What is adderall

Adderall contains a combination of amphetamine and dextroamphetamine (brand names Adderall, Adderall XR and Mydayis). Amphetamine and dextroamphetamine are central nervous system stimulants that affect chemicals in the brain and nerves that contribute to hyperactivity and impulse control. It works by changing the amounts of certain natural substances in the brain.

• • Adderall is used to treat narcolepsy and attention deficit hyperactivity disorder (ADHD).
  • Adderall may also be used for purposes not listed in this medication guide.

• Adderall is used to treat ADHD in adults and children 3 years of age and older.
• Adderall XR is used to treat ADHD in adults and children 6 years of age and older.
• Mydayis is used to treat ADHD in adults and children 13 years of age and older.
• Dextroamphetamine and amphetamine (Adderall) is also used to treat narcolepsy (a sleep disorder that causes excessive daytime sleepiness and sudden attacks of sleep) in adults and children 12 years of age and older.
• Adderall (amphetamine and dextroamphetamine) is not approved for use by anyone younger than 6 years old.

Adderall Generic name:

DEXTROAMPHETAMINE SACCHARATE 1.25mg, AMPHETAMINE ASPARTATE MONOHYDRATE 1.25mg, DEXTROAMPHETAMINE SULFATE 1.25mg, AMPHETAMINE SULFATE 1.25mg

US Brand Name

• Adderall
• Adderall XR

Canadian Brand Name

• Adderall XR – 10mg
• Adderall XR – 15mg
• Adderall XR – 20mg
• Adderall XR – 25mg
• Adderall XR – 30mg
• Adderall XR – 5mg

What is Adderall XR (amphetamine and dextroamphetamine) ?

Adderall XR= extended-release Adderall. When taking Adderall XR do not crush, chew, break, or open an extended-release capsule. Swallow it whole.

Amphetamine and dextroamphetamine may be habit-forming, and this medicine is a drug of abuse. Tell your doctor if you have had problems with drug or alcohol abuse.

Stimulants have caused stroke, heart attack, and sudden death in people with high blood pressure, heart disease, or a heart defect.

Do not use this medicine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

What is Adderall used for

Adderall (amphetamine and dextroamphetamine combination) works in the treatment of attention deficit hyperactivity disorder (ADHD) to increase attention and decrease restlessness in patients who are overactive, cannot concentrate, or are easily distracted. It is used as part of a total treatment program that also includes social, educational, and psychological therapy.

Adderall (amphetamine and dextroamphetamine combination) is available only with a doctor’s prescription. Prescriptions cannot be refilled. A new prescription must be obtained from your doctor each time you need this medicine.

This product is available in the following dosage forms:

Tablet
Capsule, Extended Release (XR)

Proper Use of Adderall

Take Adderall only as directed by your doctor. Do not take more or less of it, do not take it more often and do not take it for a longer time than your doctor ordered. If you take too much, Adderall may become habit-forming (causing mental or physical dependence).

• Keep track of your medicine. Amphetamine and dextroamphetamine is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Adderall should come with a Medication Guide. Read and follow these instructions carefully. Talk to your doctor if you have any questions.

If you think Adderall is not working properly after you have taken it for several weeks, do not increase the dose and check with your doctor.

Take the Adderall regular tablet in the morning and early afternoon. If you take the Adderall tablet in the evening, you may have trouble falling asleep at night.

If you are using the Adderall XR extended-release capsule:

• Swallow the capsule whole with water or other liquids. Do not crush, break, or chew it.
• Take the Adderall XR capsule in the morning. If you take it in the afternoon or evening, you may have trouble falling asleep at night.
• You may take the Adderall XR capsule with or without food.
• If you cannot swallow the capsule, carefully open it and sprinkle the small beads over a spoonful of applesauce. Swallow the mixture right away without chewing. Do not store the mixture for future use. Do not crush or chew the beads from the capsule.
• Avoid drinking fruit juices or taking vitamin C at the same time you take amphetamine and dextroamphetamine. These can make your body absorb less of the medicine.

Before Using Adderall

In deciding to use Adderall, the risks of taking Adderall must be weighed against the good it will do. This is a decision you and your doctor will make. For Adderall, the following should be considered:

• You may not be able to use Adderall (amphetamine and dextroamphetamine) if you are allergic to any stimulant medicine. You may not be able to use Adderall if you have:
  • high blood pressure, heart disease, coronary artery disease (hardened arteries);
  • overactive thyroid;
  • glaucoma;
  • severe anxiety, tension, or agitation (stimulant medicine can make these symptoms worse); or
  • a history of drug or alcohol addiction.

