Metabolism and Excretion: Mostly metabolized (80%) by the liver. Interactions
Half-life: 2– 4 hr.
Drug-Drug:qsympathomimetic effects with other adrenergics, including vaso-
TIME/ACTION PROFILE (CNS stimulation) constrictors, decongestants, and halogenated anesthetics. Use with MAO in-
ROUTE ONSET PEAK DURATION hibitors or vasopressors may result in hypertensive crisis (concurrent use or use
PO unknown 1–3 hr 4–6 hr within 14 days of MAO inhibitors is contraindicated). Metabolism of warfarin, phe-
PO-ER unknown 4–7 hr 3–12 hr† nytoin, phenobarbital, primidone, phenylbutazone, selective serotonin
Transdermal unknown unknown 12 hr reuptake inhibitors, and tricyclic antidepressants may bepand effectsq. Avoid
†Depends on formulation concurrent use with pimozide (may mask cause of tics). Maypthe effectiveness of
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/methylphenidate 02/17/2014 07:37AM
2 NURSING IMPLICATIONS
antihypertensives. Alcohol mayqrate of release of drug from some methylpheni-
date formulations (Metadate CD, Ritalin LA).
Drug-Natural Products: Use with caffeine-containing herbs (guarana, tea,
coffee)qstimulant effect. St. John’s wort mayqserious side effects (concurrent
use is NOT recommended).
Drug-Food: Excessive use of caffeine-containing foods or beverages (coffee,
cola, tea) may causeqCNS stimulation.
Route/Dosage
PO (Adults): ADHD— 5– 20 mg 2– 3 times daily as prompt-release tablets. When
maintenance dose is determined, may change to extended-release formulation. Nar-
colepsy— 10 mg 2– 3 times/day; maximum dose 60 mg/day.
PO (Children ⬎6 yr): Prompt release tablets— 0.3 mg/kg/dose or 2.5– 5 mg be-
fore breakfast and lunch;qby 0.1 mg/kg/dose or by 5– 10 mg/day at weekly intervals
(not to exceed 60 mg/day or 2 mg/kg/day). When maintenance dose is determined,
may change to extended-release formulation. Ritalin SR, Metadate ER— may be
used in place of the prompt-release tablets when the 8-hour dosage corresponds to
the titrated 8-hour dosage of the prompt-release tablets; Ritalin LA— can be used in
place of twice daily regimen given once daily at same total dose, or in place of SR
product at same dose; Concerta (patients who have not taken methylphenidate
previously)— 18 mg once daily in the morning initially, may be titrated as needed
up to 54 mg/day. Concerta (patients are currently taking other forms of methyl-
phenidate)— 18 mg once daily in the morning if previous dose was 5 mg 2– 3 times
daily or 20 mg daily as SR product, 36 mg once daily in the morning if previous dose
was 10 mg 2– 3 times daily or 40 mg daily as SR product, 54 mg once daily in the
morning if previous dose was 15 mg 2– 3 times daily or 60 mg once daily as SR prod-
uct. Metadate CD— 20 mg once daily. Dosage may be adjusted in weekly 20-mg in-
crements to a maximum of 60 mg/day taken once daily in the morning. Quillivant
XR— 20 mg once daily. Dose may be adjusted in weekly 10– 20-mg increments to a
maximum of 60 mg/day taken once daily in the morning.
Transdermal (Children 6– 17 yr): Apply one 10-mg patch initially (should be ap-
plied 2 hr before desired effect and removed 9 hr after application); may be titrated
based on response and tolerability; mayqto 15-mg patch after 1 week, and then to
20-mg patch after another week, and then to 30-mg patch after another week.
Plate # 0-Composite pg 2 # 2
Assessment PDF Page #2
● Monitor BP, pulse, and respiration before administering and periodi-
cally during therapy. Obtain a history (including assessment of family
history of sudden death or ventricular arrhythmia), physical exam to as-
sess for cardiac disease, and further evaluation (ECG and echocardio-
gram), if indicated. If exertional chest pain, unexplained syncope, or
other cardiac symptoms occur, evaluate promptly.
● Monitor closely for behavior change.
● Monitor for signs and symptoms of peripheral vasculopathy (numbness and burn-
ing in fingers, digital changes). May require reduction in dose or discontinuation.
● Pedi: Monitor growth, both height and weight, in children on long-term therapy.
● May produce a false sense of euphoria and well-being. Provide frequent rest peri-
ods and observe patient for rebound depression after the effects of the medication
have worn off.
● Methylphenidate has a highabuse potential; may lead to tolerance and psychologi-
cal dependence.
● ADHD: Assess children for attention span, impulse control, and interactions with
others. Therapy may be interrupted at intervals to determine whether symptoms
are sufficient to continue therapy.
● Narcolepsy: Observe and document frequency of episodes.
● Transdermal: Assess skin for signs of contact sensitization (erythema with
edema, papules, or vesicles that does not improve within 48 hr or spreads beyond
patch site) during therapy. May lead to systemic sensitization to other forms of
methylphenidate (flare-up of previous dermatitis or prior positive patch-test sites,
generalized skin eruptions, headache, fever, malaise, arthralgia, diarrhea, vomit-
ing). If contact sensitization develops and oral methylphenidate is instituted, mon-
itor closely.
