Methylphenidate is a stimulant which can be used to help as part of the treatment for the symptoms of hyperactivity or Attention Deficit (Hyperactivity) Disorder (ADHD). It is usually used where other treatments have not worked. It will be used along with educational, social and psychological help. Methylphenidate can help the child's abilities to concentrate and to reduce overactivity and destructive behaviour. It is usually available from specialist centres only, and from GPs under "shared care" agreements with specialist centres. It also has been and is used sometimes to help narcolepsy, depression in the elderly and for ADHD in adults (not just children). The text here is based upon use in children.

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It is not clear how methylphenidate works. It seems to help to reduce hyperactivity and improve concentration. It may act by stimulating the part of the brain responsible for concentrating. It also helps to improve behavioural problems associated with hyperactivity.

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Tablets and capsules:
Plain methylphenidate should be taken in the morning, with a second (and third) doses at lunchtime (and teatime). Giving the tablets at meal times may make it easier to remember, as methylphenidate should be taken with or after food. As methylphenidate is a stimulant, doses are not usually prescribed after about 4pm in the afternoon as this might otherwise cause lack of sleep.
Concerta XL®, Equasym XL® and Medikinet XL® capsules are once daily doses and should be taken each morning. They are complex capsules and should be swallowed whole, and not be broken or split.

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Methylphenidate should be taken as directed on the medicine label. The XL tablets or capsules (e.g. Concerta XL, Equasym XL or Medikinet XL) should be taken once a day at breakfast time. The plain tablets should be taken at meal times to make it easier to remember as there is no problem about taking methylphenidate with or after food. However, as methylphenidate is a stimulant, it is best not to take any doses after about 4pm in the afternoon as this might otherwise cause lack of sleep.

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The tablets take about 30 minutes to begin to have an effect. The effect lasts about 3-4 hours. Concerta XL®, Equasym XL® and Medikinet XL® release methylphenidate over 6-12 hours. They take about an hour or so to start but last most of the day. It may take a few weeks for  the full effect to be seen.

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This will depend on why you are taking the medication. Click the links below for the appropriate answer if you are taking methylphenidate for:

    •   Attention Deficit Hyperactivity Disorder

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You should talk about this with your doctor as different people respond differently. Children usually need to take methylphenidate for some time after it has been started. If it works, your child may need to take methylphenidate for quite a long time e.g. several years or longer. Sometimes your doctor will ask you not to give the medicine at weekends and/or school holidays. It may be stopped or reduced once or twice a year to see if your child still needs it.

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You should talk about this with your doctor as people respond differently. Children usually need to take methylphenidate for some time after it has been started. If it works, your child may need to take methylphenidate for quite a long time. It will probably be stopped or reduced once or twice a year to see if your child still needs it.

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Methylphenidate is a stimulant drug, as are the amphetamines and caffeine (in tea and coffee). In adults, it is possible that the drug can be addictive because it can be taken for its stimulant effect. In children, addiction appears unlikely. There is no evidence that taking methylphenidate will cause someone to take illicit drugs when they are older. In fact the opposite might be true because the person will not try to self-medicate to manage their symptoms.

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This will depend on the dose you are taking. At smaller doses, it can be stopped suddenly. At higher doses, it is possible that 'withdrawal' effects might be seen. These would include extreme tiredness, rebound hyperactivity, increased appetite and depression. If this were to happen by accident, then starting methylphenidate again would get rid of these effects.

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If you remember within two hours of when the next dose is due, then give the missed dose (unless it is after 4pm in the afternoon, see the previous page). Otherwise, start again when you remember. Do not give two doses at the same time to 'catch up'. This might produce more side effects and upset your child. If taking the once-a-day tablets or capsules, do not take a dose after late morning, because if you do the capsules will release methylphenidate in the evening, which will make it difficult to sleep.

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Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission (www.ukppg.org.uk)

Do not be worried by this list of side effects. You may get none at all. There are a few other rare side-effects. If you develop any unusual symptoms ask your doctor about them next time you meet. Side effects in adults may be different.

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This is unlikely as methylphenidate is generally stimulant, but it can happen in a very few people if the dose prescribed is too high for them.

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There are no known problems with drinking alcohol with methylphenidate.

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You should have no problem with any foods or drinks with methylphenidate.

