How it works
What does methylphenidate do?
Methylphenidate is a central nervous stimulant, sometimes called a CNS stimulant, which makes more noradrenaline and dopamine available in your brain.
It might seem odd that you would use a stimulant as a treatment for hyperactivity, but in people with ADHD, stimulant medicines do not make them more active (as they do in other people). Instead these medicines make them better able to focus.
Methylphenidate stimulates centres in the brain that are underactive in people with ADHD, such as the bits of the brain involved with concentration.
Methylphenidate helps people with ADHD to increase their attention span and concentration. It also helps them to stop acting on impulse without thinking.
Methylphenidate works by blocking noradrenaline and dopamine (two chemicals in the brain that carry messages between nerve cells) from being taken back up into the nerve cells in the brain after being released. This results in higher levels of noradrenaline and dopamine between the nerve cells and allows these chemicals to hang around for longer.
Having higher levels of noradrenaline and dopamine in the brain affects different parts of the body, including the heart, the gut, and the lungs. Overall, this leads to the good effects of the medicine, but it can also produce unwanted side effects. It is hard to control how much of each effect someone will experience, as every person is different.
In people with narcolepsy, the action of methylphenidate (as explained above) helps them to stay awake and alert.
Methylphenidate is a controlled drug. This means that the pharmacy must store the tablets extra securely by locking them in a cupboard. The doctor must also write extra things on the prescription, like the total amount needed in words and figures to make it harder for a genuine prescription to be altered.
A prescription for methylphenidate must be dispensed by the pharmacy within 28 days of the prescription being written (you can keep most other prescriptions for six months).
You cannot get an emergency supply of methylphenidate without a prescription.
This is all because methylphenidate can make people without ADHD feel high, and it might be sold as a street drug.
If you must take it to school, it might have to be locked in a safe place.
How long does methylphenidate take to start working?
It can take a few weeks for methylphenidate to show its full effect.
You should see improvements in your concentration and other symptoms within one month of starting the medicine.
Your doctor might start you on a low dose and then increase it slowly over two to four weeks to your full dose.
How long will I need to take methylphenidate?
Many people take methylphenidate for a year, and then check to see if they still need it. You and your doctor should talk about how long you need to take methylphenidate.
After a year, the doctor may stop the medicine (this is known as a drug ‘holiday’) to see if you still need it. They will probably do this during a holiday if you are at school.
Some people find that they need to take methylphenidate for several years.
Medication is just one part of treatment for ADHD. Methylphenidate is prescribed as part of a wider treatment plan including educational, social and psychological counselling.
Your doctor needs to know if...
You need to talk to your doctor or pharmacist before starting treatment with methylphenidate if you have or have had any of the following conditions:
- heart or blood circulation problems
- tics (movements you cannot control), or if someone in your family has Tourette’s syndrome
- dependence on drugs or alcohol in the past
- other mental health conditions, like depression, personality disorders, mania or anorexia nervosa
- thoughts of taking your own life
- an overactive thyroid
- increased pressure in the eye (glaucoma)
- a tumour in the adrenal gland (phaeochromocytoma)
- an allergy to methylphenidate or the other ingredients of the medicine
Different brands of methylphenidate contain lactose, wheat starch and gelatin – check your type if any of these are a problem for you.
Ritalin®, Matoride XL® and Concerta XL® tablets may not be suitable for you if you have problems eating some sugars or dairy (milk-based) foods, as they contain lactose.
Ritalin® tablets contain wheat starch. This is still OK to take if you have coeliac disease, but not if you have chronic diarrhoea (fatty loose poo).
Ritalin® tablets, Equasym XL® capsules and Medikinet XL® capsules contain gelatin.
How can methylphenidate be taken?
Methylphenidate comes as a plain tablet in 5mg, 10mg and 20mg strengths.
It also comes in modified-release capsules (the ones with an XL by the name) which release methylphenidate slowly. These come in 5mg, 10mg, 20mg, 30mg 40mg, 50mg and 60mg strengths. You can also get modified-release tablets (also with XL by the name) that come in 18mg, 27mg 36mg and 54mg strengths.
The usual maximum dose to 60mg in a day.
Some brands of methylphenidate tablets and capsules can help people who have trouble swallowing medicines. Ritalin® tablets can be broken in half - or crushed and mixed with a small amount of soft food such as yogurt, honey or jam - to make them easier to swallow. Equasym XL® and Medikinet XL® capsules can be opened, and the contents can be sprinkled on a tablespoon of apple sauce (or yoghurt with Medikinet XL) for swallowing without chewing.
You should only take methylphenidate as agreed with your doctor.
You will get the best effect from your methylphenidate if you do not miss any doses.
Try to get into a routine to help you remember to take your medicine, such as taking it with meals or when you brush your teeth.
Make sure that you know your dose. If it is not written on the label, check with your pharmacist or doctor.
Taking methylphenidate with food can help you to avoid side effects of feeling sick, being sick, or having stomach pains (but see below if you take the Equasym XL brand of methylphenidate).
Avoid taking your methylphenidate doses after 4pm. If you take methylphenidate after 4pm, it could make it harder for you to get to sleep.
The ‘plain’ methylphenidate tablets need to be taken two or three times a day. Plain methylphenidate tablets can be taken with or without food, but taking them with meals might help you to remember to take them.
The plain methylphenidate tablets can be broken in half or crushed and mixed with a small amount of soft food such as yogurt, honey or jam to make them easier to swallow.
There are several brands of ‘slow-release’ methylphenidate tablets or capsules (they may also be referred to as ‘modified-release’ or ‘XL’). These release some of the methylphenidate straight away but release the rest slowly throughout the day. For this reason, they can be taken less often.
The Equasym XL brand of methylphenidate needs to be taken in the morning before breakfast. Some people who take this brand may find that it wears off in the late afternoon or early evening, in which case the doctor may prescribe a dose of the plain methylphenidate tablet for you to take at this time.
The Medikinet XL brand of methylphenidate should be taken in the morning, with or after breakfast.
The Concerta XL, Xenidate XL, and Matoride XL brands of methylphenidate should be taken in the morning, but this can be before, with, or after breakfast.
It is important not to break or chew the slow-release methylphenidate tablets or capsules. This is because they have a special system in them to deliver the medicine into your body over a few hours, which could be damaged if you chew or break them.
However, you can empty out the contents of Equasym® XL and Medikinet XL® capsules on to a tablespoon of apple sauce and swallow it without chewing. Medikinet XL® can also be added to yogurt.
What if I miss a dose?
If you remember later during the morning, take it as soon as possible.
If you forget to take it by lunchtime, just start again on the next day.
Do not take a double dose.
There are tablets and capsules that you can take once a day. If this would help you to remember, ask your doctor about them.
What will happen if I forget to take my methylphenidate?
If you forget to take methylphenidate for a few days, your symptoms may come back.
Stopping the use of methylphenidate
Once you start taking methylphenidate, the brain adjusts to having a new level of noradrenaline and dopamine around. If you stop taking methylphenidate all at once, the balance of these chemicals starts to change again. You could get some unwanted symptoms from the change.
Your ADHD symptoms could also return, or the sudden drop in noradrenaline and dopamine in your brain could bring on symptoms of depression.
You can stop taking it safely with your doctor’s help.
Go and speak to your doctor if you have missed a few doses or have decided to stop taking your medication.