only. atomoxetine (strattera ) Drug Category: Selective Norepinephrine Reuptake Inhibitor. Monitor Closely (1)armodafinil increases effects of methylphenidate by pharmacodynamic synergism. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. epinephrine racemic and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Serious - Use Alternative (1)ergoloid mesylates, methylphenidate. Methylphenidate may diminish antihypertensive effects. Modify Therapy/Monitor Closely. ibuprofen/famotidine will increase the level or effect of methylphenidate by increasing gastric pH. methylphenidate will increase the level or effect of phenobarbital by unknown mechanism. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. thioridazine, methylphenidate. nortriptyline, methylphenidate. Use Caution/Monitor. Methylphenidate OROS tablets are converted in an 18:5 ratio with methylphenidate. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. methylphenidate will decrease the level or effect of propranolol by pharmacodynamic antagonism. Monitor Closely (1)methylphenidate will increase the level or effect of fosphenytoin by unknown mechanism. Avoid or Use Alternate Drug. The recommended dose of CONCERTA for patients who are currently taking methylphenidate twice daily or three times daily at doses of 10 to 60 mg/day is provided in Table 2. Monitor BP. Use Caution/Monitor. Monitor BP. Use Caution/Monitor. Modify Therapy/Monitor Closely. Other (see comment). Use Caution/Monitor. Caffeine should be avoided or used cautiously. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. rotigotine, methylphenidate. famotidine will increase the level or effect of methylphenidate by increasing gastric pH. Monitor Closely (2)trifluoperazine, methylphenidate. Monitor BP. only. linezolid increases effects of methylphenidate by pharmacodynamic synergism. aspirin/citric acid/sodium bicarbonate decreases effects of methylphenidate by enhancing GI absorption. Use Caution/Monitor. Interaction more likely in certain predisposed pts. Desflurane. Contraindicated. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Use Caution/Monitor. Use Caution/Monitor. amitriptyline, methylphenidate. Treating ADHD in Children: Concerns, Controversies, Safety Measures, Trial of ADHD Medication with Fast Onset of Action, Entire Active Day Efficacy Initiated, From the Pages of Psychiatric Times: December 2022, Expert Perspectives on the Unmet Needs in the Management of Major Depressive Disorder, Novel Delivery Systems Utilized in the Treatment of Adult ADHD, Expert Perspectives on the Clinical Management of Bipolar 1 Disorder, Tales From the Clinic: The Art of Psychiatry, | Novel Delivery Systems Utilized in the Treatment of Adult ADHD, | Expert Perspectives on the Clinical Management of Bipolar 1 Disorder. Risk of acute hypertensive episode. Use Caution/Monitor. Mechanism: unknown. Use Caution/Monitor. Concerta is long-acting Ritalin (methylphenidate). Monitor Closely (1)loxapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Monitor Closely (1)methylphenidate will decrease the level or effect of clevidipine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Use Caution/Monitor. In general, administer drugs at least 2 hr before or after sodium zirconium cyclosilicate. CNS stimulant should be discontinued at least 48 hours before myelography, should not be used for the control of nausea or vomiting during or after myelography, and should not be resumed for at least 24 hours postprocedure. Use Caution/Monitor. Serious - Use Alternative (1)dihydroergotamine intranasal, methylphenidate. Use Caution/Monitor. Use Caution/Monitor. Monitor Closely (1)esketamine intranasal, methylphenidate. Risk of V tach, HTN. Mechanism: pharmacodynamic synergism. Other (see comment). Additive vasospasm; risk of hypertension. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Applies only to oral form of both agents. Monitor Closely (1)hydralazine, methylphenidate. Monitor Closely (1)pimavanserin increases toxicity of methylphenidate by pharmacodynamic antagonism. Mechanism: unknown. Monitor Closely (1)cocaine topical increases effects of methylphenidate by pharmacodynamic synergism. Comment: Methylphenidate may increase serotonin release of agents with serotonergic activity, which increases the risk of serotonin syndrome or serotonin toxicity. Monitor BP. Modify Therapy/Monitor Closely. Use Caution/Monitor. only.trifluoperazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Applies only to oral form of both agents. Use Caution/Monitor. Avoid or Use Alternate Drug. Caffeine is a CNS-stimulant and additive effects may be seen when coadministered with other CNS stimulants. Applies only to oral form of both agents. Use Caution/Monitor. The recommended dose of CONCERTA for patients who are currently taking methylphenidate twice daily or three times daily at doses of 10 to 60 mg/day is provided in Table 2. Modify Therapy/Monitor Closely. commonly, these are "preferred" (on formulary) brand drugs. promazine, methylphenidate. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. methylphenidate will decrease the level or effect of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor. Interaction more likely in certain predisposed pts. Contraindicated. Use Caution/Monitor. Monitor BP. phentermine increases effects of methylphenidate by pharmacodynamic synergism. diethylpropion increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Avoid or Use Alternate Drug. Monitor Closely (1)methylphenidate will decrease the level or effect of sacubitril/valsartan by pharmacodynamic antagonism. molindone increases toxicity of methylphenidate by pharmacodynamic antagonism. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. Applies only to oral form of both agents. only. Other (see comment). Monitor Closely (1)fenfluramine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Either increases effects of the other by pharmacodynamic synergism. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. quetiapine increases toxicity of methylphenidate by pharmacodynamic antagonism. methamphetamine increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. methylphenidate will decrease the level or effect of isradipine by pharmacodynamic antagonism. Monitor Closely (1)promazine, methylphenidate. Interaction more likely in certain predisposed pts. Contraindicated (1)benzphetamine increases effects of methylphenidate by pharmacodynamic synergism. Methylphenidate may diminish antihypertensive effects. Monitor BP. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. Use Caution/Monitor. Potential for additive CNS stimulation. Use Caution/Monitor. Use Caution/Monitor. Contraindicated (1)rasagiline increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Use Caution/Monitor. Modify Therapy/Monitor Closely. only.perphenazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Blood and lymphatic system disorders: Pancytopenia, thrombocytopenia, thrombocytopenic purpura, Cardiac disorders: Angina pectoris, bradycardia, extrasystole, supraventricular tachycardia, ventricular extrasystole, hypertension, Eye disorders: Diplopia, mydriasis, visual impairment, General Disorders: Chest pain, chest discomfort, hyperpyrexia, long-term growth suppression, Hepatobiliary disorders: Hepatocellular injury, acute hepatic failure, Immune system disorders: Hypersensitivity reactions such as angioedema, anaphylactic reactions, auricular swelling, bullous conditions, exfoliative conditions, urticaria, pruritus, rashes, eruptions, and exanthemas, Investigations: Alkaline phosphatase increased, bilirubin increased, hepatic enzyme increased, platelet count decreased, white blood cell count abnormal, severe hepatic injury, Musculoskeletal, connective tissue and bone disorders: Arthralgia, myalgia, muscle twitching, rhabdomyolysis, Nervous system disorders: Convulsion, grand mal convulsion, dyskinesia, serotonin syndrome in combination with serotonergic drugs, lethargy, somnolence, Psychiatric disorders: Disorientation, hallucination, hallucination auditory, hallucination visual, libido changes, mania, depression, drug dependence, Vascular system: Peripheral vasculopathy, including Raynaud phenomenon, Skin and subcutaneous tissue disorders: Alopecia, erythema, Hypersensitivity to methylphenidate or other components of product, Coadministration with monoamine oxidase inhibitors (MAOIs) or within 14 days after discontinuing MAOIs, Assess risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy, May cause an increase in blood pressure (BP) and heart rate (HR); monitor for hypertension and tachycardia, Prolonged and painful erections, sometimes requiring surgical intervention, reported with methylphenidate products, including another formulation of methylphenidate hydrochloride extended-release tablets, in both pediatric and adult patients, Priapism was not reported with drug initiation but developed during treatment, often after an increase in dose and during a period of drug withdrawal (drug holidays or during discontinuation); if such reaction occurs, seek immediate medical attention, CNS stimulants are associated with peripheral vasculopathy, including Raynaud phenomenon; signs and symptoms are usually intermittent and generally improve after dose reduction or discontinuing treatment; monitor for digital changes is necessary during treatment; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients, Closely monitor growth (weight and height) in pediatric patients treated with stimulants; patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted, Stimulants may lower the convulsive threshold in patients with a history of seizures, in patients with prior EEG abnormalities in absence of seizures, and, very rarely, in patients without a history of seizures and no prior EEG evidence of seizures; if seizures occur, discontinue drug, Difficulties