Some medicines can interact with Adderall (amphetamine and dextroamphetamine) and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

Stimulants have caused stroke, heart attack, and sudden death in certain people. Tell your doctor if you have:

• heart problems or a congenital heart defect;
• high blood pressure; or
• a family history of heart disease or sudden death.

To make sure this Adderall (amphetamine and dextroamphetamine) is safe for you, tell your doctor if you or anyone in your family has ever had:

• depression, mental illness, bipolar disorder, psychosis, or suicidal thoughts or actions;
• motor tics (muscle twitches) or Tourette’s syndrome;
• seizures or epilepsy;
• an abnormal brain wave test (EEG); or
• blood circulation problems in the hands or feet.

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to Adderall or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of Adderall (amphetamine and dextroamphetamine combination) to treat ADHD in children. However, safety and efficacy have not been established in children younger than 6 years of age (Adderall XR extended-release capsules) or children younger than 3 years of age (tablets).

Geriatric

Appropriate studies on the relationship of age to the effects of Adderall (amphetamine and dextroamphetamine) combination have not been performed in the geriatric population.

Pregnancy

• Taking Adderall during pregnancy can cause premature birth, low birth weight, or withdrawal symptoms in the newborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Breastfeeding

Studies in women breastfeeding have demonstrated Adderall harmful infant effects. An alternative to Adderall should be prescribed or you should stop breastfeeding while using Adderall.

• Amphetamine and dextroamphetamine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using Adderall.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking Adderall, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using Adderall with any of the following medicines is not recommended. Your doctor may decide not to treat you with Adderall or change some of the other medicines you take.

• Clorgyline
• Furazolidone
• Iproniazid
• Isocarboxazid*
• Linezolid*
• Methylene Blue*
• Moclobemide
• Nialamide
• Pargyline
• Phenelzine*
• Procarbazine
• Rasagiline*
• Safinamide
• Selegiline*
• Sibutramine
• Toloxatone
• Tranylcypromine*

*Do not use Adderall if you have used an MAO (monoamine oxidase) inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine and others ¹.

Using Adderall with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acetazolamide
• Benzthiazide
• Chlorothiazide
• Chlorpromazine
• Diazoxide
• Donepezil
• Furazolidone
• Hydrochlorothiazide
• Hydroflumethiazide
• Hydroxytryptophan
• Polythiazide
• Safinamide
• Sodium Bicarbonate
• Trichlormethiazide
• Xipamide

Using Adderall with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Guanethidine

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of Adderall. Make sure you tell your doctor if you have any other medical problems, especially:

• Agitation, severe or
• Anxiety, severe or
• Arteriosclerosis (hardening of the arteries), severe or
• Coronary artery disease or
• Drug abuse, history of or
• Glaucoma or
• Heart attack, recent or
• Heart or blood vessel disease (eg, cardiomyopathy), severe or
• Heart rhythm problems (eg, ventricular arrhythmia) or a family history of or
• Hypertension (high blood pressure), moderate to severe or
• Hyperthyroidism (overactive thyroid) or
• Stroke, history of or
• Tension, severe or—Should not be used in patients with these conditions.
• Bipolar disorder (manic-depressive illness), or a family history of or
• Depression, or a family history of or
• Mania, history of or
• Psychosis (mental illness), history of or
• Raynaud disease or
• Seizures, history of or
• Tachycardia (fast heart rate) or
• Tourette syndrome (tics), or a family history of—Use with caution. May make these conditions worse.

Amphetamine and dextroamphetamine may cause new or worsening psychosis (unusual thoughts or behavior), especially if you have a history of depression, mental illness, or bipolar disorder.

You may not be able to use Adderall if you have glaucoma, overactive thyroid, severe agitation, moderate to severe high blood pressure, heart disease or coronary artery disease, or a history of drug or alcohol addiction.

You may have blood circulation problems that can cause numbness, pain, or discoloration in your fingers or toes.

• See your doctor right away if you have: signs of heart problems–chest pain, feeling light-headed or short of breath; signs of psychosis–paranoia, aggression, new behavior problems, seeing or hearing things that are not real; signs of circulation problems–unexplained wounds on your fingers or toes.

