ADHD: METHYLPHENIDATE Flashcards
Methylphenidate - MOA
Potent CNS stimulant.
Increased dopamine and noradrenaline levels in the brain.
CI
- CVD
- Psychosis
- Hyperthyroidism
- Severe hypertension
- Severe depression/ Suicidal tendencies
Cautions
- Epilepsy
- Alcohol & drug dependence
- Anxiety/ Depression
- FMHx of Tourette’s
Side effects
- Anxiety, Depression
- Drowsiness (sedation, patients should be warned about driving)
- Growth retardation in children
- Seizures (stop if increased seizure frequency)
- Pyschiatric symptoms: aggitation, aggression
- Weight loss (decreased appetite)
- Tics
Monitoring
- Pulse and blood pressure
- Psychiatric symptoms
- Weight/ height appetite at initiation, each dose change, and every 6 months (MAINLY IN CHILDREN)
Which formulation of Methylphenidate must be brand specific? and Why?
- MR
- Diff preps may not have same clinical effect
MR preps preferred due to
- Pharmacokinetic profile
- Convenience – take less a day
- Improved adherence
Should be prescribed as brand only
Take in morning with breakfast for these two brands of methylphenidate
Medikinet, Equasym
If a patient has dysphagia, the following three brands of methylphenidate do not have appropriate dose form due to restricted GI lumen
concerta xl, demlosart PR tabs, xaggitin xl
Why should alcohol be avoided with methylphenidate
it might increase conc of methylphenidate
TCAs interaction with methylphenidate
methylphenidate may increase conc of TCAs e.g. amitriptyline, imipramine, doxepin, dosulepin etc
use with caution and adjust dose
interaction - MAOB inhibitor and methylphenidate
selegiline, rasagiline
these are predicted to increase risk of hypertensive crisis when given with methylphenidate - avoid
avoid this high risk abx because methylphenidate may increase risk of elevates BP when given with it
linezolid