with accommodation and blurry vision reported, Periodic complete blood cell count, differential, and platelet counts are advised during prolonged therapy, Published studies and postmarketing reports on use during pregnancy have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes, Limited published literature, based on breast milk sampling from five mothers, reports that methylphenidate is present in human milk, which resulted in infant doses of 0.16% to 0.7% of the maternal weight-adjusted dosage and a milk/plasma ratio ranging between 1.1 and 2.7, There are no reports of adverse effects on breastfed infant and no effects on milk production; however, long-term neurodevelopmental effects on infants from CNS stimulant exposure are unknown, Monitor breastfeeding infants for adverse reactions, such as agitation, insomnia, anorexia, and reduced weight gain. selegiline increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Monitor BP. Monitor BP. Applies only to oral form of both agents. The recipient will receive more details and instructions to access this offer. Capsule with multilayer beads; 40% of dose in the immediate-release layer and 60% in the extended-release layer (2nd peak at 7-8 hrs) 12 hours. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. Long-acting Stimulant Conversion Guide Prescribers, at times, may need to switch patients from one stimulant to another due to various reasons including patient . Contraindicated. Applies only to oral form of both agents. Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased. Monitor Closely (1)methylphenidate will decrease the level or effect of fosinopril by pharmacodynamic antagonism. Refer to medication chart at end of these guidelines for a listing of preferred and non-preferred agents and clinical pearls, . Ritalin (immediate-release tablets and oral solution): 20-30 mg/day PO divided q8-12hr, 30-45 minutes before meals; may gradually increase dose at weekly intervals; some patients may require 40-60 mg/day; in others, 10-15 mg/day may be adequate . Use Caution/Monitor. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. Modify Therapy/Monitor Closely. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. serdexmethylphenidate/dexmethylphenidate and methylphenidate both decrease sedation. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. Monitor Closely (1)protriptyline, methylphenidate. Use Caution/Monitor. lurasidone, methylphenidate. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Additive vasospasm; risk of hypertension. Use Caution/Monitor. Monitor Closely (1)methylphenidate will decrease the level or effect of ramipril by pharmacodynamic antagonism. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Use Caution/Monitor. Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. ergoloid mesylates, methylphenidate. lansoprazole decreases effects of methylphenidate by enhancing GI absorption. Use Caution/Monitor. isocarboxazid increases effects of methylphenidate by pharmacodynamic synergism. Use Caution/Monitor. Most Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Risk of acute hypertensive episode. Monitor BP. Aptensio XR. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Narcolepsy. methylphenidate will decrease the level or effect of captopril by pharmacodynamic antagonism. Use Caution/Monitor. . Use Caution/Monitor. Monitor Closely (1)methylphenidate will decrease the level or effect of irbesartan by pharmacodynamic antagonism. Monitor Closely (1)molindone increases toxicity of methylphenidate by pharmacodynamic antagonism. Methylphenidate may diminish antihypertensive effects. hydrocodone, methylphenidate. Use Caution/Monitor. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. Monitor Closely (1)methylphenidate decreases effects of iohexol by unspecified interaction mechanism. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Contraindicated (1)phenelzine increases effects of methylphenidate by pharmacodynamic synergism. Monitor BP. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. dopexamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. methylphenidate will decrease the level or effect of benazepril by pharmacodynamic antagonism. Monitor Closely (1)amitriptyline, methylphenidate. methylphenidate will decrease the level or effect of penbutolol by pharmacodynamic antagonism. Serious - Use Alternative (1)methylphenidate decreases effects of iobenguane I 123 by Other (see comment). Comment: Potential for additive CNS effects.lurasidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Monitor BP. Use Caution/Monitor. Mechanism: unknown. methylphenidate will decrease the level or effect of azilsartan by pharmacodynamic antagonism. Applies only to oral form of both agents. ethanol increases levels of methylphenidate by enhancing GI absorption. Modify Therapy/Monitor Closely. Mechanism: unknown. Either increases effects of the other by pharmacodynamic synergism.