1. About methylphenidate for adults
Methylphenidate is used to treat attention deficit hyperactivity disorder (ADHD). It is also sometimes used to treat narcolepsy.
It comes as standard (immediate release) tablets and capsules. You can also get slow release (extended, modified or prolonged release) tablets and capsules which release the medicine into your body gradually.
For children and young people aged 18 years and under, read our information on methylphenidate for children.
2. Key facts
- Methylphenidate is a controlled drug, which means that you may have to prove your identity when collecting your prescription. You also have to collect your prescription within 28 days.
- Slow release methylphenidate is usually taken once a day. With standard tablets or capsules, your doctor may recommend taking them up to 3 times a day.
- It's best to stick to the same brand of methylphenidate. Different brands of slow release tablets and capsules work differently in how they release the medicine into your body, and this can affect how they work to manage your symptoms.
- Do not stop taking methylphenidate suddenly, speak to your doctor first.
- Other brand names for methylphenidate are Tranquilin, Xaggitin and Xenidate
3. Who can and cannot take methylphenidate
Methylphenidate can be taken by most adults. However, it is not suitable for everyone.
Tell your doctor before starting the medicine if you:
- have ever had an allergic reaction to methylphenidate or any other medicine
- have difficulty swallowing – some brands may not be suitable for you
- have heart problems
- have an overactive thyroid
- have a tumour in the adrenal gland (phaeochromocytoma)
- have mental health problems (or a close family member has mental health problems)
- have high blood pressure or problems with blood vessels, such as vasculitis
- have epilepsy
- have tics (sudden muscle twitches of the face or body), or a family history of Tourette's syndrome
- have glaucoma or are at risk of getting glaucoma
- are trying to get pregnant, are already pregnant or breastfeeding
- have problems with drugs or alcohol
4. How and when to take methylphenidate
Always follow the instructions that come with your medicine carefully.
How you take your methylphenidate depends on whether the medicine is standard (immediate release) or slow release. Different brands of slow release methylphenidate may also have different instructions.
Standard release tablets and capsules
These are also called immediate release, although it can still take a while for the medicine to release into your body. You may not notice any changes in your behaviour straight away.
Slow release tablets and capsules
Also called XL, extended, modified or prolonged release.
Slow release tablets and capsules start to work with a first release of the medicine into the body. After that, the medicine continues to release into the body more slowly.
Dosage and strength
The dose you need depends on the type of methylphenidate you’re taking and what you're taking it for.
Dose for standard tablets or capsules
The usual starting dose for adults is 5mg, taken 2 or 3 times a day. For narcolepsy, you will usually take between 10mg and 60mg a day. Your doctor may increase your dose gradually (usually weekly) until they find the dose of methylphenidate that works best for you.
Dose for slow release capsules
The usual starting dose for adults is 10mg, taken once in the morning. Your doctor may increase the dose gradually (usually weekly) until they find the dose that works best for you.
Dose for slow release tablets
The usual starting dose for adults is 18mg, taken once in the morning. Your doctor may gradually increase the dose by 18mg at a time (usually weekly) until they find the dose that works best or you.
How to take it
How to take standard tablets or capsules
Swallow the tablets whole with a glass of water, milk or squash. Do not chew them.
Standard tablets or capsules are usually taken 2 or 3 times a day – in the morning, at midday and in the late afternoon. Leave at least 4 hours between doses.
If you have problems swallowing pills, some brands of standard tablets can be crushed and added to food. For example, if you are taking Medikinet or Ritalin tablets, you can crush them and mix it with a small amount of soft food such as yogurt, honey or jam. Swallow the mixture straight away, without chewing.
How to take slow release tablets or capsules
Swallow the capsules whole with a glass of water, milk or squash. Do not chew them.
Take slow release tablets and capsules in the morning.
Check the leaflet that comes with the medicine for when to take it and whether to take it with food.
If you're taking the brand called Equasym XL, take it before breakfast. If you are taking Medikinet XL, take it with or after breakfast.
If you have problems swallowing capsules, some brands of methylphenidate slow release capsules can be opened up and added to a small amount of soft food, such as yogurt, honey or jam. Swallow the mixture straight away, without chewing.
Important
Do not crush or break slow release tablets. If you do, the medicine will not work properly. Talk to your pharmacist if you are unsure about how to take methylphenidate tablets or capsules
What if I'm sick?
If you are sick (vomit) less than 30 minutes after taking methylphenidate, take the same dose again. If you are sick more than 30 minutes after taking your medicine, do not take another dose. Wait until the next dose is due.
If you are sick again, ask your doctor or pharmacist for advice.
What if I forget to take it?
If you forget a dose, skip the missed dose and wait until it’s time for the next dose. Take the next dose as usual.
