Methylphenidate

Medication name

Methylphenidate ("MEE-thile-FEN-i-date")
Brand names
Affenid XL (AF-fen-id)

Concerta XL ("con-SERT-a")

Delmosart (“DEL–mo–sart”)

Equasym XL ("ECK-wa-sim")

Matoride XL ("MAT-o-ride")

Medikinet and Medikinet XL ("medi-KIE-net")

Ritalin ("RIT-a-lin")

Xaggitin XL (“ZAG-it-in”)

Xenidate XL ("ZEN-i-date")
Medication type

Central nervous stimulant

Tablets: 5mg, 10mg and 20mg strengths (Medikinet, Ritalin and Tranquiyn)

Modified-release capsules: 5mg, 10mg, 20mg, 30mg, 40mg, 50mg and 60mg strengths (Equasym XL, Medikinet XL, Metyrol XL, Ritalin XL)

It is possible to open the capsules and sprinkle the content into soft food if it helps you to take the medicine. Just don’t chew or crush the granules before swallowing them.

All modified release capsules contain a mixture of immediate release and modified release methylphenidate. This mixture varies between different brands.

If you are prescribed a modified release capsule it will be prescribed by brand name to make sure you get the same product each time. Switching between products can change the way the medicine is released into your body and might mean your symptoms are not as well controlled.

Prolonged-release tablets: 18mg, 27mg, 36mg and 54mg strengths (Affenid XL, Delmosmart, Matoride XL, Xaggitin XL, Xenidate XL and Concerta XL)

Prolonged release tablets need to be swallowed whole. Do not crush or chew them. An exception to this is Xenidate tablets which can be broken in half before taking. Always check the information leaflet or ask your pharmacist if you are unsure how to take them.

If you are aged six years and over, your doctor can prescribe methylphenidate as a licensed medicine for treatment of attention deficit hyperactivity disorder (ADHD).

If you started treatment when under 18 years old, this can be continued when you become an adult if you are still benefiting from the medication.
Methylphenidate may be prescribed for adults even if treatment wasn’t prescribed before the age of 18.

Read our guide to ADHD and mental health

About methylphenidate

Methylphenidate is a central nervous stimulant (CNS). It can also be called a dopamine and noradrenaline reuptake inhibitor. This describes how it works in the brain.

Methylphenidate stimulates parts of the brain that are underactive in people with ADHD, like the bits of the brain involved with concentration. 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 help to improve concentration and ability to focus, and help with behaviour and other activities such as the ability to plan, organise time, manage emotions and make decisions.

Dopamine and noradrenaline are naturally occurring chemical messengers (or ‘neurotransmitters’) that have an important role in areas of the brain that control mood, thinking, feelings, emotions and perception. Methylphenidate works by blocking noradrenaline and dopamine 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 in people with narcolepsy, methylphenidate helps them to stay awake and alert.

Methylphenidate is a 'controlled drug'

This is because there is an increased risk of the medicine being supplied or sold illegally and misused.

Methylphenidate is a stimulant, so some people want to use it as a drug to get high or as a ‘performance-enhancer’ to help them work harder or revise for exams. There is little or no evidence to show this works, and it could cause serious side effects if taken by people who are not prescribed this medicine.

Sometimes people taking methylphenidate from their doctor may be targeted at school and bullied to give away or sell their medicine.

If someone is asking you to give away or sell your medicine, please ask your parent, teacher or doctor to help you. Never share (or sell) your medicine to anyone else. This is dangerous and illegal.

If you must take it to school, check with your teachers how to keep your medication safe until you need it.

There are special rules and laws for how controlled drugs are prescribed.

The doctor must write extra information 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 and collected within 28 days of the prescription being written. Other prescriptions for medication that isn’t a controlled drug are valid for up to six months.
You cannot get an emergency supply of methylphenidate without a prescription.

Methylphenidate and everyday life

Methylphenidate can start to work after the first dose, but it may take a few weeks for you to feel the full effects. Further improvements in your symptoms can then increase with time.

Your doctor might start you on a low dose and then increase it slowly over two to four weeks, sometimes longer. The doctor will monitor your symptoms and find the dose that works best for you. You should see improvements in your concentration and other symptoms within one month of starting the medicine, usually within the first week of taking it.

Methylphenidate can sometimes affect your growth. Your doctor will check your height and weight at least every six months when you are on methylphenidate.

Up to one in ten children and young people who take methylphenidate might not grow as fast as their friends. If this happens to you, your doctor might stop the methylphenidate for a while.

Methylphenidate can also affect your weight. It makes some people want to eat less, and this might result in weight loss. Weight loss is more common, but methylphenidate can also cause weight gain.
It is very difficult to know how this will affect each person who takes it.

Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking methylphenidate.

A very common side effect of methylphenidate is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking methylphenidate so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Methylphenidate is a stimulant and can therefore affect your sleep by keeping you awake. Talk to your doctor about this if it is a problem for you.

To get the best chance of sleeping normally, you should take your tablets early in the day, and ideally no later than lunchtime or early afternoon.

This advice may vary depending on whether your medicine is an immediate release or slow release product.

Depending on your lifestyle, studying or work, you may find taking a dose of your medication later in the day manages your symptoms better in the evening and helps you more. Discuss this with your doctor to work out what works best for you.

For some people, it can make you feel more drowsy than normal.

If the medication helps to improve your ADHD symptoms, this may also help to improve your sleep.

Alcohol

Drinking alcohol while taking methylphenidate can make the effect of the medication greater and you could experience side effects as if you have taken too much of it.

It is recommended that you don’t drink alcohol until you know how the medicine affects you.

If you decide to drink alcohol, only drink in small amounts and see how it affects you.

When combined, methylphenidate and alcohol can cause unpredictable effects. The combination may increase your blood pressure and heart rate. Methylphenidate can also reduce the effects of alcohol which may mean you end up drinking more than you realise which could be very dangerous.

It is advisable not to drink alone, so that there is someone else there to help you if you need it.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

Methylphenidate is dangerous to take with cocaine, ecstasy or amfetamines. This is because they are all stimulants and may together put too much pressure on your heart and the blood vessels in your brain.

Tetrahydrocannabinol (THC) is a compound found in cannabis. If mixed with methylphenidate this can increase your pulse and blood pressure putting more strain on your heart and blood vessels.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis.

There is limited information about the effects of mixing methylphenidate with opioid drugs like heroin or methadone, but this could result in effects which are dangerous and unpredictable.

Methylphenidate is a stimulant, so some people want to use it as a drug to get high or misuse methylphenidate as a ‘performance-enhancer’ to help them work harder or revise for exams. People taking methylphenidate from their doctor can be targeted at school and bullied to give away or sell their medicine. If someone is asking you to give away or sell your medicine, please ask your parent, teacher or doctor to help you. Never share or sell your medicine to anyone else – this is dangerous and illegal.

Methylphenidate can produce a false positive test for amfetamines and LSD on a urine drug screen. Talk to your doctor about this if it is a problem for you.

There are many other street drugs, but we don’t know what effect taking them with methylphenidate will have, so it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on our drugs and alcohol guide.

Methylphenidate does not mix well with some other medicines and herbal remedies.

Do not take methylphenidate if you are taking a medicine called a monoamine oxidase inhibitor (MAOI) used for depression, or if you have taken a MAOI in the last 14 days. MAOIs include isocarboxazid, phenelzine, tranylcypromine and moclobemide. Taking a MAOI with methylphenidate may cause a sudden dangerous increase in your blood pressure.

If you are taking other medicines, check with your doctor or pharmacist before taking methylphenidate, as it may affect how well they work or cause side effects.

Tell the doctor if you are going to have an operation. You may need to stop methylphenidate for that day as it does not mix well with some anaesthetics used in surgery. You also need to tell the team doing your operation if you are taking methylphenidate well in advance of it taking place.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with methylphenidate. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

Different brands of methylphenidate contain lactose, wheat starch and gelatine. Check your type if any of these are a problem for you.

Afenid®, Ritalin®, Delmosart®, Matoride XL®,Xaggitin XL® and Concerta XL® tablets may not be suitable for you if you have problems eating some sugars or dairy foods, as they contain lactose. Xenidate XL contains sucrose. An unbranded plain tablet that contains neither lactose nor sucrose is available. Ask your pharmacist.

Ritalin® tablets contain wheat starch. This is still okay to take if you have coeliac disease, but not if you have wheat intolerance leading to chronic diarrhoea (fatty, loose poo).

Ritalin® tablets, Equasym XL® capsules and Medikinet XL® capsules contain gelatine.

If you need to avoid animal products such as gelatine, please note that this is often found in capsules but also in some tablet formulations. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Taking methylphenidate may give you blurred vision, make you feel dizzy, or affect your focus when you start taking it.

It may be best to stop doing things like driving a car, riding a bike, or anything else that needs a lot of focus for the first few days until you know how it affects you.

Most people drive as normal while taking methylphenidate. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

You must tell DVLA if your ADHD or your ADHD medication affects your ability to drive safely. It is illegal to drive with medication in your body if it impairs your driving. You do not need to tell DVLA about your condition unless you think that it may affect your ability to drive safely. If you think you driving might be affected by your ADHD or your medication, don’t drive and speak to your doctor.

You may also have to prove that you have been given methylphenidate on prescription, so you should keep your repeat prescription slip or get a letter to explain it from your doctor.

Pregnancy

Taking methylphenidate in early pregnancy has been associated with an increased risk of miscarriage.

If you become pregnant while you are on methylphenidate, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing methylphenidate and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking amitriptyline during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Any decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking methylphenidate while pregnant, you should tell your midwife. If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with methylphenidate.

Postnatal

Some newborn babies whose mothers take methylphenidate during pregnancy can get withdrawal symptoms at birth and soon after, like restlessness, feeding problems or being floppy.

Tell your midwife if you are taking methylphenidate, so that they can help if the baby has nay symptoms after birth.

Breastfeeding

Methylphenidate can be passed to the baby in breastmilk in very small or undetectable amounts.

If your baby was born early, then breastfeeding while you are taking methylphenidate may not be recommended. Talk to your midwife and doctor about feeding options.

If you breastfeed while taking methylphenidate, seek urgent medical advice if your baby becomes restless, very sleepy or develops feeding problems.

Please talk to your midwife, doctor or pharmacist if you want to breastfeed whilst taking methylphenidate. They can discuss feeding options with you and help you to weigh up the benefits and possible risks based on what we currently know so you can make a decision that is best for you and your baby.

Sex

Methylphenidate can have side effects that may affect your sex life. These include:

having a lower sex drive or not wanting to have sex
losing weight, which might impact your confidence
mild hair loss, which can affect your body confidence

Some other uncommon or rare side effects include some breast growth or a long-lasting and painful erection (priapism), which needs to be treated in hospital.

Untreated ADHD can have a negative effect on your sex life, so if methylphenidate helps you then the positive effects can include improving your desire, experience and enjoyment of sex as your symptoms settle and you can concentrate on your relationships.

Fertility

There is currently no evidence to suggest that methylphenidate has any effect on fertility.

Talk to your doctor about your methylphenidate if you are trying to get pregnant or planning a family.

Methylphenidate is a banned substance in competitive sport. If you play sports to a high level, and you want to compete where testing will happen you need to inform regulators. You must not take methylphenidate during competitions. Discuss this with your doctor and they can recommend other treatment options for managing your ADHD during this time.

Most people play sports as normal while taking methylphenidate, but if methylphenidate affects your concentration or co-ordination, then you may want to wait to see if those effects go away before playing sports that need a lot of focus. If you have any concerns, discuss this with your doctor.

Taking methylphenidate may affect your concentration, give you blurred eyesight and make you feel dizzy or tired.

Ideally, it’s best not to take methylphenidate for the first time just before your exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking methylphenidate.

You should talk to your doctor about any future exams if you are starting methylphenidate. You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start methylphenidate to improve your sleep, motivation and ability to study.

Most people take exams as normal while taking methylphenidate, but if you have any concerns, discuss this with your doctor. give you blurred vision, make you feel dizzy, or affect your focus when you start taking it.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking methylphenidate

It is likely that you will take methylphenidate for several years or more. If you start this medicine when you are under 18, it may still help you when you are an adult.

Your specialist doctor should review your treatment regularly with you (at least once a year) and discuss whether you think the medicine is still helping you.

You and your doctor may agree to try a break in treatment (sometimes called a ‘drug holiday’) to see how you feel. This can help you decide whether it would be best to continue with your medicine or not.

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.

You will get the best effect from your methylphenidate if you take it regularly at the dose prescribed by your doctor. Try to get into a routine to help you remember to take your medicine, such as taking it with breakfast or when you brush your teeth.

Avoid taking your methylphenidate doses after 4pm. If you take methylphenidate after 4pm, it could make it harder for you to get to sleep.

However, if your ADHD symptoms are better controlled, this may help you sleep better, and depending on your lifestyle, college and work schedule, you may find taking a dose later in the day helps you. Discuss this with your doctor to find out what works best for you.

Taking methylphenidate with food can help you to avoid side effects of feeling sick, being sick, or having stomach pains but this may apply differently to different brands.

The ‘plain’ (immediate release) methylphenidate tablets need to be taken two or three times a day. These can be taken with or without food but taking them with meals might help you to remember to take them. They 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 manufacturers of Equasym XL® brand of methylphenidate advise that it should be taken in the morning before breakfast. If you take this medicine with fatty food it can delay how quickly it is absorbed into your body so it might take longer for it to work.

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. The exception to this is Xenidate XL ® tablets which are scored and may be broken in half once before taking if needed.

However, you can empty out the contents of Equasym XL®, Ritalin XL® and Medikinet XL® capsules on to a tablespoon of apple sauce and swallow it without chewing. Ritalin XL® and Medikinet XL® can also be added to yogurt.