● Lab Test Considerations: Monitor CBC, differential, and platelet count period-
ically in patients receiving prolonged therapy.
Potential Nursing Diagnoses
Disturbed thought process (Side Effects)
Implementation
● Do not confuse Metadate ER/CD (methylphenidate), or methylphenidate
with methadone. Do not confuse Metadate CD with Metadate ER. Do not
confuse Ritalin LA with Ritalin SR.
䉷 2015 F.A. Davis Company CONTINUED
Name /bks_53161_deglins_md_disk/methylphenidate 02/17/2014 07:37AM
3 Patient/Family Teaching
CONTINUED
methylphenidate (transdermal)
● PO: Administer immediate and sustained-release tablets on an empty stomach
(30– 45 min before a meal). Sustained-release tablets should be swallowed
whole; do not break, crush, or chew. Medate CD and Ritalin LA capsules may be
opened and sprinkled on cool applesauce; entire mixture should be ingested im-
mediately and followed by a drink of water. Do not store for future use. Concerta
may be administered without regard to food, but must be taken with water, milk,
or juice.
● Shake extended-release oral suspension for 10 seconds before administering.
May be given with or without food.
● Transdermal: Apply patch to a clean, dry site on the hip which is not oily, dam-
aged, or irritated; do not apply to waistline where tight clothing may rub it. Press
firmly in place with palm of hand for 30 seconds to make sure of good contact with
skin, especially around edges. Alternate site daily. Apply patch 2 hr before desired
effect and remove 9 hr after applied; effects last several more hours. Do not apply
or reapply with dressings, tape, or other adhesives. Do not cut patches.
● If difficulty in separating patch from release liner, tearing, or other damage occurs
during removal from liner, discard patch and apply a new patch. Inspect release
liner to ensure no adhesive containing medication has transferred to liner; if
transfer has occurred, discard patch. Avoid touching adhesive during application;
wash hands immediately after application.
● If patch does not fully adhere or partially detaches, remove and replace with an-
other patch. Wear patched for a total of 9 hr, regardless of number used. Exposure
to water during bathing, swimming, or showering may affect patch adherence.
● Patches may be removed earlier before decreasing dose if an unacceptable loss of
appetite or insomnia occurs.
● Store patches at room temperature in a safe place to prevent abuse and misuse; do
not refrigerate or freeze.
● To remove patch, peel off slowly. An oil-based product (petroleum jelly, olive oil,
mineral oil) may be applied gently to facilitate removal. Upon removal, fold so that
adhesive side of patch adheres to itself and flush down toilet or dispose of in an
appropriate lidded container.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent.
Plate # 0-Composite pg 3 # 3
● Instruct patient to take medication as directed. If an oral dose is missed, take the
PDF Page #3
remaining doses for that day at regularly spaced intervals; do not double doses.
Take the last dose before 6 PM to minimize the risk of insomnia. Instruct patient
not to alter dose without consulting health care professional. Abrupt cessation of
high doses may cause extreme fatigue and mental depression. Instruct parent/
caregiver to read the Medication Guide prior to use and with each Rx refill; new
information may be available.
● Advise patient to check weight 2– 3 times weekly and report weight loss to health
care professional.
● May cause dizziness or blurred vision. Caution patient to avoid driving or activities
requiring alertness until response to medication is known.
● Inform patient and/or parents that shell of Concerta tablet may appear in the
stool. This is no cause for concern.
● Advise patient to avoid using caffeine-containing beverages concurrently with this
therapy.
● Advise patient to notify health care professional if nervousness, insomnia, palpita-
tions, vomiting, skin rash, or fever occurs.
● Advise patient and/or parents to notify health care professional of behavioral
changes.
● Advise patient to notify health care professional of all Rx or OTC medications, vita-
mins, or herbal products being taken and to consult with health care professional
before taking other medications.
● Inform patient that health care professional may order periodic holidays from the
drug to assess progress and to decrease dependence.
● Emphasize the importance of routine follow-up exams to monitor progress.
● Transdermal: Encourage parent or caregiver to use the administration chart in-
cluded in package to monitor application and removal time and disposal method.
● Caution patient to avoid exposing patch to direct external heat sources (hair dry-
ers, heating pads, electric blankets, heated water beds, etc). May increase rate and
extent of absorption.
● Inform parent/caregiver that skin redness, itching and small bumps on the skin
are common. If swelling or blistering occurs, the patch should not be worn and
health care professional notified. Caution parent/caregiver not to apply hydrocor-
tisone or other solutions, creams, ointments, or emollients prior to application.
● Advise patient referred for MRI test to discuss patch with referring health care pro-
fessional and MRI facility to determine if removal of patch is necessary prior to test
and for directions for replacing patch.
Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/methylphenidate 02/17/2014 07:37AM Plate # 0-Composite pg 4 # 4

4
● Home Care Issues: Pedi: Advise parents to notify school nurse of medication PDF Page #4
regimen.
Evaluation/Desired Outcomes
● Improved attention span and social interactions in ADHD.
● Decreased frequency of narcoleptic symptoms.
Why was this drug prescribed for your patient?

䉷 2015 F.A. Davis Company