Methylphenidate hypertension with

Patients with marked anxiety, tension, and agitation, because the drug may aggravate these symptoms hypersensitivity to methylphenidate or other components of the product patients with glaucoma, motor tics, or a family history or diagnosis of Tourette s syndrome during treatment with monoamine oxidase inhibitors (MAOIs), and also within a minimum of 14 days following discontinuation of an MAOl (hypertensive crises may result). 

Seizures Methylphenidate may lower the convulsive threshold in patients with history of seizures, in patients with prior EEG abnormalities in the absence of a history of seizures, and, very rarely, in the absence of a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, discontinue the drug. Hypertension and other cardiovascular conditions Use cautiously in patients with hypertension. Monitor blood pressure at appropriate intervals in all patients taking dexmethylphenidate, especially those with hypertension. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate (eg, pre-existing hypertension, heart failure, recent Ml, hyperthyroidism). 

Exacerbation of psychosis Potentiation of hypertensive effects with phenylephrine, noradrenaline, methylphenidate Potentiation of effects of pheochromocytoma Can manifest as spurious hyperthyroidism, cardiac dysrhythmias, or, in some cases, enhanced therapeutic actions of tricyclics... 

The interaction with methylphenidate may be of particular significance, because of claims that tricyclic antidepressants and methylphenidate have a synergistic effect on mood, owing to interference by methylphenidate with the metabolism of imipramine, resulting in increased blood imipramine concentrations (182). The occurrence of this hypertensive interaction calls for caution in the use of such combinations, for which there is no established evidence. 

SYMPATHOMIMETICS CYTOTOXICS -PROCARBAZINE Co-administration of ephedrine, metaraminol, methylphenidate, phenylephrine or pseudoephedrine (including nasal and ophthalmic solutions) with procarbazine may cause a prolongation and t intensity of the cardiac stimulant effects and effects on BP, which may lead to headache, arrhythmias, hypertensive or hyperpyretic crisis The metabolism of sympathomimetics is impaired due to an inhibition of MAO It is recommended that sympathomimetics not be administered during and within 14 days of stopping procarbazine. Do not use any OTC nasal decongestants (sprays or oral preparations) or asthma relief agents without consulting the pharmacist/doctor... 

Hypertensive crisis with headache, intracranial bleeding, and death may result from combining MAO inhibitors with sympathomimetic drugs (e.g., amphetamines, methylphenidate, cocaine, dopamine, epinephrine, norepinephrine, and related compounds methyidopa,... 

Hypertensive episodes occurred in three adults who combined methylphenidate with tricyclic antidepressants (SED-9,11). Methylphenidate increases serum concentrations of imipramine (55). 

Intravenous injection of a mixture of methylphenidate and pentazocine intended for oral use resulted in death due to granulomatosis associated with pulmonary hypertension (17). 

Amphetamines—contraindicated with MAOIs Methylphenidate (Ritalin)— contraindicated with MAOIs Seriously elevated blood pressure (hypertensive crisis), elevated temperature, seizures, cerebral hemorrhage, death... 

The most common side effect of clonidine is dose-dependent sedation that usually subsides after 2 to 3 weeks of therapy. Of concern are reports of bradycardia, rebound hypertension, heart block, and sudden death. Four children have died on the combination of methylphenidate and clonidine however, complicating factors make it impossible to link the drug combination directly with the cause of death. Of 10,060 children exposed to clonidine and assessed by a poison control center over a 7-year period, moderate (19%) to major (2%) toxic effects (bradycardia, hypotension, and respiratory depression) including one death were reported. Overdoses, concurrent clonidine and stimulant administration, as well as missed doses of clonidine aU add to the risk of adverse cardiovascular events. Similar adverse-effect concerns apply to treatment with guanfacine, although its U2a selectivity may result in less sedation and hypotension than clonidine. ... 

Methylphenidate is indicated for the treatment of children with ADHD (5 to 10 mg p.o. daily) and for adults with narcolepsy (10 mg p.o. t.i.d.). Methylphenidate, a CNS stimulant and an analeptic, releases norepinephrine and hence stimulates the reticular activating system and the cerebral cortex. Its actions resemble those produced by amphetamine. Similar to other sympathomimetic agents, methylphenidate should be used with caution in patients with symptomatic cardiovascular disease, hyperthyroidism, angina pectoris, moderate to severe hypertension, or advanced arteriosclerosis because it may cause dangerous arrhythmias and blood pressure changes. 

Methylphenidate should not be used with monoamine oxidase inhibitors such as tranylcypromine. Symptoms of overdose may include euphoria, confusion, delirium, coma, toxic psychosis, agitation, headache, vomiting, dry mouth, mydriasis, self-injury, fever, diaphoresis, tremors, hyper-reflexia, muscle twitching, seizures, flushing, hypertension, tachycardia, palpitations, and arrhythmias. 

Sympathomimetics (indirectly acting) Combining MAOis with agents such as amphetamines, cocaine, ephedrine, methylphenidate, pemoline, pseudoephedrine, phenylpropanolamine, and others (including many cold and allergy medications) can cause a potentially fatal hypertensive crisis. 

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