Adderall side effects

Along with its needed effects, Adderall (amphetamine & dextroamphetamine) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking Adderall (amphetamine & dextroamphetamine) ², ³:

More common

• bladder pain
• bloody or cloudy urine
• difficult, burning, or painful urination
• fast, pounding, or irregular heartbeat or pulse
• frequent urge to urinate
• lower back or side pain

Less common

• Cold or flu-like symptoms
• cough or hoarseness
• fever or chills

Incidence not known

• Blistering, peeling, or loosening of the skin
• chest pain or discomfort
• confusion
• dark-colored urine
• diarrhea
• difficulty breathing
• difficulty with speaking
• difficulty with swallowing
• dizziness
• double vision
• faintness
• headache
• inability to move the arms, legs, or facial muscles
• inability to speak
• itching, skin rash
• joint or muscle pain
• large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• loss of bladder control
• muscle cramps or spasms
• muscle pain or stiffness
• muscle spasm or jerking of all extremities
• nausea
• pain or discomfort in the arms, jaw, back, or neck
• red skin lesions, often with a purple center
• red, irritated eyes
• seeing, hearing, or feeling things that are not there
• seizures
• slow speech
• sore throat
• sores, ulcers, or white spots in the mouth or on the lips
• sudden loss of consciousness
• sweating
• swelling of the feet or lower legs
• tightness in the chest
• uncontrolled repeated movements (tics)
• uncontrolled vocal outbursts
• unusual tiredness or weakness
• vomiting

Some side effects of Adderall (amphetamine & dextroamphetamine) may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Anxiety
• dry mouth
• lack or loss of strength
• stomach pain
• weight loss

Incidence not known

• Constipation
• decreased interest in sexual intercourse
• false or unusual sense of well-being
• inability to have or keep an erection
• loss in sexual ability, desire, drive, or performance
• twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs

Metabolic

Very common (10% or more): Appetite loss (up to 36%), weight loss (up to 10%)
Frequency not reported: Anorexia

Gastrointestinal

Very common (10% or more): Dry mouth (up to 35%), abdominal pain (up to 14%)
Common (1% to 10%): Nausea, vomiting, diarrhea, dyspepsia
Frequency not reported: Unpleasant taste, constipation, other GI disturbances

Cardiovascular

Very common (10% or more): Transient blood pressure elevations (up to 35%)
Common (1% to 10%): Tachycardia, palpitation
Frequency not reported: Cardiomyopathy, myocardial infarction, Raynaud’s phenomenon

Psychiatric

Very common (10% or more): Insomnia (up to 27%), nervousness (up to 13%)
Common (1% to 10%): Emotional lability, agitation, anxiety
Frequency not reported: Psychotic episodes, irritability, euphoria, dysphoria, restlessness, depression, aggression, anger, logorrhea, dermatillomania

Nervous system

Very common (10% or more): Headache (up to 26%)
Common (1% to 10%): Somnolence, dizziness, twitching, speech disorder (e.g., stuttering, excessive speech)
Frequency not reported: Overstimulation, paresthesia/formication, dyskinesia, tremor, exacerbation of motor/phonic tics and Tourette’s syndrome

Dermatologic

Common (1% to 10%): Photosensitivity reaction, sweating
Frequency not reported: Urticaria, rash, alopecia, serious skin rashes (e.g., Stevens-Johnson Syndrome, toxic epidermal necrolysis)

Endocrine

Common (1% to 10%): Decreased libido, dysmenorrhea, impotence
Frequency not reported: Frequent or prolonged erections

Genitourinary

Common (1% to 10%): Urinary tract infection

Other

Common (1% to 10%): Fever, infection, accidental injury, asthenia/fatigue, tooth disorder (e.g., teeth clenching, tooth infection)
Frequency not reported: Sudden death, bruxism

Respiratory

Common (1% to 10%): Dyspnea

Hypersensitivity

Frequency not reported: Hypersensitivity reactions (e.g., angioedema, anaphylaxis)

Ocular

Frequency not reported: Blurred vision, mydriasis

Musculoskeletal

Postmarketing reports: Rhabdomyolysis.

Long term effects of adderall

Over time, the brain gets used to the increased levels of dopamine. When this happens, amphetamine users develop a tolerance to the drug. They have to use more to feel the same highs. That can lead longtime users to have strong cravings for the drug.

When people use large amounts of amphetamines more often, it can put added stress on the heart and lead to elevated blood pressure and pulse rates, rapid breathing, and even heart failure.

Long-term abuse of amphetamines may cause people to have hallucinations, hear voices, feel paranoid, and develop a psychosis that resembles schizophrenia. Long-term amphetamine abusers might become violent or act unpredictably.

Other long-term effects include:

• physical exhaustion
• insomnia and restlessness
• dizziness and blurred vision
• headaches
• reduced appetite and health problems from not eating properly
• higher chances of getting sick because of malnutrition
• depression, anxiety, and paranoia
• severe dental problems (“meth mouth”) when using methamphetamine
• mood disturbances and delusions similar to those felt by people with bipolar disorder or psychosis

Other Possible Problems

Using too large a dose of amphetamines at one time can cause an overdose. Someone who overdoses will have a higher body temperature, hallucinations, convulsions, and could die.

