Methylphenidate extended-release ((US brand name Metadate CD® which has been discontinued and generic)) is a central nervous system stimulant.
On this page, we will provide basic information about this medication. Links to other articles on this website with more advanced information and tips related to this medication and related topics are provided below—under Related Pages below.
FDA indication
Treatment of attention deficit hyperactivity disorder (ADHD) in children 6 to 15 years of age.
Mechanism of action/ Pharmacodynamics
Methylphenidate is a central nervous stimulant. The exact mode of therapeutic action on ADHD is known though it is hypothesized that it blocks the reuptake of norepinephrine and dopamine in presynaptic neurons and increases the release of these monoamines in the extraneuronal space. Methylphenidate is a racemic mixture of d- and l-isomers. The d-isomer is more pharmacologically active than the l-isomer.
Pharmacokinetics
It is released in a biphasic manner. The first peak (Tmax1) occurs 1.5 hours after administration which is similar to immediate release methylphenidate and the second peak (Tmax2) occurs 3 hours later or 4.5 hours after administration.
Boxed warning
High potential for abuse and dependence. Assess patients for signs of abuse and dependence.
Warnings and Precautions
a) Serious cardiovascular events: Sudden death has been reported with the use of methylphenidate in patients with cardiac problems. It should be avoided in structural cardiac abnormalities, coronary artery disease, and other heart problems.
b) Increased blood pressure: Monitor for changes in heart rate or blood pressure
c) Psychiatric adverse events: May aggravate psychotic or manic symptoms
d) Priapism
e) Peripheral vasculopathy including Raynaud’s phenomenon
f) Suppression of growth: Monitor height and weight in children and adolescents
Side effects
The commonest side effects of methylphenidate extended-release (occurring in 5% or more of patients and greater than the rate of placebo) were anorexia and insomnia.
Contraindications
1. Concurrent use of monoamine oxidase (MAO) inhibitors or within 14 days after discontinuation of MAO inhibitors
2. Hypersensitivity to methylphenidate or its components
3. Fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency
Dosage
Initial: 20 mg/day
Titration: 10 mg to 20 mg per week
Max: 60 mg/day
Instructions:
a) Take orally once daily in the morning before breakfast
b) Swallow whole capsule or sprinkle contents on to a small amount of applesauce and administer
c) Do not crush or chew capsule or capsule contents
Dosage forms and strengths
Extended-release capsules: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg
Important! Please refer to the full Prescribing Information (see link below) before prescribing this medication.
Related Pages
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Should we combine methylphenidate and guanfacine?
How are methylphenidate and amphetamines metabolized?
A dozen tips to manage loss of appetite due to a stimulant (in adults)
Converting stimulants: Equivalent doses
Combine a stimulant and atomoxetine?
Tips for managing abuse potential of medications for ADHD
Stimulant medications and irritability in children with ADHD
Stimulants for ADHD with a history of a substance use disorder?
What if you refuse an early refill of a stimulant medication?
What to look for in stimulant withdrawal (including a physical sign that is little known)
Stimulant “holidays” (breaks) in adults with ADHD?
Be careful if a person is on both a stimulant and an antipsychotic
What could happen when changing from an antipsychotic to a stimulant?
Laws about prescriptions for psychostimulants
References
Prescribing information for methylphenidate extended-release capsules (Metadate CD®)
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