This group of drugs, containing Ritalin (generic = methylphenidate) have been used for many years as the mainstay of treatment for ADD and ADHD. They have been studied extensively and found to be safe and effective. As a matter of fact, in children, this group of drugs has been studied more extensively than any other behavioral drug.
The studies have shown that all the drugs in this category meet the following criteria:
- Do not lead to any form of drug abuse in children.
- Do not result in tolerance to the drug.
SAFE means that the drugs do not adversely affect the liver, kidneys, or blood count.
EFFECTIVE means that the drugs reduce hyperactivity, impulsiveness, improve inattention. Overall, about 70 % of kids have a good response to this group of drugs. Some other kids have a partial response and some no response at all.
The DRUG ABUSE was a big concern, and has been extensively studied. There is absolutely no evidence of abuse or drug dependence or addiction from any child taking this class of drugs. There is absolutely no evidence of any child becoming a drug addict because of the use of these meds. As a matter of fact, there is an increased chance of a child with ADD/ADHD becoming a substance abuser, if they are not treated as a child. If properly treated as a child, a person has the same chance of later abusing drugs as any other child without ADHD.
TOLERANCE does not develop with the use of this class of drugs. This means that the dosage does not have to be continually increased, except as the child gets bigger and older. Often times as the patient gets older, the dosage can be reduced.
The following drugs contain Ritalin or a Ritalin derivative: Methylphenidate, Ritalin LA, Ritalin SR, Focalin, Focalin XR, Concerta, Metadate CD, Methylin, and Daytrana.
Ritalin and Methylphenidate
This is the original "Ritalin". Works quickly-in about 30 - 45 minutes. Usually lasts about 4 hours, but only 2 hours in some people. Requires multiple dosings (3 - 4) per day for full coverage. Causes "hyperfocusing" about 30 minutes after the dose is taken--like a "deer in headlights". Supplied in 5, 10 & 20 mg. Max dose approved = 60 mg /d.
Long acting form of Ritalin. Effects last about 8 hours. Supplied in 10, 20, 30, & 40 mg. Max. approved dose = 60 mg.
This was the original attempt to make Ritalin last longer. It didn't work--only lasts about 2 - 3 hours. It is rarely used anymore.
This was the first successful long-acting Ritalin. It also has the largest marketshare of all the branded ADHD drugs. The drug is made by putting the long-acting portion of the drug into a capsule with a small hole in the end. It is released slowly throughout the day thru that small opening. Some of the short acting Ritalin in coated on the outside of the capsule for immediate release. Note: The capsule passes thru the intestine and into the stool intact. Don't be alarmed when you see the capsule mixed in with the BM. Starts to work a little in 30 - 45 min., peaks at 4 hours, and continues to be effective for 12 hours. Supplied in 18, 27, 36, 54 mg. Max dose approved = 72 mg once daily in am.
Another long-acting version. Lasts about 8 hours--sometimes up to 12 hours. Supplied in 10, 20, 30 mg. Max dose approved = 60 mg. Can be sprinkled on applesauce, but do not chew.
This is essentially Ritalin cut in half. The active half was kept and the half causing a lot of the side effects was discarded. Short acting--about 4 hours. Supplied in 2.5, 5, and 10 mg. Max. approved dose = 20 mg. Give twice daily.
Long acting version of Focalin. Peaks faster that Concerta--in ~ 1 hour. Effects last 12 hours. In some people, seems to have fewer side effects. Supplied in 5, 10, and 20mg. Max approved dose = 20 mg.
Uncommonly used form which is available as chewable tab and oral solution.
Brand new, just released. First methylphenidate product available as a patch. It is applied to the child's hip daily in the am. Recommeded to be removed in 9 hours, but effects continue to last for 12 hours(according to the company's literature).
At present, the FDA has approved it as a second-line drug to be used after the oral forms have failed or can't be used. Side effects seem to be higher in the studies than other long-acting forms--insomnia- 13% and decreased appetite- 26 %. Some people, with any patch, will have skin sensitivity and develop itching and a rash at the site.
The FDA is concerned that some of these people will develop a generalized sensitivity to the methylphenidate. This would mean they could no longer use any form of methylphenidate, including all the oral forms. This has not yet happened with this patch, but has with some other kinds of patches.
Supplied as 10, 15, 20 & 30 mg. Max dose approved = 30 mg daily. Apply once daily, in the am, to the hip. Remove in 9 hours--effects may continue up to 12 hours.
- The following statements apply to all of the drugs discussed today.
- Every Ritalin-based product can sometimes cause sleep problems, decreased appetite, slight weight loss, headache, and stomach ache. In most cases these side effects are not severe, and can be managed by reducing the dosage.
- When the medicine is wearing off, there may be a short period of 30 min to 1 hour when the child is more irritable, whiny. Once it wears off, those symptoms usually go away.
- If the dosage is too high, your child may be too quiet, not appear as happy and outgoing as usual, and loose the little "sparkle" from his/her eyes. This is to be avoided at all costs. Do not allow your child to remain in this situation.
- There is a WARNING on all the Stimulant-type drugs, including Ritalin. Do not use if there is pre-existing heart disease or high blood pressure. This warning was not applied to Ritalin because there has been a problem with it, but rather because there could be a problem with these pre-existing diseases.