Do not take a double dose to make up for a forgotten dose.
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
The amount of methylphenidate that can lead to an overdose varies from person to person.
Taking too much methylphenidate can cause symptoms such as:
- being sick
- feeling unusually happy, confused or agitated
- muscle twitching, seizures or fits (shaking, uncontrolled movements
- seeing, feeling or hearing things that are not real (hallucinations)
- a fast, slow or uneven heart beat (palpitations)
- sweating, flushing (red face) or high temperature
- headaches
Immediate action required: Call 999 or go to A&E if:
- you have had a fit or seizure (shaking or jerking uncontrollably)
- you have a fast, slow or uneven heart beat (palpitations)
If you have taken too much methylphenidate and need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the methylphenidate packet, or the leaflet inside it, plus any remaining medicine with you.
Urgent advice: Contact 111 for advice now if:
- you take too much methylphenidate
Go to 111.nhs.uk or call 111
5. Side effects
Like all medicines, methylphenidate can cause side effects, although not everyone gets them.
Common side effects
These common side effects may happen in more than 1 in 100 people. Keep taking the medicine, but tell your doctor if they bother you or do not go away:
- headache
- feeling aggressive, irritable, depressed, anxious or tense
- trouble sleeping (insomnia)
- loss of appetite – this can lead to weight loss or poor weight gain
- stomach ache
- dry mouth
- feeling or being sick
Serious side effects
Serious side effects are uncommon and happen in less than 1 in 100 people.
Tell your doctor straight away if you:
- have mood or personality changes
- have thoughts about harming yourself others
- have fast or irregular heartbeats (palpitations)
- start seeing, feeling or hearing things that are not real (hallucinations)
- have started to get facial tics, tell your doctor – these are quick, little movements in the muscles of your face that you cannot control and are sudden – if this starts happening, your doctor will stop your treatment.
Methylphenidate can cause a small increase in blood pressure and heart rate. Your doctor will usually measure your blood pressure and pulse every 6 months.
Serious allergic reaction
It's extremely rare to have an allergic reaction (anaphylaxis) to methylphenidate but if this happens to you, stop taking the medicine and:
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of methylphenidate. For a full list, see the leaflet inside the medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with the side effects of methylphenidate
What to do about:
- headaches – make sure you rest and drink plenty of fluids. Painkillers such as paracetamol can help. Talk to your doctor if the headaches are severe or do not go away.
- feeling aggressive, irritable, depressed, anxious or tense – this may go away as you get used to the medicine. If it doesn't, speak to your doctor. They may want to recommend a lower dose or try a different medicine.
- trouble sleeping – if you are finding it hard to sleep, try taking the last dose of methylphenidate more than 6 hours before bedtime.
- loss of appetite – it may help to take methylphenidate with a meal. You may notice some weight loss during the first few months of treatment. You will probably put this weight back once you’re used to the medicine. If you notice that you are losing a lot of weight, speak to your doctor.
- dry mouth – this usually gets better quite quickly. Taking sips of water and eating citrus fruits (like oranges or satsumas) can help.
- feeling or being sick (nausea or vomiting) – stick to simple meals and do not eat rich or spicy food if you feel sick. It might help to take methylphenidate with or after a meal or snack. If you are being sick try taking small, frequent sips of water or squash to avoid dehydration. See your doctor if you are being sick or having severe stomach pains.
7. Pregnancy and breastfeeding
Methylphenidate and pregnancy
Methylphenidate is not usually recommended in pregnancy. However, you may need to continue taking it during your pregnancy to remain well.
Your doctor will be able to explain the benefits and the risks of taking methylphenidate. They can help you decide what’s best for you and your baby.
Methylphenidate and breastfeeding
You can usually take methylphenidate while you’re breastfeeding.
However, this medicine passes into breast milk so your doctor or health visitor will need to monitor your baby. They will check for any signs of side effects, such as your baby being irritable or having problems sleeping.
Taking high doses of methylphenidate may also affect your milk supply when your breastfeeding,
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
8. Cautions with other medicines
There are some medicines that can affect the way methylphenidate works.
Do not take methylphenidate if you are taking antidepressants called monoamine oxidase inhibitors (MAOIs), or if you’ve stopped taking them in the last 14 days.
Taking methylphenidate with these medicines can cause a sudden increase in your blood pressure. This could be dangerous. MAOIs include:
- isocarboxazid
- moclobemide
- phenelzine
- tranylcypromine
If you are taking any of the following medicines, talk to your doctor or pharmacist before taking methylphenidate:
- medicines to treat depression or other mental health problems
- medicines for epilepsy
- blood pressure medicines
- medicines to treat or prevent blood clots
Some cough and cold medicines can also affect your blood pressure. Speak to your pharmacist or doctor if you are buying any cough and cold medicines. It’s important to check whether these are OK for you to have while taking methylphenidate.
