Disclaimer: This article is for informational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.
Overview
Methylphenidate is a prescription stimulant medicine used to treat attention deficit hyperactivity disorder (ADHD). In Canada it is sold as the long-acting brands Concerta, Biphentin and Foquest, and as generic short-acting and sustained-release tablets. Ritalin, the original brand, was discontinued in Canada in 2022. The same medicine is still available as generic tablets.
Health Canada has authorized methylphenidate for ADHD in children from age 6, adolescents and adults, as part of a treatment program that also includes psychological, educational and social support. Short-acting methylphenidate is also authorized for narcolepsy. It is a controlled drug because it can be misused and can lead to dependence.
Methylphenidate is normally started and followed by a treating doctor after an ADHD diagnosis. It is not handled by a phone prescription. BC residents can speak with a BC-licensed doctor by phone through Avee Health about their symptoms and next steps.
In Canada, methylphenidate is authorized for:
- ADHD in children from age 6, adolescents and adults
- Narcolepsy (short-acting and sustained-release tablets only)
It is not authorized for children under 6 or for adults over 65. It does not cure ADHD and is meant to be used along with other support. It is not authorized for weight loss, or to improve focus or performance in people who do not have a diagnosed condition.
Methylphenidate
Central nervous system stimulant
mental health
Prescription required
Available
How Methylphenidate Works
Methylphenidate is a central nervous system stimulant. In people with ADHD it can improve attention and reduce impulsive and overactive behaviour. The exact way it works in ADHD is not fully known.
The products differ mainly in how long one dose lasts:
- Short-acting tablets wear off within a few hours, so they are taken 2 or 3 times a day.
- Sustained-release 20 mg tablets last about 8 hours.
- Concerta and Biphentin are taken once in the morning and are designed to work through the day.
- Foquest is taken once in the morning. In studies its effect lasted up to 13 hours in children and up to 16 hours in adults.
Dosage Instructions of Methylphenidate
Your doctor sets your dose. The usual doses in the Canadian product monographs are:
- Concerta (long-acting tablet): start at 18 mg once a day in the morning. The dose can be adjusted once a week. The maximum is 54 mg a day for children and adolescents aged 6 to 18, and 72 mg a day for adults.
- Biphentin (long-acting capsule): start at 10 to 20 mg once a day in the morning, raised by 10 mg a week if needed. The maximum is 60 mg a day for children and adolescents, and 80 mg a day for adults.
- Foquest (long-acting capsule): start at 25 mg once a day in the morning. The dose is adjusted no more often than every 5 days. The maximum is 70 mg a day for children and adolescents, and 100 mg a day for adults.
- Short-acting tablets: children start on a low dose that is raised by 5 to 10 mg a week. Adults usually take 20 to 30 mg a day, split into 2 or 3 doses. The maximum is 60 mg a day. If the medicine keeps you awake, take the last dose before 6 p.m.
Concerta, Biphentin and Foquest can be taken with or without food. Swallow Concerta and sustained-release tablets whole. Do not chew, split or crush them. The empty Concerta tablet shell may pass out in the stool, which is normal. Biphentin and Foquest capsules are also swallowed whole. If you cannot swallow them, open the capsule, sprinkle all of the contents on a spoonful of applesauce, yogurt or ice cream, and eat it right away without chewing. Do not sprinkle the contents into liquids.
Missed dose: if you miss the morning dose of a long-acting form, do not take it in the afternoon. Take your usual dose the next morning. If you miss a short-acting dose, take it as soon as you can and space out the rest of that day's doses. Never take a double dose.
Do not change your dose or stop the medicine without talking to your doctor.
Storage Instructions
Store Concerta, Biphentin and Foquest at room temperature, between 15°C and 30°C, and protect them from moisture. For other products, follow the label. Keep methylphenidate in a safe place, out of sight and reach of children, pets and anyone it was not prescribed for.
Side Effects of Methylphenidate
The most common side effects are decreased appetite, trouble sleeping, headache, nervousness, nausea, stomach pain and dry mouth. In a clinical trial of Biphentin in adults, they were reported by:
- Headache: 28% of people, compared with 24% on placebo
- Decreased appetite: 26%, compared with 6%
- Nervousness: 24%, compared with 4%
- Trouble sleeping: 22%, compared with 10%
- Nausea: 20%, compared with 8%
- Anxiety: 18%, compared with 0%
- Dry mouth: 12%, compared with 2%
In a 4-week trial of Concerta in children, headache was reported by 14% (10% on placebo), stomach pain by 7% (1%) and trouble sleeping by 4% (1%). Methylphenidate can also raise blood pressure and heart rate.
Get medical help right away if you have:
- Chest pain, fainting, shortness of breath, or a very fast or irregular heartbeat
- New or worse agitation or aggression, hearing or seeing things that are not there, unusual or manic behaviour, or thoughts of suicide or self-harm
- A seizure
- A painful erection, or one that will not go away
- Fingers or toes that feel numb, cold or painful, or that change colour
- Signs of a serious allergic reaction, such as swelling of the face or throat or trouble breathing
Important Safety Information About Methylphenidate
- Misuse and dependence (boxed warning): like other stimulants, methylphenidate can be abused and can lead to dependence and tolerance. Take it only as prescribed, never share it, and keep it in a safe place.
- Who should not take it: people with symptomatic heart disease, moderate or severe high blood pressure, advanced hardening of the arteries, an overactive thyroid, glaucoma, or an allergy to methylphenidate. Some products also must not be used by people with marked anxiety, tension or agitation, tics or Tourette's syndrome (or a family history of it), a history of drug abuse, or a tumour of the adrenal gland called pheochromocytoma.
- MAOI antidepressants: do not take methylphenidate with an MAOI or within 14 days of stopping one.
- Heart: sudden death has been reported in children and adolescents with structural heart problems, and serious heart events have been reported in adults. Tell the doctor about any heart problem or family history of heart problems. Blood pressure and heart rate are checked during treatment.
- Mental health: methylphenidate can cause or worsen psychotic or manic symptoms, aggression and suicidal thoughts. Tell the doctor about any mental health history.
- Growth in children: long-term stimulant use can slow weight gain and growth in height, so children on long-term treatment are monitored.
- Circulation: stimulants can reduce blood flow to the fingers and toes (Raynaud's phenomenon). Symptoms are usually mild and come and go.
- Driving: methylphenidate may affect performance. Be careful when driving or using machines until you know how it affects you.
- Pregnancy and breastfeeding: methylphenidate is used in pregnancy only if the benefit outweighs the risk to the baby. It passes into breast milk, so you and your doctor need to decide between breastfeeding and treatment. Tell your doctor if you are pregnant or planning a pregnancy.
Drug Interactions
Tell your doctor and pharmacist about everything you take, including non-prescription and herbal products. The main interactions are:
- MAOI antidepressants: must not be combined, or used within 14 days of each other. A dangerous rise in blood pressure can result.
- Clonidine: serious events, including sudden death, have been reported when the two were used together.
- Medicines that raise serotonin, such as some antidepressants: serotonin syndrome has been reported.
- Blood pressure medicines: methylphenidate can make them less effective.
- Warfarin, some seizure medicines and some antidepressants: methylphenidate can slow how the body breaks them down, so their doses may need to be adjusted.
- Antipsychotic medicines: movement side effects can appear when the two are used together.
- Anaesthetics: tell the surgical team you take methylphenidate before any operation, because some anaesthetic gases can cause a sudden rise in blood pressure and heart rate.
- Alcohol: avoid it during treatment. It can make side effects on the brain and nervous system worse.
Brands & DIN Number of Methylphenidate
Brand Names
- Concerta
- Biphentin
- Foquest
Key Takeaways
- 1Methylphenidate is a controlled stimulant authorized in Canada for ADHD in children from age 6, adolescents and adults.
- 2The long-acting brands are Concerta, Biphentin and Foquest. Short-acting tablets are sold as generics. The Ritalin brand was discontinued in Canada in 2022.
- 3Long-acting forms are taken once in the morning. Short-acting tablets are taken 2 or 3 times a day.
- 4Misuse and dependence are a boxed warning. Take it only as prescribed, never share it and store it safely.
- 5Serious risks include heart problems, new or worse mental health symptoms and slower growth in children.
- 6Common side effects are decreased appetite, trouble sleeping, headache, nervousness, nausea and dry mouth.
- 7It is normally started and followed by a treating doctor. BC residents can speak with a BC-licensed doctor by phone about symptoms and next steps.
Frequently Asked Questions
How much does methylphenidate cost in Canada, and does BC PharmaCare cover it?
Who prescribes methylphenidate in BC?
What is the difference between short-acting and long-acting methylphenidate?
Is Ritalin still available in Canada, and is there a generic?
Can methylphenidate be addictive?
Can methylphenidate affect a child's growth?
Can I drink alcohol while taking methylphenidate?
Is methylphenidate safe in pregnancy or when breastfeeding?
Avee Editorial
Avee Editorial Team