Other Warnings/Precautions

• Use with caution in patients with any degree of hypertension, hyperthyroidism, or history of drug abuse

• Children who are not growing or gaining weight should stop treatment, at least temporarily

• May worsen motor and phonic tics

• May worsen symptoms of thought disorder and behavioral disturbance in psychotic patients

• Stimulants have a high potential for abuse and must be used with caution in anyone with a current or past history of substance abuse or alcoholism or in emotionally unstable patients

• Administration of stimulants for prolonged periods of time should be avoided whenever possible or done only with close monitoring, as it may lead to marked tolerance and drug dependence, including psychological dependence with varying degrees of abnormal behavior

• Particular attention should be paid to the possibility of subjects obtaining stimulants for nontherapeutic use or distribution to others and the drugs should in general be prescribed sparingly with documentation of appropriate use

• Usual dosing has been associated with sudden death in children with structural cardiac abnormalities

• Not an appropriate first-line treatment for depression or for normal fatigue

• May lower the seizure threshold

• Emergence or worsening of activation and agitation may represent the induction of a bipolar state, especially a mixed dysphoric bipolar II condition sometimes associated with suicidal ideation, and require the addition of a mood stabilizer and/or discontinuation of d,l-methylphenidate

• Certain transdermal patches containing even small traces of aluminum or other metals in the adhesive backing can cause skin burns if worn during MRI, so warn patients taking the transdermal formulation about this possibility and advise them to disclose this information if they need an MRI

Do Not Use

• If patient has extreme anxiety or agitation

• If patient has motor tics or Tourette’s syndrome or if there is a family history of Tourette’s, unless administered by an expert in cases when the potential benefits for ADHD outweigh the risks of worsening tics

• Should generally not be administered with an MAOI, including within 14 days of MAOI use, except in heroic circumstances and by an expert

• If patient has glaucoma

• If patient has structural cardiac abnormalities

• If there is a proven allergy to methylphenidate

METHYLPHENIDATE (D,L): SPECIAL POPULATIONS

Renal Impairment

• No dose adjustment necessary

Hepatic Impairment

• No dose adjustment necessary

Cardiac Impairment

• Use with caution, particularly in patients with recent myocardial infarction or other conditions that could be negatively affected by increased blood pressure

• Do not use in patients with structural cardiac abnormalities

Elderly

• Some patients may tolerate lower doses better

Children and Adolescents

• Safety and efficacy not established in children under age 6

• Use in young children should be reserved for the expert

• Methylphenidate has acute effects on growth hormone; long-term effects are unknown but weight and height should be monitored during long-term treatment

• Sudden death in children and adolescents with serious heart problems has been reported

• American Heart Association recommends EKG prior to initiating stimulant treatment in children, although not all experts agree