ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
CNS Stimulant (Dopamine/Noradrenaline Reuptake Inhibitor) Pregnancy: Avoid — insufficient data; possible fetal harm

Methylphenidate

Brand names: Ritalin, Concerta XL, Equasym XL, Medikinet, Tranquilyn

Adult dose

Dose: Starting: 5–10 mg BD–TDS (IR). Modified release (Concerta XL): 18 mg OD, titrate to 54 mg OD (max 72 mg in adults).
Route: Oral
Frequency: BD–TDS (IR) or OD (MR)
Max: 100 mg/day IR; 72 mg/day Concerta XL
Class B controlled drug (Schedule 2 — CD prescription required)

Paediatric dose

Route: Oral
Frequency: BD–TDS (IR) or OD (MR)
Max: 60 mg/day IR (children); 54 mg/day (Concerta XL, 6–17 years)
Concentration: Various — 5 mg, 10 mg, 20 mg tablets (IR); 18 mg, 27 mg, 36 mg, 54 mg (Concerta XL); 5 mg, 10 mg, 20 mg, 30 mg (Medikinet XL) mg/ml
Start at 5 mg BD–TDS (IR) for ages 6+. Titrate by 5–10 mg weekly. MR formulations: Concerta XL (OD, 12h), Medikinet XL (OD, with breakfast — partial rapid release). Take in morning to avoid insomnia. Drug holidays (weekends/school holidays) considered for appetite/growth.

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Clinical pearls

  • Schedule 2 CD — FP10 (blue) prescription required; dispensing within 28 days of date
  • NICE NG87: first-line pharmacotherapy for ADHD in school-age children after environmental/psychological interventions
  • Growth monitoring: plot height and weight 6-monthly — drug holiday may be indicated for growth faltering
  • Cardiac screening before starting: ECG if family or personal history of cardiac disease; resting tachycardia >100 bpm — review before prescribing

Contraindications

  • Symptomatic cardiovascular disease
  • Structural cardiac defects
  • Advanced arteriosclerosis
  • Thyrotoxicosis
  • History of drug abuse
  • MAOI use (within 14 days)
  • Phaeochromocytoma
  • Glaucoma

Side effects

  • Decreased appetite (common — take with or after meals)
  • Insomnia (avoid late doses)
  • Headache
  • Abdominal pain
  • Tachycardia and hypertension
  • Growth suppression (height/weight — monitor)
  • Tics (may worsen existing tics)
  • Mood lability/rebound
  • Psychosis (rare)

Interactions

  • MAOIs — hypertensive crisis (absolute contraindication, 14-day washout)
  • Antihypertensives — reduced effect
  • Anticoagulants (warfarin) — increased INR (monitor)
  • SSRIs — serotonin syndrome risk
  • Phenytoin/phenobarbital — increased anticonvulsant levels

Monitoring

  • Height and weight (6-monthly — growth suppression)
  • Blood pressure and heart rate (baseline, after each dose increase)
  • Sleep and appetite assessment
  • ADHD symptom scoring (Conners/SNAP)
  • Psychiatric symptoms

Reference: BNF for Children; NICE NG87; British Association for Psychopharmacology (BAP) Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways