January 2019

Methylphenidate (Ritalin)

Dr. Joseph E. Graas, Scientific Director
Dr. Edward Moore, Medical Director
Dr. Paul Robandt, Scientific Director

Methylphenidate was first synthesized in 1944 and approved for medical use in the United States in 1955.  Methylphenidate is a sympathomimetic amine that is prescribed primarily for attention deficit hyperactive disorder (ADHD) but can also be prescribed for narcolepsy.

Methylphenidate improves function by improving the action of catecholamine in the brain.1 Off-label uses for methylphenidate include treatment-resistant bipolar disorder and major depressive disorder.2 In 2013 it was estimated that 2.4 billion doses were taken world-wide, with 80% of the consumption in the United States.

For ADHD, methylphenidate is estimated to be effective in 70% of legitimate cases.  It is considered a safe, cost-effective compound to manage ADHD.  When used effectively, patients generally have better relationships with family and peers, perform better at work and school, and are less likely to engage in risky behaviors.  However, as ADHD diagnosis around the world increases, the risk of misdiagnosis can occur and some say that the drug can cause more harm than good in some populations.

Therapeutic doses of methylphenidate can improve memory, performance and concentration, so most methylphenidate misuse is often found in higher education and overworked individuals.  Higher doses of methylphenidate can interfere with any improvement seen with lower doses, and it has been suggested that students using methylphenidate as a study aid may be compensating for other issues.3 26% of teens believe that methylphenidate is a legitimate study aid.4

Side effects can include nervousness, insomnia, rash, anorexia, dizziness and nausea.  Patients should be checked for blood pressure and heart rate before taking any stimulant treatment, and periodically thereafter.  Methylphenidate can cause serious heart or blood vessel problems, particularly in patients with a family history of heart disease.  Raynaud phenomenon, a circulatory problem where the small blood vessels in the extremities over-react to temperature changes, can occur more frequently in patients treated with methylphenidate.

There is an alarming ease of access of stimulant drugs to the public.  Methylphenidate is listed by the Drug Enforcement Agency (DEA) as one of the “most stolen” medications.  In 2013, 12% of US teenagers reported misusing a prescription stimulant drug in their lifetime, 5% within the last month.  The DEA has collected reports indicating that those who legitimately receive Methylphenidate may give or sell it to peers who misuse it. Methylphenidate may also be diverted through “Attention Deficit Scams” in which an adult obtains several prescriptions for methylphenidate for a child. The adult may use the drug themselves or divert it for personal gain.

Severe toxic effects of methylphenidate injection have been observed in the IV drug-user population.  A Swiss study noted that of the four IV-use cases reported to them, injection resulted in one abscess and two amputations.  However, the researchers did note that the individuals were multiple-substance abusers and had a history of IV drug use.5 This is most likely due to the tablet fillers that do not dissolve in water when a solution is prepared for injection. The illicit use for memory enhancement and recreational use can certainly lead to serious medical problems which are, in the long term, not worth the risk. The legal and prescribed use of Methylphenidate is safe and effective for treating certain disorders under the care of a physician.

REFERENCES 

  1. “Methylphenidate Hydrochloride Monograph for Professionals”. Drugs.com. AHFS. Retrieved 19 December 2018.
  2. Dell’Osso B, Dobrea C, Cremaschi L, Arici C, Altamura AC (December 2014). “Wake-promoting pharmacotherapy for psychiatric disorders”. Curr Psychiatry Rep. 16 (12): 524.
  3. Abelman, Dor David (2017-10-06). “Mitigating risks of students use of study drugs through understanding motivations for use and applying harm reduction theory: a literature review”. Harm Reduction Journal. 14 (1): 68.
  4. The Partnership Attitude Tracking Study: Teens and Parents 2013, MetLife Foundation, April 2013
  5. Brugisser, M., et.al., Severe toxicity due to injected but not oral or nasal abuse of methylphenidate tablets, Swiss Med Wkly. 09.10.2011