If your medication helps you but you feel like the benefits wear off during the day, talk to your specialist doctor about how to manage this. A different form of methylphenidate that releases the medicine over a longer time during the day might help.

If you remember later during the morning, take it as soon as possible. If you don’t remember until after lunchtime, wait and start taking your medication again the next day. Do not try and catch up by taking a double dose.

If you forget to take methylphenidate for a few days, your symptoms may come back.

You may get an unwanted effect of feeling very low as the chemicals in your brain change their balance, with less noradrenaline and dopamine around. You may also feel very tired.

If you miss doses, even if you didn’t mean to, it is helpful to record how you managed during the day and how you felt. This will be useful to share with your doctor when they next review your medication with you.

You can stop taking methylphenidate safely and gradually with your doctor’s help.

Speak to your doctor if you decide you want to stop your medicine. Your doctor will also assess if the medication is still helping you at each treatment review and talk to you about trying a treatment break if appropriate.

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.

If you are on a low dose, you will be able to stop it suddenly. If you are on a higher dose, it may be better to reduce the dose before stopping it.

It is safe to stop this medication suddenly, but stopping it abruptly, or reducing the dose too much at once, may cause uncomfortable withdrawal symptoms. These may include feeling tired, low mood or irritability, increased appetite, aches and pains.

Not everyone experiences these, but it is important to be aware of them so you know what to look out for. They are caused by the brain adjusting to not having the medicine, and some may be due to a return of ADHD symptoms. If you do experience any withdrawal symptoms, they should stop after a few days. If they do not, or they are stopping you getting on with your life, discuss this with your doctor.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

being sick
feeling very happy, agitated or confused
shaking or muscle movements that you cannot control
having a seizure (fit), which can lead to a coma
hallucinations (seeing, feeling or hearing things that are not real)
sweating, flushing or high fever
headache
changes in your heartbeat (slow, fast or uneven)
high blood pressure
your pupils dilating (getting bigger)
dry nose and mouth

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

While taking methylphenidate you may have thoughts about hurting yourself or taking your own life. These thoughts could be caused by mental illness or may be a side effect of your medicine.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

Methylphenidate can cause serious side effects, including allergic reactions.

Stop taking methylphenidate and go to a hospital straight away if you get any of the following symptoms:

severe headache, numbness, weakness, paralysis and any changes or impairment to vision, speech, language, memory or coordination
difficulty breathing
an allergic reaction or allergy (including symptoms such as swelling of your face, eyelids, lips, tongue or throat so that you cannot swallow or breathe, really bad itching of the skin with raised lumps, rash, blistering, scaling, redness, peeling of skin or hives)
fast, uneven heartbeat and fainting (this could mean a life-threatening condition called Torsades de Pointes)
seizures or fits
a painful erection (priapism) that lasts longer than three hours

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking methylphenidate, if you get any of the following symptoms:

concerns about weight loss, weight gain, or slower growth
any changes or worsening of your mood or behaviour
feeling or hearing things that are not real or believing things that are not true
your behaviour changes because you feel very happy or over-excited
uncontrolled speech or body movements
uneven or racing heartbeats that feel like thumping inside your chest

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking a new medicine. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor, specialist team or pharmacist about them.

Very common side effects of taking methylphenidate (affecting more than one in ten people) include:

headache – try paracetamol or talk to your pharmacist about options to help
feeling nervous
feeling sick
dry mouth
not being able to sleep
loss of or decreased appetite
Common side effects of methylphenidate (affecting up to one in ten people) include:
feeling unusually sleepy or drowsy
itching, rash or raised red itchy rashes (hives)
hair loss
fast heartbeat (tachycardia), raised blood pressure (you may not get any symptoms of this)
feeling dizzy, experiencing movements which you cannot control, being unusually active
feeling aggressive, agitated, anxious, depressed, irritable and generally behaving unusually
stomach pain, diarrhoea, or feeling sick or being sick (these usually occur at the beginning of treatment and may be reduced by taking the medicine with food)
irritation of the nose and throat areas
joint pains

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Additional monitoring is recommended with this medicine to check for any unwanted changes the medicine might cause and make sure your doctor can review them quickly.

Before you start taking methylphenidate, and at least every six months after you start, the doctor will do some tests to check that methylphenidate is still right for you.

They will ask about your appetite, as methylphenidate can make you want to eat less.

They will check your weight and height, as methylphenidate can make you grow more slowly.

They will check your heart rate and blood pressure, as methylphenidate can sometimes increase these.

They will also ask you about your mood and how you are feeling, to check that the medicine is working but also whether you are having any side effects.

They will ask you about any feelings of aggression or dislike towards others, which can be a side effect of the medicine.

Before starting methylphenidate, your doctor may also check your heart using an electrocardiogram (ECG).