People who use lots of amphetamines can become emotionally dependent on them. These users may become fixated on finding and taking amphetamines. They may do whatever they can to keep getting high, including taking risks.

People whose bodies are used to taking lots of amphetamines might keep using them to avoid withdrawal symptoms. This may lead to binges of drug abuse that can last for days, making the eventual crash even more difficult.

Amphetamines are listed as a Schedule II stimulant, meaning they have a high potential for abuse. Although amphetamines are used in medicines, they are available only through a limited prescription. People who use amphetamines without a prescription could end up in jail.

How Can Someone Quit ?

People who are used to taking large amounts of amphetamines may have a hard time quitting. They may go through various mood problems, such as aggression, anxiety, and intense cravings for the drugs. They also might feel depressed and even have suicidal thoughts when they try to quit.

If you think you might be addicted to amphetamines, talk with a counselor or join a support group. These things can help make it easier to quit.

Avoiding Amphetamines

Unless amphetamines are in powder form, they can look like any other pill. Because people rarely call them “amphetamines,” it can help to be aware of other names for amphetamines, from brand names like Ritalin or Adderall to nicknames like Bennies or Black Mollies.

If someone offers you amphetamines, chances are he or she might not know quite how dangerous they can be. Even when drugs are prescribed by a doctor, that doesn’t make them safe for anyone to take. Protect yourself by being aware of the risks!

Dosing of Adderall

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (extended-release capsules):
For ADHD:
Adults—20 milligrams (mg) once a day in the morning. Your doctor may adjust your dose if needed.
Teenagers 13 to 17 years of age—At first, 10 mg once a day in the morning. Your doctor may adjust your dose if needed.
Children 6 to 12 years of age—At first, 10 mg once a day in the morning. Your doctor may adjust your dose if needed. However, the dose is usually not more than 30 mg per day.
Children younger than 6 years of age—Use and dose must be determined by your doctor.
For oral dosage form (tablets):
For ADHD:
Adults and children 6 years of age and older—At first, 5 milligrams (mg) given one or two times a day. Your doctor may adjust your dose if needed.
Children 3 to 5 years of age—At first, 2.5 mg once a day. Your doctor may adjust your dose if needed.
Children younger than 3 years of age—Use is not recommended.
For narcolepsy:
Adults and children 12 years of age and older—At first, 10 milligrams (mg) per day, divided and given in 2 doses. Your doctor may adjust your dose if needed.
Children 6 to 12 years of age—At first, 5 mg per day. Your doctor may adjust your dose if needed.
Children younger than 6 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of Adderall, take it as soon as possible, but not late in the day. Skip the missed dose if it is almost evening. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses and do not take extra medicine to make up the missed dose.

What happens in Adderall overdose ?

Seek emergency medical attention, call your local emergency number.

An overdose of amphetamine and dextroamphetamine could be fatal.

Overdose symptoms may include:

• restlessness,
• tremor,
• muscle twitches,
• rapid breathing,
• confusion,
• hallucinations,
• panic,
• aggressiveness,
• muscle pain or weakness, and
• dark colored urine.

These symptoms may be followed by depression and tiredness. Other overdose symptoms include nausea, vomiting, diarrhea, stomach pain, uneven heartbeats, feeling light-headed, fainting, seizure (convulsions), or coma.

Storage

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
• Keep out of the reach of children.
• Do not keep outdated medicine or medicine no longer needed.
• Ask your healthcare professional how you should dispose of any medicine you do not use.

Adderall Dosage

Regardless of indication, amphetamines should be administered at the lowest effective dosage, and dosage should be individually adjusted according to the therapeutic needs and response of the patient. Late evening doses should be avoided because of the resulting insomnia.

Attention Deficit Hyperactivity Disorder

Not recommended for children under 3 years of age. In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained.

Age 3 to 5 Years:
-Initial Dose: 2.5 mg orally per day
-Maintenance Dose: Daily dose may be raised in 2.5 mg increments at weekly intervals until optimal response is obtained.

Age 6 to 17 Years:
-Initial Dose: 5 mg orally 1 or 2 times a day
-Maintenance Dose: Daily dose may be raised in 5 mg increments at weekly intervals until optimal response is obtained.
-Maximum Dose: Only in rare cases will it be necessary to exceed 40 mg per day.

In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy.

