The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)--not necessarily inclusive (major clinical significance):


Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Anticholinergics or other medications with anticholinergic activity (concurrent use may intensify anticholinergic effects because of secondary anticholinergic effects of methylphenidate).

arial'>Anticonvulsants, especially phenytoin, phenobarbital, and primidone or Anticoagulants, coumarin-or indanedione-derivative or Phenylbutazone (serum concentrations of these medications may be increased because of inhibition of metabolism by methylphenidate, possibly resulting in toxicity; dosage adjustments may be necessary)



Antidepressants, tricyclic, especially desipramine and imipramine    (serum concentrations of these medications may be increased because of inhibition of metabolism by methylphenidate, possibly resulting in toxicity; also, concurrent use may antagonize the effects of methylphenidate)

Antihypertensives or Diuretics used as antihypertensives    (hypotensive effects may be reduced when these medications are used concurrently with methylphenidate; the patient should be carefully monitored to confirm that the desired effect is being obtained)

CNS stimulation–producing medications, other  (concurrent use with methylphenidate may result in additive CNS stimulation to excessive levels, causing nervousness, irritability, insomnia, or possibly seizures or cardiac arrhythmias; close observation is recommended)

Monoamine oxidase (MAO) inhibitors, including furazolidone, procarbazine, and selegiline (concurrent use may potentiate the effects of methylphenidate, possibly resulting in a hypertensive crisis; methylphenidate should not be administered during or within 14 days following the administration of MAO inhibitors)

Pimozide (methylphenidate may provoke tics; before therapy with pimozide is initiated, methylphenidate should be withdrawn to determine the cause of observed tics; pimozide is not indicated for the treatment of tics caused by other medications)


Vasopressors (pressor effects may be potentiated when vasopressors are used concurrently with methylphenidate)

Medical considerations/Contraindications The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)-- not necessarily inclusive (major clinical significance).

Except under special circumstances, this medication should not be used when the following medical problems exist: Anxiety, tension, or agitation, severe or Depressive disorder amenable to treatment with conventional antidepressants. Glaucoma or Motor tics other than Tourette's disorder (may be exacerbated).
Risk-benefit should be considered when the following medical problems exist.

Emotional instability, including history of drug dependence or alcoholism (increased potential for addiction or abuse).

Epilepsy or other seizure disorders (seizure threshold may be lowered)

Gastrointestinal Obstructions, pathologic or iatrogenic    (increased chance of obstructions due to nondeformable controlled-release tablet design)

Gilles de la Tourette's syndrome, family history or diagnosis of    (motor and vocal tics may be exacerbated; however, some patients, under close supervision, may benefit from cautious trials)

Hypertension (may be exacerbated)


Psychosis: (symptoms of behavior disturbance and thought disorder may be exacerbated in children with psychoses)

Sensitivity to methylphenidate

Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; major clinical significance):
Assessment of amount and frequency of medication use    (recommended at periodic intervals to detect signs of dependence or abuse during long-term therapy)


Blood pressure determinations (recommended at periodic intervals during therapy, especially for patients with hypertension)


Complete blood cell, differential, and platelet counts (recommended at periodic intervals for patients on prolonged therapy)


Monitoring of growth, both height and weight gain, in children (recommended during long-term therapy, since data are inadequate to determine whether chronic administration of methylphenidate may be associated with growth inhibition)

Reassessment of need for therapy for behavioral syndrome in children (interruption of therapy at periodic intervals is recommended to determine if a recurrence of behavioral symptoms is sufficient to continue therapy; tapering of dose may be necessary to prevent withdrawal symptoms)