Methylphenidate hydrochloride

• a central nervous system stimulant - it is structurally related to amphetamine but has milder central nervous system stimulant properties (1)
• has been advocated as part of a comprehensive treatment programme for children with severe Attention Deficit / Hyperactivity Disorder (ADHD). Hyperkinetic Disorder (HKD) is broadly similar to ADHD
• previous NICE guidance stated that in some cases treatment with methylphenidate hydrochloride may be appropriate for children and adolescents who do not fit the diagnostic criteria for HKD but are experiencing severe problems as a result of hyperactivity/ impulsiveness or inattention (3)

Prescribers and dispensers should use caution if switching patients between different long-acting formulations of methylphenidate (Concerta XL, Medikinet XL, Equasym XL, Ritalin LA, and generics) as different instructions for use and different release profiles may affect symptom management (4):

• Advice to healthcare professionals: Advice to provide to patients or parents and caregivers:
• caution should be used if long-acting formulations of methylphenidate are to be used interchangeably due to the differences between formulations in dosing frequency, administration with food, amount and timing of the modified-release component, and overall clinical effect
• follow specific dosage recommendations for each formulation
• if considering a switch to another long-acting preparation:
  • consult with the patient (and their parent or caregiver if relevant) to discuss the reasons for this and the possible changes they may experience in symptom management and side effects (and what to do if these occur)
  • consider patient preferences such as their individual needs, dose frequency, possible side effects, or other issues related to the patient’s condition
  • reiterate the instructions for use for the newly prescribed formulation, especially whether it should be taken with or without food
• clinical guidance advises to prescribe these long-acting formulations of methylphenidate by specifying brand name or by using the generic drug name and name of the manufacturer
• report any suspected adverse drug reactions associated with methylphenidate or other medicines on a Yellow Card
  
  
• there are differences between long-acting methylphenidate medicines in how they release the medicine to manage ADHD symptoms and in the instructions on how to take them
• we have asked doctors and pharmacists to be cautious when switching patients between different long-acting formulations of methylphenidate
• carefully read and follow the advice in the Patient Information Leaflet that comes with your medicine and speak to a healthcare professional if you are concerned about side effects or are concerned about your child’s health or medicines
• it is especially important to follow advice on how much methylphenidate to take and to follow instructions on when and how to take it – these can affect how well the medicine works for your ADHD

The Summary of Product Characteristics should be consulted before prescribing this drug.

Reference:

1. NICE (March 2006). Methylphenidate, atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and adolescents
2. Drug and Therapeutics Bulletin (2001), 39 (7), 52-54.
3. NICE (October 2000). Guidance on the Use of Methylphenidate (Ritalin, Equasym) for Attention Deficit / Hyperactivity Disorder (ADHD) in childhood.
4. MHRA. Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations Drug Safety Update volume 16, issue 2: September 2022: 1.