Adderall XR:

Age 6 to 12 Years (starting treatment for the first time or switching from another medication):
-Initial Dose: 5 or 10 mg orally once a day in the morning
-Maintenance Dose: Daily dose may be raised in 5 to 10 mg increments at weekly intervals.
-Maximum Dose: 30 mg/day

Age 13 to 17 Years (starting treatment for the first time or switching from another medication):
-Initial Dose: 10 mg orally once a day
-Maintenance Dose: Daily dose may be increased to 20 mg/day after one week if symptoms are not adequately controlled.
-Maximum Dose: 30 mg/day

Adult Patients starting treatment for the first time or switching from another medication:
-Initial Dose: 20 mg orally once a day

Narcolepsy

Usual dose 5 mg to 60 mg per day in divided doses, depending on the individual patient response.

Narcolepsy seldom occurs in children under 12 years of age; however, when it does, dextroamphetamine sulfate may be used. The suggested initial dose for patients aged 6 to 12 is 5 mg daily; daily dose may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. In patients 12 years of age and older, start with 10 mg daily; daily dosage may be raised in increments of 10 mg at weekly intervals until optimal response is obtained. If bothersome adverse reactions appear (e.g., insomnia or anorexia), dosage should be reduced. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours.

Ritalin vs adderall

Ritalin (methylphenidate) is a central nervous system stimulant ⁴. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. Ritalin is used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and narcolepsy. Ritalin may also be used for purposes not listed here.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.

To help prevent trouble with sleeping, take the last dose of the short-acting tablets before 6 PM, unless your doctor gives you a different time.

If you are taking the chewable tablet, drink at least 8 ounces of water or other liquid when you chew the tablet. Take it preferably 30 to 45 minutes before meals.

Shake the oral liquid gently just before using it. Use a marked measuring spoon, oral syringe, or medicine cup to measure the right dose. Take it preferably 30 to 45 minutes before meals.

If you are taking the long-acting forms of Methylphenidate:

• The Concerta® extended release tablets, Aptensio XR™, Metadate CD®, or Ritalin LA® capsules, and Ritalin SR® tablets are to be swallowed whole with water or other liquids. Do not break, open, crush, or chew them before swallowing.
• If you are unable to swallow the Aptensio XR™, Metadate CD®, or Ritalin LA® extended-release capsule whole, carefully open the capsule and sprinkle the small beads over a spoonful of applesauce. The mixture of drug and applesauce should be taken right away without chewing. The drug and applesauce mixture should not be stored for future use.
• If you are taking the Concerta® extended-release tablets, you may sometimes notice what looks like a tablet in your stool. This is the empty tablet shell that is left after the medicine has been absorbed into your body.
• You may take Concerta® extended release tablets or Aptensio XR™ capsules with or without food.
• If you are taking the Quillivant™ XR extended-release suspension, shake the bottle well for at least 10 seconds before measuring each dose. Use only the oral dosing dispenser provided in the package to get the right dose. You may take it with or without food.
• If you are taking the Quillichew ER™ tablets, you may cut the 20- and 30-milligram (mg) scored chewable tablets into two if needed.

Dosing of Ritalin

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For attention deficit hyperactivity disorder (ADHD):

• For short-acting oral dosage forms (chewable tablets or solution):
  • Adults—Administer 2 or 3 times a day and take 30 to 45 minutes before meals. The average dose is 20 to 30 milligrams (mg) per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
  • Children 6 years and older—At first, 5 mg 2 times a day, taken before breakfast and lunch. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
  • Children younger than 6 years—Use and dose must be determined by the doctor.
• For short-acting oral dosage form (tablets):
  • Adults—5 to 20 milligrams (mg) 2 or 3 times a day, taken 30 to 45 minutes before meals.
  • Children 6 years and older—At first, 5 mg two times a day, taken before breakfast and lunch. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
  • Children younger than 6 years—Use and dose must be determined by the doctor.
• For long-acting oral dosage form (extended-release capsules):
  • Patients who have not been treated with methylphenidate:
    • Adults and children 6 years and older—At first, 10 to 20 milligrams (mg) once a day, taken in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
    • Children younger than 6 years—Use and dose must be determined by the doctor.
  • Patients who are already taking methylphenidate:
    • Adults and children 6 years and older—10 to 60 milligrams (mg) once a day, taken in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
    • Children younger than 6 years—Use and dose must be determined by the doctor.
• For long-acting oral dosage form (extended-release suspension):
  • Adults and children 6 years and older—At first, 20 milligrams (mg) once a day, taken in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
  • Children younger than 6 years—Use and dose must be determined by the doctor.
• For long-acting oral dosage form (extended-release chewable tablets):
  • Adults and children 6 years and older—At first, 20 milligrams (mg) once a day, taken in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
  • Children younger than 6 years—Use and dose must be determined by the doctor.
• For long-acting oral dosage form (extended-release tablets):
  • For patients who have not been treated with Concerta®:
    • Adults—At first, 18 to 36 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 72 mg per day.
    • Children 6 years and older—At first, 18 mg once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 72 mg per day.
    • Children younger than 6 years—Use and dose must be determined by your doctor.
  • For patients already using Concerta®:
    • Adults and children 6 years and older—At first, 18 to 72 milligrams (mg) once a day in the morning. Your doctor may adjust your dose as needed. However, the dose is usually not more than 72 mg per day.
    • Children younger than 6 years—Use and dose must be determined by your doctor.