Mixing methylphenidate with herbal remedies and supplements
There might be a problem taking some herbal remedies and supplements alongside methylphenidate, especially ones that cause sleepiness or a dry mouth, or make it difficult to pee.
Ask your pharmacist for advice.
9. Common questions about methylphenidate
How does methylphenidate work?
It's not known exactly how methylphenidate works. It's thought to boost the levels of chemicals called dopamine and noradrenaline in your brain. This can increase activity in the parts of the brain that control attention and behaviour.
How long does it take to work?
When you first take methylphenidate, you will start on a low dose. Your doctor will usually increase this gradually until they find the dose that works best for you.
This means it might take a few weeks before you see any benefits. When you have found the right dose, methylphenidate should start to work within 30 to 60 minutes of taking it. How quickly it works depends on whether it’s a standard or slow release tablet or capsule.
How long will I take it for?
You may need to take methylphenidate for several months or even years. You will not usually need to take it for the rest of your life.
It’s a good idea to talk to your doctor every year about taking methylphenidate. That way, you can check how you are getting on with it and whether you still need it. Your doctor may recommend stopping methylphenidate for a while, or reducing the dose.
Is it safe to take for a long time?
It's not really known how safe it is to take methylphenidate for a long time.
This is why it’s a good idea for you to have a yearly review with your doctor to check whether you still need it.
Is methylphenidate addictive?
You’re unlikely to have any problems if you follow your doctor’s instructions when taking methylphenidate.
However, if methylphenidate is not taken properly, you can become physically dependent on it. This means you're more likely to get withdrawal symptoms if you stop taking it suddenly.
Always follow the instructions carefully, and do not stop taking your medicine suddenly. Talk to your doctor first.
Addiction problems usually only happen if you take methylphenidate more often than prescribed, or at a higher dose than recommended.
What will happen if I stop taking it?
Only stop taking methylphenidate if your doctor tells you to. If you suddenly stop taking it, you may get withdrawal symptoms, such as depression.
Talk to your doctor if you want to stop taking methylphenidate. They may want to slowly reduce the amount you’re taking, before you stop completely. This is to help you avoid any extra side effects.
Do I need to stick to the same brand of methylphenidate?
Once you're on a brand of methylphenidate that works for you, you'll usually keep taking the same brand. This is because it can be a problem to change brands, particularly if you're taking slow release tablets or capsules.
Different brands of slow release methylphenidate tablets and capsules work differently in how they release the medicine into your body. This can affect how they work to manage your symptoms. Side effects can also vary.
Different brands also have different instructions for how and when to take it, such as whether to take it with food.
If you do need to change brands, check the instructions that come with your medicine carefully.
Can I drink alcohol with it?
Try not to drink alcohol while taking methylphenidate. This is because alcohol can increase the effects of methylphenidate and make you more likely to get side effects.
Is there any food or drink I need to avoid?
Apart from alcohol, there’s no particular food or drink you need to be careful with when taking methylphenidate.
Will it affect my contraception?
Methylphenidate will not affect any type of contraception. This includes the combined pill and emergency contraception.
However, if using methylphenidate makes you sick, or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.
Find out what to do if you're on the pill and you're sick or have diarrhoea.
Will it affect my fertility?
There is no evidence to suggest that methylphenidate will affect fertility in either men or women. However, speak to your pharmacist or doctor if you’re trying to get pregnant. They may want to review your treatment.
Can I drive or ride a bike?
Some people might get side effects like feeling dizzy, blurred vision, difficulty focusing or feeling sleepy when taking methylphenidate. If this happens it may be dangerous to drive or ride a bike.
It’s best not to drive or ride a bike until you know how methylphenidate affects you. And the same applies to any sports, games or other activities where you need good vision, balance and concentration to be safe.
It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.
Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking methylphenidate.
GOV.UK has more information on the law on drugs and driving.
Are there alternative treatments for ADHD?
Some people find that methylphenidate does not work for them. If this applies to you, your doctor may recommend other ADHD medicines, such as dexamfetamine, lisdexamfetamine and atomoxetine.
Psychological treatments for ADHD can also be helpful for some people. This includes behavioural therapy and talking therapy. Speak to your doctor if you are interested in finding out about alternative treatments.
Do not stop taking your methylphenidate without talking to your doctor first.
Can taking supplements help ADHD?
Some studies have suggested that supplements of omega-3 and omega-6 fatty acids can help people with ADHD. However, the evidence is very limited and more research is needed.
You should talk to your doctor before taking any supplements. This is because some supplements can react with methylphenidate - and cause side effects, or make your medicine work less well.