There are several options for printing:

• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here for adults with ADHD. This can then be printed.
• Download a handy QuILL (Quick Information Leaflet), a shorter, simpler version, pictorial version of the PILL, designed for younger people with ADHD. This can then be printed.
• Download a handy PILL for parents, carers and guardians of younger people taking methylphenidate for ADHD

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Methylphenidate is a stimulant that can be used to help as part of the treatment for the symptoms of hyperactivity or Attention Deficit (Hyperactivity) Disorder (ADHD). It may be used along with educational, social and psychological help. Methylphenidate can help the child's abilities to concentrate and to reduce over-activity and impulsive behaviour. It is usually available from specialist centres only, and is also used sometimes for adult ADHD.

Concerta XL®, Equasym XL® and Medikinet XL® are controlled release, once-daily capsule versions of methylphenidate. Each capsule releases methylphenidate in a varied way over about 6-12 hours, meaning that it is unnecessary to take it a tablet three times a day.

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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).

^{Updated 10.11}

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The usual dose of methylphenidate for ADHD depends on your age and which brand of tablet or capsule you are taking.

Plain tablets:

In children the dose starts at 5mg once or twice a day (morning and lunchtime). It can be increased by 5-10mg a day each week. The usual dose in adults starts at around 5mg two to three times a day and can go up to 100mg a day.

The XL or longer-acting tablets and capsules:

Medikinet XL and Equasym XL start at 10mg a day at breakfast, increasing up to 60mg/d in children and adolescents. The adult dose can be higher. Equasym XL should be given in the morning before breakfast.

If you've not been taking methylphenidate the starting dose of Concerta XL is 18mg once a day. This can then be increased in under 18s up to 54mg once a day.

If you have already been taking methylphenidate, the doses are:

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To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines for ADHD:

• main options, main medicines and handy chart

^{Updated 8.11}

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It is not clear exactly how methylphenidate works. It seems to help children and adults pay attention and control their impulses. It may work by boosting the part of the brain that controls concentration. It also helps to improve behavioural problems associated with hyperactivity.

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Plain tablets: 

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.

XL or long-acting tablets and capsules:

The XL tablets or capsules (e.g. Concerta XL, Equasym XL or Medikinet XL) should be taken once a day at breakfast time.

Equasym XL should not be taken too late in the morning as it may disturb sleep. If the effect of the Equasym XL wears off too early in the late afternoon or evening, the ADHD symptoms can start up again. if this happens, a small dose of the tablet may help to solve this problem.

Medikinet XL should be given in the morning with or after breakfast.

^{Updated 10.11}

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Plain methylphenidate tablets should be taken in the morning, with a second (and third) doses at lunchtime (and teatime). Taking 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 with or after food. They are complex capsules.

Concerta XL® should be swallowed whole, and not be broken, emptied or split.

Equasym XL® and Medikinet XL® can be swallowed whole, or opened and the contents sprinkled on a tablespoon of apple sauce, yoghurt or anything you can't chew. The dose must then be taken straight away, follwed by a drink, not stored for later. The body taking in methylphenidate from Equasym XL and Medikinet XL is slowed down by food. If it is taken on an empty stomach (ie before breakfast) the full effect may not last all day and it may wear off in the afternoon. If this happens, an extra dose of the plain (immediate release) tablets may help.

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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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The plain tablets take about 30 minutes to begin to have an effect (for more information click here for ADHD). 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 working after a dose but last most of the day. It may take a few weeks for the full effect to be seen.

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You should talk about this with your doctor as different people respond differently for ADHD. 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. Adults may need to take it as long as they find it helpful. That may be many years, but that choice will be yours. Sometimes your doctor will ask you not to take it at weekends and/or holidays. It may be stopped for a week or two once or twice a year to see if you still need 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.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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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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If you have the plain methylphenidate tablets and remember within two hours of when the next dose is due, then have the missed dose (unless it is after 4pm in the afternoon, see a previous question). 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 won't help anyway. 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 more difficult to sleep.

If you have problems remembering the doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by your bed etc.

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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, increased activity, being irritable, poor sleep, increased appetite and depression. If this were to happen by accident, then starting methylphenidate again would get rid of these effects.

There are no set rules about stopping methylphenidate, but an American group (Kutcher et al 2004) and the USPDI (the US Medicines regulators) suggest dropping the dose by a quarter (25%) every week over 3 weeks. This should reduce any chances of any withdrawal effects.

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The table below will show you some of the main side effects you might get from methylphenidate.

There is no evidence that methylphenidate has any effect on growth or weight when taken for ADHD ^{(Biederman 2010)}. 

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

^{Updated 12.11}

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

^{Updated 1.12}

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When some people first start methylphenidate, they can lose their appetite and then might lose a bit of weight. After that things settle down. A major long-term study (271 people over 10 years) has shown that having ADHD doesn’t seem to make any difference to height or weight compared to people without ADHD. It also found that methylphenidate doesn't make any difference to height or weight either, unless you are female and depressed as well, in which case you might put on some weight (Biederman 2010).

Click here for a few tips on how to help you feel less hungry and lose weight.

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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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Medikinet needs to be taken with or after food, or too much methylphenidate might be absorbed after the dose. If the breakfast has a high fat content (e.g. sausages, bacon, or a fry-up), it might not work as quickly and it will start to work slower. It should not be taken on an empty stomach or the acid in the stomach can mean it is less effective. Concerta XL is not affected by food so it can be taken before, with or after breakfast.

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger). However, there are no known problems with drinking alcohol with methylphenidate.  

It is not safe to drive after drinking alcohol, with or without methylphenidate. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

^{Updated 11.11}

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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 is just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions.  

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, it seems that there are no extra problems if smoking with methylphenidate.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, it seems that there are no extra problems if smoking cannabis with methylphenidate.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. It seems that there are no extra problems with cocaine and methylphenidate, although this doesn't mean it's safe, and both are stimulants.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. There are no reports of extra problems with methylphenidate and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). There are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with methylphenidate, but again this doesn't mean it's safe.

^{Updated 1.12}

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

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours afterwards. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking methylphendiate, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily methylphenidate doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

^{Updated 11.11}

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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:

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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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

Although methylphenidate gets into breast milk, the amount is probably low. Feeding before a morning dose of methylphenidate should have a low risk.

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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.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any 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, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

^{Updated 11.11}

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You should not need a blood test or a test on your heart (an ECG) if you are taking methylphenidate.

To be on the safe side, every every six months you should have the following checked:

• your pulse and blood pressure
• height, weight and appetite

^{Updated 10.11}

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