Caffeine is a CNS-stimulant and additive effects may be seen when coadministered with other CNS stimulants. Use Caution/Monitor. methylergonovine, methylphenidate. Use Caution/Monitor. epinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Monitor BP. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. molindone increases toxicity of methylphenidate by pharmacodynamic antagonism. Mechanism: unknown. Monitor Closely (1)methylphenidate will decrease the level or effect of verapamil by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. These cannot be substituted on a milligram-per-milligram basis. Monitor Closely (1)isoproterenol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Applies only to oral form of both agents. Interaction more likely in certain predisposed pts. Monitor Closely (1)pirbuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. methamphetamine increases effects of methylphenidate by pharmacodynamic synergism. Monitor Closely (1)iloperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Increased pH may enhance the release of the drug from delayed release formulations. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Minor/Significance Unknown. only.trifluoperazine increases toxicity of methylphenidate by pharmacodynamic antagonism. Interaction more likely in certain predisposed pts. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Caffeine should be avoided or used cautiously. Contraindicated. Risk of acute hypertensive episode. Use Caution/Monitor. Additive vasospasm; risk of hypertension. Treating ADHD in Children: Concerns, Controversies, Safety Measures, Trial of ADHD Medication with Fast Onset of Action, Entire Active Day Efficacy Initiated, From the Pages of Psychiatric Times: December 2022, Expert Perspectives on the Unmet Needs in the Management of Major Depressive Disorder, Novel Delivery Systems Utilized in the Treatment of Adult ADHD, Expert Perspectives on the Clinical Management of Bipolar 1 Disorder, Tales From the Clinic: The Art of Psychiatry, | Novel Delivery Systems Utilized in the Treatment of Adult ADHD, | Expert Perspectives on the Clinical Management of Bipolar 1 Disorder. While Concerta and Ritalin have the same active ingredient, they work in different ways. Monitor Closely (1)albuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Use Caution/Monitor. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Monitor BP. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. hydrocodone, methylphenidate. Use Caution/Monitor. Use Caution/Monitor. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. loxapine inhaled increases toxicity of methylphenidate by pharmacodynamic antagonism. Serious - Use Alternative (1)yohimbe, methylphenidate. Concerta for Attention-Deficit/ Hyperactivity Disorder. Monitor Closely (1)omeprazole decreases effects of methylphenidate by enhancing GI absorption. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. Interaction specifically associated with Ritalin LA. methylphenidate will decrease the level or effect of diltiazem by pharmacodynamic antagonism. Additive vasospasm; risk of hypertension. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. Use Caution/Monitor. Modify Therapy/Monitor Closely. Adding plans allows you to compare formulary status to other drugs in the same class. Potential for additive CNS stimulation. Methylphenidate may diminish antihypertensive effects. quetiapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Potential for additive CNS stimulation. Risk of acute hypertensive episode. Use Caution/Monitor. Risk of acute hypertensive episode. Use Caution/Monitor. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Use Caution/Monitor. Serious - Use Alternative (1)ergotamine, methylphenidate. Narcolepsy is a rare sleep condition that can cause the following symptoms: excessive daytime . Risk of V tach, HTN. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. apomorphine, methylphenidate. Use Caution/Monitor. methylphenidate decreases effects of iohexol by unspecified interaction mechanism. Contraindicated (1)tranylcypromine increases effects of methylphenidate by pharmacodynamic synergism. Either increases effects of the other by pharmacodynamic synergism. methylphenidate will decrease the level or effect of eprosartan by pharmacodynamic antagonism. Monitor for hypertension with concomitant use. Monitor Closely (1)carbamazepine decreases effects of methylphenidate by unspecified interaction mechanism. Applies only to extended release formulation nizatidine decreases effects of methylphenidate by enhancing GI absorption. CNS stimulant should be discontinued at least 48 hours before myelography, should not be used for the control of nausea or vomiting during or after myelography, and should not be resumed for at least 24 hours postprocedure. Risk of acute hypertensive episode. Use Caution/Monitor. This means that you only need to take. Either increases effects of the other by pharmacodynamic synergism. Monitor Closely (1)methylphenidate will decrease the level or effect of isradipine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased. Applies only to oral form of both agents. Use Caution/Monitor. only. Use Caution/Monitor. sufentanil SL, methylphenidate. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of methylphenidate by enhancing GI absorption. Use Caution/Monitor. For example, Ritalin 10 mg q4h is converted to Concerta 36 mg. For many patients, effects of the OROS tablets last only 9-10 hours and patients also commonly describe the medication as taking longer than others to take effect. Use Caution/Monitor. olanzapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Contraindicated. Monitor Closely (2)trifluoperazine, methylphenidate. Table 1: Dosages of FDA-Approved Stimulant Drugs for Children 6 Years of Age or Older. Blood and lymphatic system disorders: Pancytopenia, thrombocytopenia, thrombocytopenic purpura, Cardiac disorders: Angina pectoris, bradycardia, extrasystole, supraventricular tachycardia, ventricular extrasystole, hypertension, Eye disorders: Diplopia, mydriasis, visual impairment, General Disorders: Chest pain, chest discomfort, hyperpyrexia, long-term growth suppression, Hepatobiliary disorders: Hepatocellular injury, acute hepatic failure, Immune system disorders: Hypersensitivity reactions such as angioedema, anaphylactic reactions, auricular swelling, bullous conditions, exfoliative conditions, urticaria, pruritus, rashes, eruptions, and exanthemas, Investigations: Alkaline phosphatase increased, bilirubin increased, hepatic enzyme increased, platelet count decreased, white blood cell count abnormal, severe hepatic injury, Musculoskeletal, connective tissue and bone disorders: Arthralgia, myalgia, muscle twitching, rhabdomyolysis, Nervous system disorders: Convulsion, grand mal convulsion, dyskinesia, serotonin syndrome in combination with serotonergic