Methylphenidate is associated with many known unwanted side effects that are common but rarely require medical attention. A strong medication that treats attention deficit-hyperactivity disorder (ADHD), it also has some serious side effects that need emergency care.
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Common Methylphenidate Side Effects
The most common side effects of methylphenidate are insomnia, nausea and headaches. One of the most prevalently prescribed ADHD medications, methylphenidate causes other side effects, including anxiety, restlessness and tics.
Common Methylphenidate Side Effects:
Central Nervous System Side Effects: Among these are headache, dizziness, anxiety, akathisia (restlessness), irritability, lethargy and tics.
Gastrointestinal Side Effects: Most reported are nausea, vomiting, reduced appetite, dry mouth, abdominal pain and weight loss.
Cardiovascular Side Effects: These include increased heart rate (tachycardia), heart palpitations and changes in blood pressure.
All these adverse effects are usually mild and don’t require medical treatment. You can often find relief by having your doctor lower your dosage.
As a stimulant, methylphenidate (Ritalin) makes you feel more alert, awake, energized or excited. You may also feel less impulsive and distractible and have a longer attention span. However, the drug can also make you feel agitated and anxious.
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A powerful medication, methylphenidate has some serious side effects that require immediate medical attention. However, these severe effects are rare. According to a 2018 Cochrane review, about 1 in 100 people who take methylphenidate reports serious side effects.
Serious Side Effects of Methylphenidate Include:
Cardiovascular Risks: Drug researchers reported serious heart-related events, such as sudden death, stroke and heart attack, in children and adults with structural heart abnormalities and other heart problems. However, the association between the medical use of methylphenidate and serious cardiovascular events is low.
Hypersensitivity: Some people may react poorly to methylphenidate or to other ingredients in the medication. Hypersensitivity typically manifests as skin rashes, hives and fever. This is more likely to affect patients using a transdermal methylphenidate patch.
Psychiatric Risks: In patients who are psychotic, methylphenidate may worsen the condition and, in rare situations, trigger new psychotic or manic symptoms.
Priapism: A prolonged, often painful erection is a serious condition that needs emergency medical attention.
Peripheral Vasospasms: Treatment using methylphenidate and other stimulants is associated with conditions like Raynaud’s phenomenon, where blood flow to the fingers and toes is restricted.
Long-term Growth Suppression: Because methylphenidate is the dominant medication for children with ADHD, growth suppression is always a concern when the drug is taken long-term. Growth suppression is characterized by lower-than-normal weight, height and bone density.
Hallucinations: Hallucinations have been reported with methylphenidate usage. In most cases, hallucinations disappear upon discontinuation of use.
Blurry Vision: This stems from dry eyes and pupil dilation. Some people also may report double vision.
Methylphenidate interacts at times with other medications, which can affect the drug’s efficacy or cause harm. Taking methylphenidate with other medications increases the risk of serious adverse effects. Because of methylphenidate interactions, your doctor must manage all your medications carefully when you start taking the ADHD medication.
Drugs that may cause interactions with methylphenidate include serotonergic drugs: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), other antidepressants, fentanyl, blood pressure medications, antipsychotics, seizure medications, warfarin (a blood thinner) and acid reflux drugs.
Managing Methylphenidate Side Effects
Methylphenidate affects people differently. Some side effects present more commonly than others, but all of them are usually easy to manage. Three keys to that management are:
Taking the medication in the exact dosage amount and at the correct time
Keeping an open dialogue with your doctor about the drug’s overall effects on you
Informing your doctor when another physician adds a new medication to your daily regimen
Once alerted to how methylphenidate makes you feel, your doctor can help minimize side effects by adjusting the dosage. If side effects persist, your doctor may recommend alternative ADHD medications, such as Adderall.
The discussion of methylphenidate vs. Adderall is usually one of choice and preference. Both are stimulants and recommended ADHD treatments. Adderall typically takes longer to work and stays in your system longer.
Other ADHD treatments include nonstimulants such as atomoxetine, viloxazine, guanfacine, and behavioral therapies.
“While side effects exist with all medications, from my clinical experience, the side effects of methylphenidate can be minimized by always starting at a low dose and titrating the dose up slowly for appropriate symptom control.”
Is It Safe to Take Methylphenidate Long Term?
Many studies indicate long-term usage of methylphenidate to treat ADHD is safe, effective and well tolerated, with minimal risk of serious adverse side effects. Proper dosing, ongoing monitoring and regular communication between you and your doctor can ensure long-term safe use.
However, doctors and researchers have concerns about anyone who takes methylphenidate over a period of years. The biggest concern is growth suppression in children, especially when someone is diagnosed with ADHD during preschool years. Medical professionals also watch out for people at risk of substance abuse and those who develop tics.
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“While side effects exist with all medications, from my clinical experience, the side effects of methylphenidate can be minimized by always starting at a low dose and titrating the dose up slowly for appropriate symptom control.”
