methylphenidate extended release
In this drug factsheet:
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- agitation, nervousness, or anxiety
- dry mouth
- joint pain
- loss of appetite
- muscle cramps
- skin rash or itching (mild)
- stomach pain
- trouble sleeping
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible any of the following side effects occur:
- abnormal thoughts or behaviour
- chest pain
- hallucinations (hearing, seeing, or feeling things that are not actually there)
- increased blood pressure
- itchy rash, hives
- muscle twitching or tics
- palpitations (feeling your heart beat quickly or irregularly)
- pinpoint-sized red spots on skin or unusual bruising
- signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
- signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
- sudden high fever
- symptoms of depression (e.g., losing interest in your usual activities, feeling sad, having thoughts of suicide)
- symptoms of liver damage (e.g., yellow skin or eyes, abdominal pain, loss of appetite, pale stools, dark urine)
- tics or symptoms of Tourette's syndrome (involuntary, sudden body movements, or uncontrolled vocal outbursts)
- uncontrolled movements (twitching, jerking)
- vision changes
Stop taking the medication and seek immediate medical attention if any of the following occur:
- convulsions (seizures)
- signs of a serious allergic reaction (difficulty breathing; hives; swelling of the face, lips, eyes, mouth, or throat)
- signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
- signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.
HEALTH CANADA ADVISORY
[April 21, 2015]
Health Canada has issued new information concerning the use of methylphenidate extended release. To read the full report, visit Health Canada's website at www.hc-sc.gc.ca.
A previous advisory on methylphenidate extended release was issued on March 30, 2015. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Behaviour or mood changes: There have been reports of agitation, hallucinations, symptoms of depression, and thoughts of self-harm in people taking this medication. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.
Blood pressure: This medication can increase blood pressure. If you have high blood pressure or heart problems, talk to your doctor before taking this medication.
Drowsiness/reduced alertness: Methylphenidate extended release may cause dizziness, which could affect your ability to drive or operate machinery. Avoid activities requiring alertness until you have determined how this medication affects you.
Drug dependence: There does not appear to be an increased risk of dependence or addiction with the use of methylphenidate by children and adolescents. However, abuse of methylphenidate is possible by certain individuals. Regular, long-term abuse can lead to high levels of tolerance and psychological dependence, and a wide range of abnormal behaviours. If you have a history of drug or alcohol dependence, you should be closely monitored by your doctor while using this medication.
Drug holidays: It is sometimes helpful to stop methylphenidate to determine whether it is still needed to help the ADHD symptoms. Talk to your doctor about whether a drug holiday (not giving this medication during school holidays) might be appropriate for you or your child. Do not stop this medication without discussing it with your doctor first.
Exercise: If you participate in strenuous exercise or activities, consult your doctor before taking methylphenidate extended release. Strenuous exercise combined with the effects of methylphenidate of the heart and blood pressure may increase the risk of sudden death.
Heart problems and blood pressure: This medication can increase heart rate and blood pressure. It may also increase the risk of sudden death for people with heart problems. This medication should generally not be used by people with known structural heart abnormalities (such as abnormal size, missing or poorly functioning heart valves, or problems with blood vessels connected to the heart) or a family history of sudden or cardiac death. People taking more than one stimulant medication for ADHD should be closely monitored by their doctor.
Misuse of methylphenidate may also be associated with sudden death and other serious heart-related effects.
Long-term use: If you will be using methylphenidate extended release for a long period of time, your doctor will want you to have regular heart checkups, blood pressure checks and lab tests to monitor your liver and blood.
Seizures: There is some evidence that methylphenidate extended release may increase the risk of seizures, particularly for people who have had seizures in the past. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Stomach and intestinal problems: This medication should not be used by people with certain stomach or intestinal problems (e.g., narrowing of the intestines, "short gut" syndrome, a history of peritonitis, cystic fibrosis, chronic intestinal pseudo-obstruction, or Meckels' diverticulum).
Stopping the medication: Check with your doctor before stopping this medication.
Suppression of growth: Growth suppression (i.e., less increase in height or weight than usual) has been reported for children using stimulants such as methylphenidate for long periods of time. It is not known if methylphenidate extended release causes growth suppression in children (i.e., less increase in height or weight than usual). Children who need long-term treatment should be carefully monitored for growth. Their doctor may also recommend a "drug holiday," where the medication is not given on weekends or during school holidays.
Tics: This medication may cause tics or worsening of motor or verbal tics. If you have Tourette's syndrome or develop tics while on this medication, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication,
Vision: Rarely, people taking methylphenidate extended release have experienced vision changes. If you notice any changes in your vision, contact your doctor.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking methylphenidate extended release, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of this medication have not been established for children less than 6 years of age. Methylphenidate extended release should not be used by children in this age group.
What other drugs could interact with this medication?
There may be an interaction between methylphenidate extended release and any of the following:
- amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
- antacids (aluminum hydroxide, calcium carbonate, magnesium hydroxide)
- anti-Parkinson's medications (e.g., bromocriptine, levodopa, pramipexole, ropinirole
- antipsychotics (e.g., chlorpromazine, haloperidol, quetiapine, risperidone)
- appetite suppressants (e.g., phentermine)
- blood pressure-lowering medications
- H2-antagonists (e.g., famotidine, ranitidine)
- monoamine oxidase (MAO) inhibitors (e.g., moclobemide, phenelzine, selegiline, tranylcypromine)
- other medications for ADHD
- proton pump inhibitors (e.g., lansoprazole, omeprazole)
- tricyclic antidepressants (e.g., amitriptyline, imipramine, nortriptyline)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than the ones listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.