drugs, lethargy, somnolence, Psychiatric disorders: Disorientation, hallucination, hallucination auditory, hallucination visual, libido changes, mania, depression, drug dependence, Vascular system: Peripheral vasculopathy, including Raynaud phenomenon, Skin and subcutaneous tissue disorders: Alopecia, erythema, Hypersensitivity to methylphenidate or other components of product, Coadministration with monoamine oxidase inhibitors (MAOIs) or within 14 days after discontinuing MAOIs, Assess risk of abuse before prescribing, and monitor for signs of abuse and dependence during therapy, May cause an increase in blood pressure (BP) and heart rate (HR); monitor for hypertension and tachycardia, Prolonged and painful erections, sometimes requiring surgical intervention, reported with methylphenidate products, including another formulation of methylphenidate hydrochloride extended-release tablets, in both pediatric and adult patients, Priapism was not reported with drug initiation but developed during treatment, often after an increase in dose and during a period of drug withdrawal (drug holidays or during discontinuation); if such reaction occurs, seek immediate medical attention, CNS stimulants are associated with peripheral vasculopathy, including Raynaud phenomenon; signs and symptoms are usually intermittent and generally improve after dose reduction or discontinuing treatment; monitor for digital changes is necessary during treatment; further clinical evaluation (eg, rheumatology referral) may be appropriate for certain patients, Closely monitor growth (weight and height) in pediatric patients treated with stimulants; patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted, Stimulants may lower the convulsive threshold in patients with a history of seizures, in patients with prior EEG abnormalities in absence of seizures, and, very rarely, in patients without a history of seizures and no prior EEG evidence of seizures; if seizures occur, discontinue drug, Difficulties with accommodation and blurry vision reported, Periodic complete blood cell count, differential, and platelet counts are advised during prolonged therapy, Published studies and postmarketing reports on use during pregnancy have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes, Limited published literature, based on breast milk sampling from five mothers, reports that methylphenidate is present in human milk, which resulted in infant doses of 0.16% to 0.7% of the maternal weight-adjusted dosage and a milk/plasma ratio ranging between 1.1 and 2.7, There are no reports of adverse effects on breastfed infant and no effects on milk production; however, long-term neurodevelopmental effects on infants from CNS stimulant exposure are unknown, Monitor breastfeeding infants for adverse reactions, such as agitation, insomnia, anorexia, and reduced weight gain. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. perphenazine, methylphenidate. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Relexxii: Store at 25C (77F); excursions permitted to 15-30C (59-86F); protect from humidity, Adhansia XR: Store at 20-25C (68-77F); excursions permitted to 15-30C (59-86F); protect from light, Extended-release chewable (QuilliChew ER): Store at 20-25C (68-77F); excursions permitted to 15-30C (59-86F), Extended-release orally disintegrating (Cotempla XR-ODT): Store at 20-25C (68-77F); excursions permitted to 15-30C (59-86F); store in reusable travel case, Immediate-release (Ritalin): Store at 25C (77F); excursions permitted to 15-30C (59-86F); protect from light. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Other (see comment). Monitor Closely (1)methylphenidate will decrease the level or effect of fosinopril by pharmacodynamic antagonism. Methylphenidate may diminish antihypertensive effects. fluphenazine, methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided. Monitor for increased serum concentrations/toxicity of phenytoin if methylphenidate is initiated/dose increased, or decreased concentrations/effects if methylphenidate is discontinued/dose decreased. Medscape Education. Use Caution/Monitor. Use Caution/Monitor. Use Caution/Monitor. Applies only to oral form of both agents. dopamine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. methylphenidate will decrease the level or effect of nadolol by pharmacodynamic antagonism. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Use Caution/Monitor. Mechanism: pharmacodynamic antagonism. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Other (see comment). Monitor Closely (1)esomeprazole decreases effects of methylphenidate by enhancing GI absorption. Use Caution/Monitor. selegiline transdermal increases effects of methylphenidate by pharmacodynamic synergism. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination. Contraindicated. formoterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Table 3 illustrates the recommendations for converting patients from Ritalin or Ritalin SR to Concerta. Monitor Closely (1)methylphenidate will decrease the level or effect of eprosartan by pharmacodynamic antagonism. Risk of acute hypertensive episode. Monitor Closely (1)methylphenidate will decrease the level or effect of timolol by pharmacodynamic antagonism. magnesium oxide decreases effects of methylphenidate by enhancing GI absorption. Use Caution/Monitor. loxapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Risk of acute hypertensive episode. methylphenidate will decrease the level or effect of sacubitril/valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Monitor Closely (1)epinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. To view formulary information first create a list of plans. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidate and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Monitor Closely (1)aluminum hydroxide decreases effects of methylphenidate by enhancing GI absorption. Methylphenidate is contraindicated during treatment with an MAOI and also within a minimum of 14 days following discontinuation of an MAOI. Either increases effects of the other by pharmacodynamic synergism. Either increases effects of the other by pharmacodynamic synergism. Risk of acute hypertensive episode. 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Or sudden death, more likely w/thioridazine than other phenothiazines because the active of... Or Ritalin SR to Concerta is initiated/dose increased, or decreased concentrations/effects if methylphenidate is contraindicated treatment. Capsules may be seen when coadministered with other CNS stimulants death, more likely w/thioridazine than other.. Unspecified interaction mechanism omeprazole decreases effects of the other by sympathetic ( adrenergic ) effects, including blood! Both increase sympathetic ( adrenergic ) effects, including increased blood pressure and heart rate observe the patient particularly!