For narcolepsy:

• For short-acting oral dosage forms (chewable tablets or solution):
  • Adults—Administer 2 or 3 times a day and take 30 to 45 minutes before meals. Average dose is 20 to 30 milligrams (mg) per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
  • Children 6 years and older—At first, 5 mg 2 times a day, taken before breakfast and lunch. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
  • Children younger than 6 years—Use and dose must be determined by the doctor.
• For short-acting oral dosage form (tablets):
  • Adults—5 to 20 milligrams (mg) 2 or 3 times a day, taken 30 to 45 minutes before meals.
  • Children 6 years and older—At first, 5 mg 2 times a day, taken before breakfast and lunch. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per day.
  • Children younger than 6 years—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

For the extended-release suspension: Throw away any unused suspension 4 months after it is used for the first time.

Precautions

Your doctor should check your or your child’s progress at regular visits to make sure this medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

You or your child will also need to have your blood pressure and heart rate measured before starting this medicine and while you are using it. If you notice any change in your blood pressure, call your doctor right away. If you have questions about this, talk to your doctor.

You or your child should not use this medicine if you have used a drug for depression called an MAO inhibitor (MAOI), such as Eldepryl®, Marplan®, Nardil®, or Parnate®, in the past 14 days.

Methylphenidate may cause dizziness, drowsiness, or changes in vision. Do not drive a car, ride a bicycle, operate machinery, or do other things that might be dangerous until you know how this medicine affects you.

Methylphenidate may cause serious heart or blood vessel problems. This may be more likely in patients who have a family history of heart disease. Check with your doctor right away if you or your child has chest pain, shortness of breath, fainting, or a fast, irregular heartbeat while using this medicine.

Tell your doctor right away if you or your family notice any unusual changes in behavior, such as an increase in aggression, hostility, agitation, irritability, or suicidal thinking or behaviors. Also tell your doctor if you have hallucinations or any unusual thoughts, especially if they are new or getting worse quickly.

This medicine may cause slow growth. If your child is using this medicine, the doctor will need to keep track of his height and weight to make sure that he is growing properly.

Methylphenidate may cause a condition called Raynaud phenomenon. Check with your doctor right away if you or your child has tingling or pain in the fingers or toes when exposed to cold, paleness or a cold feeling in the fingertips and toes, or a skin color change in your fingers.

Make sure any doctor or dentist who treats you knows that you are using Metadate CD®. You may need to stop using this medicine before you have surgery.

Avoid drinking alcohol while taking the Aptensio XR™, Metadate CD®, Quillichew ER™ tablets, or Ritalin LA® extended-release capsules.

If you or your child experience a prolonged or painful erection of the penis for more than 4 hours, check with your doctor right away.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines, herbal or vitamin supplements, and medicine for appetite control, asthma, colds, cough, hayfever, or sinus problems.

Ritalin Side Effects

Along with its needed effects, methylphenidate (the active ingredient contained in Ritalin) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking methylphenidate ⁵, ⁶, ⁷, ⁸, ⁹, ¹⁰, ¹¹:

More common

• Fast heartbeat

Less common

• Chest pain
• fever
• joint pain
• skin rash or hives

Rare

• Black, tarry stools
• blood in the urine or stools
• blurred vision or other changes in vision
• crusting, dryness, or flaking of the skin
• muscle cramps
• pinpoint red spots on the skin
• scaling, severe redness, soreness, or swelling of the skin
• seizures
• uncontrolled vocal outbursts or tics (uncontrolled and repeated body movements)
• unusual bleeding or bruising

Incidence not known

• Confusion
• depression
• feeling like surroundings are not real
• numbness of the hands
• painful or difficult urination
• pale skin
• paleness or cold feeling in the fingertips and toes
• red, irritated eyes
• red, swollen, or scaly skin
• seeing, hearing, or feeling things that are not there
• severe or sudden headache
• sores, ulcers, or white spots on the lips or in the mouth
• sudden loss of coordination
• sudden slurring of speech
• tingling or pain in the fingers or toes when exposed to cold
• unusual behavior
• unusual tiredness or weakness
• weight loss
• yellow skin or eyes

Get emergency help immediately if any of the following symptoms of overdose occur while taking methylphenidate:

