Methylphenidate Concerta

Extended-Acting Stimulants Methylphenidate Concerta c 30-mg tab daily 18-, 27-, 36-, or 54-mg tab daily ... 

Many psychomotor stimulants possess activities similar to those of amphetamine and have been discussed previously (see Chapter 10). Of primary importance to our discussion of the psychomotor stimulants are amphetamine Adderall, Benzedrine, Dexedrine), methampheta-mine (Desoxyn), and methylphenidate (Concerta, Ritalin, Metadate, Methylin). 

More recently, a new oral, osmotic, extended-release formulation of methylphenidate (Concerta), with both an immediate and continuous release component, has been approved by the FDA (72). When taken once daily, it results in plasma levels similar to those achieved with a three-times-a-day schedule of the immediate-release formulation. In addition, serum concentrations appear to fluctuate less. The additional cost, however, is significant. 

Stimulants (amphetamines [Adderall, Dexedrine] and methylphenidate [Concerta, Ritalin]) increase alertness, attention, and energy. They also increase blood pressure and heart rate, constrict blood vessels, increase blood glucose, and open up the pathways of the respiratory system. Historically, stimulants were prescribed to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the prescribing of stimulants by physicians began to wane. Now, stimulants are prescribed for treating only a few health conditions, most notably ADHD, narcolepsy, and, in some instances, depression that has not responded to other treatments. 

A 17-year-old girl attempted suicide with methylphenidate (Concerta ) 270 mg since more than 3 hours had elapsed, charcoal was not used. All vital signs and laboratory findings were normal, except for the heart rate, which was 132/minute. 

Ozdemir E, Karaman MG, Yurteri N, Erdogan A. A case of suicide attempt with long-acting methylphenidate (Concerta). Atten Deflc Hyperact Disord 2010 2 103-5. 

A 25-year-old man experienced spontaneous ejaculation without sexual arousal following testicular pain after micturition with the use of methylphenidate. His drug history included atomoxetine, which also gave spontaneous ejaculations following micturition. After 2 years, the patient mainly used the long-acting variant of methylphenidate (Concerta ) and sometimes the shorter-acting variant of methylphenidate (Ritalin ) [26 ]. 

The prescribing physician should be notified immediately if tics or psychosis (usually paranoia) develop. The medication should always be stopped when psychosis occurs. We once said the same about tics, but recent research suggests that stimulants may not worsen tics. Methylphenidate is now available in a controlled-release preparation (Concerta), which can be prescribed once daily. One key advantage to once-daily dosing is not pharmacological, but rather that it avoids the stigma children may experience when they need to go to the school nurse s office to receive their afternoon dose. Focalin is the active isomer of methylphenidate. 

Methylphenidate (Ritalin, Concerta, Focalin). Methylphenidate was introduced in the late 1950s and is now the most widely used prescription stimulant. It was first used to treat ADHD in children but is also effective for narcolepsy. Like dextroamphetamine, methylphenidate should be started at 5 mg per dose given two to three times each day with meals. The average effective dose is 20-30 mg/day, but some patients require as much as 60 mg/day. The benefit of methylphenidate should also be apparent on the first day or so, and the dose can be increased every 5-7 days as needed. Focalin dosing is approximately half that of methylphenidate. 

Recommended Dose Conversion from Methylphenidate Regimens to Concerta ... 

Previous methylphenidate daily dosage Recommended Concerta starting dose... 

Absorption - Rapidly and well absorbed from the Gl tract, methylphenidate achieves peak blood levels in 1 to 3 hours. Peak plasma levels occur in children in 4.7 hours for the SR tablets and 1.9 hours for the regular tablets. Mean times to reach peak plasma concentrations across all doses of Concerta occurred between 6 and 10 hours. Plasma half-life for Metadate CD is reportedly 6.8 hours. SR and ER tablets are more slowly but as extensively absorbed as regular tablets. 

Memantine (Namenda) Methylphenidate, Oral (Concerta, Ritalin,... 

Methylphenidate and D-amphetamine are both short-acting compounds, with an onset of action within 30 to 60 minutes and a peak clinical effect seen usually between 1 and 2 hours after administration, lasting 2 to 5 hours. Therefore, multiple daily administrations are required for a consistent daytime response. The amphetamine compound Adderall, the sustained-release preparations of methylphenidate and dextroamphetamine, and pemoline are all intermediate-acting compounds with an onset of action within 60 minutes and a peak clinical effect seen usually between 1 and 3 hours after administration and maintained for up to 8 hours (8 hours with metadate C.D. and Ritalin LA 12 hours with Concerta), allowing for a single dose for the entire school day. Adderall XR is a 12 hour preparation. 

Methylphenidate (Ritalin, Methylin, (Metadate) (Concerta) (Ritalin LA) d-Methylphenidate (Focalin)... 

Methylphenidate Ritalin-SR Ritalin LA Metadate ER Metadate CD Concerta Slowly absorbed tablet Capsule with 50% methylphenidate dose as immediate-release beads and 50% as delayed-release beads Slowly absorbed tablet with methylphenidate incorporated in a wax matrix tablet, allowing gradual diffusion Capsule that provides 30% of methylphenidate dose hy immediate-release beads and 70% of the dose by extended-release beads Tablet that contains approximately 22% of the methylphenidate dose in an immediate-release capsule overcoat and 78% within the tablet that is released by an osmotic process over an extended period... 

Lopez F, Silva R, Pestreich L, et al Comparative efficacy of two once daily methylphenidate formulations (Ritalin LA and Concerta) and placebo in children with attention-deficit hyperactivity disorder across the school day. Paediatr Drugs 5 545-555, 2003... 

Pelham WE, Gnagy EM, Burrows-Maclean L, et al Once-a-day Concerta methylphenidate versus three-times-daily methylphenidate in laboratory and natural settings. Pediatrics 107 1-15, 2001... 

Swanson L, Greenhill W, Pelham WE. Initiating Concerta (OROS methylphenidate HCI) qd in children with attention deficit hyperactivity disorder. J Clin Res 2000 3 59-76. 

Ditropan XL Procardia XL Glucotrol XL Alpress XL (France) Cardura XL (Germany) Concerta Covera HS DynaCirc CR Oxybutynin chloride Nifedipine Glipizide Prazosin Doxazosin mesylate Methylphenidate HC1 Verapamil HC1 Isradipine... 

MPH is most often taken in pill form. It is available in prescribed quantities of 5-, 10-, and 20-mg tablets. A sustained or delayed release 20-mg tablet is also available. In 2001, the FDA approved Concerta, a longer acting MPH tablet that is taken once a day. Besides its long lasting action, Concerta has another benefit Abusers sometimes grind MPH tablets into a powder and snort it up their noses, but Concerta is formulated so that it cannot be ground into a powder. According to the DEA, methylphenidate abusers also dissolve the immediate-release MPH tablets in water and then inject the mixture. 

Concerta see Methylphenidate Coties see Codeine Cough syrup see Codeine Cough-X see Dextromethorphan Cozmo s see PCP (phencyclidine)... 

Methylphenidate is marketed in the United States under the prescription names Concerta, Metadate, Methylin, and Ritalin (26). It is available in immediate and sustained-release formulations for the treatment of attention deficit/hyperactivity disorder (ADHD) and the symptomatic management of narcolepsy (a disorder characterized by excessive daytime sleepiness). 

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