Methylphenidate hydrochloride

How it works

It blocks the reuptake of dopamine and noradrenaline by inhibiting their presynaptic transporters, increasing synaptic catecholamine availability in prefrontal and striatal circuits that govern attention and impulse control.

Prescribing in practice

• Assess cardiovascular status before treatment and avoid use where there is known structural cardiac disease or uncontrolled hypertension, as it can raise heart rate and blood pressure.
• Modified-release brands differ in their release profiles and are not interchangeable, so prescribe and dispense by brand.
• It is a controlled drug with abuse and diversion potential, and may unmask or worsen tics, anxiety and psychotic symptoms.

Monitoring

Monitor heart rate, blood pressure, weight, height (in children), appetite, sleep, mood and emergence of tics or psychiatric symptoms at baseline and at regular intervals.

Counselling the patient

• Report palpitations, chest pain, fainting, or new agitation, anxiety or aggression promptly.
• Take modified-release doses in the morning to limit sleep disturbance, and keep the medicine secure from others.
• Reduced appetite and weight changes are common, so monitor growth in children.

Evidence & guidelines

NICE recommends methylphenidate as a first-line medication option for ADHD in most age groups after a comprehensive diagnostic assessment.