Symptoms of overdose

• Agitation
• anxiety
• bigger, dilated, or enlarged pupils of the eyes
• confusion as to time, place, or person
• dark-colored urine
• diarrhea
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• dry eyes, mouth, nose, or throat
• false or unusual sense of well-being
• fast, slow, irregular, pounding, or racing heartbeat or pulse
• holding false beliefs that cannot be changed by fact
• increased sensitivity of the eyes to light
• loss of consciousness
• muscle pain or stiffness
• muscle twitching
• nervousness
• overactive reflexes
• pounding in the ears
• rapid, shallow breathing
• sweating
• tremors
• unusual excitement, nervousness, or restlessness

Some side effects of methylphenidate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Headache
• loss of appetite
• nervousness
• stomach pain
• stuffy nose
• trouble sleeping
• unusually warm skin

Less common

• Anger
• decreased appetite
• dizziness
• drowsiness
• fear
• irritability
• muscle aches
• nausea
• runny nose
• scalp hair loss
• talking, feeling, and acting with excitement
• vomiting

General

In children, the following adverse reactions may occur more frequently: loss of appetite, abdominal pain, weight loss during prolonged therapy, insomnia, and tachycardia.

Other

• Very common (10% or more): Infections and infestations (45.2%)
• Common (1% to 10%): Lethargy, ear infection, pyrexia, fatigue, ear and labyrinth disorders, reproductive system and breast disorders, growth retardation (reduced weight and height gain), thirst, asthenia, influenza, erectile dysfunction, injury/poisoning/procedural complications
• Uncommon (0.1% to 1%): Chest pain
• Rare (less than 0.1%): Gynecomastia
• Frequency not reported: Increased erection, prolonged erection, chest discomfort, hyperpyrexia, abuse and dependence
• Postmarketing reports: Priapism

Psychiatric

• Very common (10% or more): Psychiatric disorders (27.9%), insomnia (13.3%), irritability (11%)
• Common (1% to 10%): Anxiety, restlessness, sleep disorder, agitation, affect lability, aggression, depression, depressed mood, abnormal behavior, bruxism, confusional state, initial insomnia, decreased libido, nervousness, emotional poverty, tension, panic attack
• Uncommon (0.1% to 1%): Psychotic disorders, hallucinations (auditory, visual, tactile), anger, suicidal ideation, altered mood, mood swings, tearfulness, tics, worsening of pre-existing tics or Tourette’s syndrome, hypervigilance
• Rare (less than 0.1%): Mania, disorientation, libido disorder
• Very rare (less than 0.01%): Suicidal attempt/completed suicide, transient depressed mood, abnormal thinking, apathy, repetitive behaviors, over-focusing
• Frequency not reported: Delusions, thought disturbances, confessional state, logorrhea

Metabolic

• Very common (10% or more): Decreased appetite (27.1%), metabolism and nutrition disorders (11.5%)
• Common (1% to 10%): Anorexia, decreased weight

Gastrointestinal

• Very common (10% or more): Gastrointestinal disorders (23.5%), dry mouth (21.5%), nausea (12.2%), vomiting (10.2%)
• Common (1% to 10%): Abdominal pain (upper and general), diarrhea, dyspepsia, toothache, stomach discomfort
• Uncommon (0.1% to 1%): Constipation

Nervous system

• Very common (10% or more): Nervous system disorders (23.5%), headache (23.2%)
• Common (1% to 10%): Dizziness, dyskinesia, tremor, drowsiness, feeling jittery, psychomotor hyperactivity, somnolence, vertigo, paresthesia, motion sickness, tension headache
• Uncommon (0.1% to 1%): Sedation, tremor
• Very rare (less than 0.01%): Convulsions, choreoathetoid movements, reversible ischemic neurological deficit, cerebrovascular disorders (vasculitis, cerebral hemorrhages, cerebrovascular accidents, cerebral arteritis, cerebral occlusion), neuroleptic malignant syndrome (NMS)
• Frequency not reported: Grand mal convulsions, migraine, sedation

Respiratory

• Very common (10% or more): Nasopharyngitis (19.1%), respiratory/thoracic/mediastinal disorders (10.6%)
• Common (1% to 10%): Upper respiratory tract infection, cough, oropharyngeal/pharyngolaryngeal pain, sinusitis, dyspnea

Musculoskeletal

Very common (10% or more): Musculoskeletal and connective tissue disorders (14.4%),
Common (1% to 10%): Joint sprain, arthralgia
Uncommon (0.1% to 1%): Myalgia, muscle twitching, muscle tightness, muscle spasms
Very rare (less than 0.01%): Muscle cramps
Frequency not reported: Rhabdomyolysis

Local

Very common (10% or more): Administration site and general disorders (12.9%)
Postmarketing reports: Patch application site reactions