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Methylphenidate has only a few interactions with other medicines:

• Methylphenidate should not be taken with a class of antidepressant called the MAOIs (e.g. phenelzine, isocarboxazid, tranylcypromine)
• Methylphenidate can increase the effect of phenytoin and tricyclics (e.g. dosulepin, imipramine, lofepramine)

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions.  

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You should have no problems with "The Pill" and methylphenidate.

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You should not need a blood test if you are taking methylphenidate.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur 'spontaneously' in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed 'teratogenicity' i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a 'teratogen'. Since a baby has completed its main development between days 17 and 60 of the pregnancy (the so-called 'first trimester') these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:

A = Studies show no risk, so harm to the unborn child appears only a remote possibility

B = Animal and human studies indicate a lack of risk but are not fully conclusive

C = Animal studies indicate a risk but there is no safety data in humans

D = a definite risk exists but the benefit may outweigh the risk in some people

X = the risk outweighs any possible benefit

Methylphenidate is classified as "C" and is not recommended in pregnancy but there is no evidence of problems.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Methylphenidate is not thought to have a significant effect on any of these.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur 'spontaneously' in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed 'teratogenicity' i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a 'teratogen'. Since a baby has completed its main development between days 17 and 60 of the pregnancy (the so-called 'first trimester') these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:

A = Studies show no risk, so harm to the unborn child appears only a remote possibility

B = Animal and human studies indicate a lack of risk but are not fully conclusive

C = Animal studies indicate a risk but there is no safety data in humans

D = a definite risk exists but the benefit may outweigh the risk in some people

X = the risk outweighs any possible benefit

Methylphenidate is classified as "C" and is not recommended in pregnancy but there is no evidence of problems.

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Methylphenidate should not make you feel drowsy. If you have ADHD, then methylphenidate may improve your concentration and actually improve your driving.

Under Section 4 of the Road Traffic Act 1988 anyone driving while unfit to drive, due to illness or any drug, can be prosecuted. Under UK law it does not matter if the drug is a prescribed medicine or an illegal drug. It’s the effect on your driving that is the main thing. If your ability to drive might be reduced due to illness or medicines, under UK law you must let your insurance company know. If you don’t, the insurance might say this is as 'withholding a material fact' (ie not telling them something they ought to know) and might mean that if you have an accident they might not pay up. Your doctor will be able to advise you.

Medical rules for all drivers:
For the full story click here (opens in new window) and go to "Medical standards". Here there is a pdf document (regularly updated) called "At a glance guide to the current medical standards of fitness to drive" that can be downloaded. It is aimed at medical practitioners (GPs).
For the "Customers guide" (ie a guide for the general public) click here (opens in new window) and download the 'Customer service guide for drivers with medical conditions'.

How to tell the UK DVLA:
If you need to tell the DVLA and you already have a license, you need to download the medical questionnaire from the DVLA website. Or you can call the DVLA to ask them to send it to you. You also need to fill out a form to give your consent for doctors from the DVLA doctors to contact your doctor or a specialist. You can either post, fax or email these forms back to:
Drivers Medical Group, DVLA, Swansea, SA99 1TU
Tel: 0870 600 0301
Fax: 0845 850 0095
Email: eftd@dvla.gsi.gov.uk
Web www.direct.gov.uk/motoring (opens in new window)
You should always allow DVLA to contact your doctor, as what your doctor says will help the DVLA decide if you can keep your license. Rarely, the DVLA may ask you to have a (free) medical examination, which will be free. This is called a medical enquiry.

What happens next
If you give the DVLA all the information they need, they can usually sort things out within 15 days. If they need more information from you, your doctor or other sources, they will try to sort it out within 90 days. What they decide will also depend on what you’re doing e.g. driving a bus is different to driving down to the shops. What can happen includes:

• You may be able to keep your license or be issued with a new one.
• If the DVLA’s doctor thinks your fitness to drive needs to be reviewed again, you may be given a license valid for 1, 2 or 3 years.
• Your license may be taken from you (revoked) or your application refused. This will only happen if you do not meet the standards of fitness to drive at the moment. If this happens, you would be told the reasons for the decision. You would also be told when you can apply again.

Driving safely
If you want to carry on driving, you must take sensible steps to reduce any risk:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make an drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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