Cardiovascular

Common (1% to 10%): Palpitations, tachycardia, cardiac disorders, vascular disorders, arrhythmias, hypertension, hot flush, changes in blood pressure and heart rate (usually an increase)
Uncommon (0.1% to 1%): Cardiac murmur
Rare (less than 0.1%): Angina pectoris
Very rare (less than 0.01%): Cardiac arrest, myocardial infarction, peripheral coldness, Raynaud’s phenomenon, sudden cardiac death
Frequency not reported: Supraventricular tachycardia, bradycardia, ventricular extrasystoles, extrasystoles

Dermatologic

Common (1% to 10%): Rash, pruritus, urticaria, fever, scalp hair loss/alopecia, dermatitis, excoriation hyperhidrosis, skin and subcutaneous tissue disorders
Uncommon (0.1% to 1%): Angioneurotic edema, bullous conditions, exfoliative conditions
Rare (less than 0.1%): Macular rash, erythema
Very rare (less than 0.01%): Thrombocytopenic purpura, exfoliative dermatitis, erythema multiforme, fixed drug eruption

Immunologic

Common (1% to 10%): Immune systems disorders

Ocular

Common (1% to 10%): Eye disorders, eye pain
Uncommon (0.1% to 1%): Diplopia, blurred vision
Rare (less than 0.1%): Visual accommodation difficulties, mydriasis, visual disturbance
Frequency not reported: Dry eye
Postmarketing reports: Visual impairment[Ref]

Genitourinary

Uncommon (0.1% to 1%): Hematuria, pollakiuria

Hepatic

Uncommon (0.1% to 1%): Hepatic enzyme elevations
Very rare (less than 0.01%): Abnormal liver function, hepatic coma, increased blood alkaline phosphatase, increased blood bilirubin
Postmarketing reports: Hepatocellular injury, acute hepatic failure

Hypersensitivity

Uncommon (0.1% to 1%): Hypersensitivity reactions (angioedema, anaphylaxis, auricular swelling, exanthemas)

Hematologic

Very rare (less than 0.01%): Leukopenia, thrombocytopenia, anemia, decreased platelet count, abnormal white blood count
Postmarketing reports: Pancytopenia

Concerta vs adderall

Concerta is a brand name of a drug containing the same methylphenidate as Ritalin. See Ritalin above for details.

Methylphenidate US Brand Names:

• Aptensio XR
• Concerta
• Metadate CD
• Metadate ER
• Methylin
• Methylin ER
• QuilliChew ER
• Quillivant XR
• Ritalin
• Ritalin LA
• Ritalin-SR

Adderall alternatives

There are two main kinds of ADHD medications: stimulants and non-stimulants.

1. Stimulants include Concerta, Ritalin LA, Focalin XR, Metadate CD, Daytrana, Adderall, and Vyvanse. They come as a liquid, pill, capsule, and even a patch. Stimulants work very quickly, and people with ADHD may see an improvement right away.
2. Non-stimulants work a little differently in the brain than stimulants. They may take longer to work, but they work better than stimulants for some people. Non-stimulants include atomoxetine (Strattera), extended release guanfacine (Intuniv), extended release clonidine (Kapvay), and certain antidepressants (such as Wellbutrin).

Doctors work closely with people who have ADHD to figure out which medicine will be most helpful. Because everyone’s different, doctors might try a couple of medicines before finding the one that works best.

Some teens need a combination of medicines. They might need both a stimulant and a non-stimulant at the same time to get the best results.

1. Adderall XR. https://www.drugs.com/mtm/adderall-xr.html
2. “Product Information. Adderall (amphetamine-dextroamphetamine)” Shire Richwood Pharmaceutical Company, Florence, KY.
3. “Product Information. Adderall XR (amphetamine-dextroamphetamine).” Shire Richwood Pharmaceutical Company Inc, Florence, KY.
4. Ritalin. https://www.drugs.com/ritalin.html
5. “Product Information. Metadate CD Capsules (methylphenidate)” Celltech Pharmaceuticals, Inc, Applegate, WI.
6. “Product Information. Quillivant XR (methylphenidate).” NextWave Pharmaceuticals , Vernon Hills, IL.
7. “Product Information. Metadate ER (methylphenidate).” Celltech Pharmacueticals Inc, Appleton, WI.
8. “Product Information. Concerta (methylphenidate).” Alza, Palo Alto, CA.
9. Cerner Multum, Inc. “UK Summary of Product Characteristics.”
10. Cerner Multum, Inc. “Australian Product Information.”
11. “Product Information. Ritalin (methylphenidate).” Novartis Pharmaceuticals, East Hanover, NJ.