:en:Methylphenidate

Methylphenidate is most commonly used to treat ADHD and narcolepsy.{{cite web |title=Methylphenidate |url=https://www.drugbank.ca/drugs/DB00422 |website=DrugBank |access-date=30 January 2019 |archive-url=https://web.archive.org/web/20190131040915/https://www.drugbank.ca/drugs/DB00422 |archive-date=31 January 2019 }}

Methylphenidate is used for the treatment of attention deficit hyperactivity disorder (ADHD).{{cite journal | vauthors = Fone KC, Nutt DJ | title = Stimulants: use and abuse in the treatment of attention deficit hyperactivity disorder | journal = Current Opinion in Pharmacology | volume = 5 | issue = 1 | pages = 87–93 | date = February 2005 | pmid = 15661631 | doi = 10.1016/j.coph.2004.10.001 }} The dosage may vary and is titrated to effect, with some guidelines recommending initial treatment with a low dose.{{cite journal | vauthors = Huss M, Duhan P, Gandhi P, Chen CW, Spannhuth C, Kumar V | title = Methylphenidate dose optimization for ADHD treatment: review of safety, efficacy, and clinical necessity | journal = Neuropsychiatric Disease and Treatment | volume = 13 | pages = 1741–1751 | date = 2 June 2021 | pmid = 28740389 | pmc = 5505611 | doi = 10.2147/NDT.S130444 | doi-access = free }} Methylphenidate is available in both immediate-release and modified-release formulations.{{cite journal | vauthors = Wolraich M, Brown L, Brown RT, DuPaul G, Earls M, Feldman HM, Ganiats TG, Kaplanek B, Meyer B, Perrin J, Pierce K, Reiff M, Stein MT, Visser S | title = ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit / hyperactivity disorder in children and adolescents | journal = Pediatrics | volume = 128 | issue = 5 | pages = 1007–1022 | date = November 2011 | pmid = 22003063 | pmc = 4500647 | doi = 10.1542/peds.2011-2654 }}{{cite book | vauthors = Neinstein L | year=2009 | title=Handbook of Adolescent Health Care | publisher=Wolters Kluwer Health / Lippincott Williams & Wilkins | location=Philadelphia, PA | isbn=978-0-7817-9020-8 | oclc=226304727 }}{{rp|722}} Methylphenidate is not approved for children under six years of age.{{cite journal | vauthors = Vitiello B | date = October 2001 | title = Psychopharmacology for young children: clinical needs and research opportunities | journal = Pediatrics | volume = 108 | issue = 4 | pages = 983–989 | pmid = 11581454 | doi = 10.1542/peds.108.4.983 | s2cid = 33417584 }}{{cite journal | vauthors = Hermens DF, Rowe DL, Gordon E, Williams LM | date = May 2006 | title = Integrative neuroscience approach to predict ADHD stimulant response | journal = Expert Review of Neurotherapeutics | volume = 6 | issue = 5 | pages = 753–763 | pmid = 16734523 | doi = 10.1586/14737175.6.5.753 | s2cid = 15971025 }}

The International Consensus Statement on ADHD shows that the results from systematic reviews, meta-analyses and large scale studies are clear: methylphenidate is safe and among the most efficacious drugs in all of medicine; treatment in the long-term substantially reduces accidental injuries, traumatic brain injury, substance abuse, cigarette smoking, educational underachievement, bone fractures, sexually transmitted infections, depression, suicide, criminal activity, teenage pregnancy, vehicle crashes, burn injuries and overall-cause mortality, and eliminates the increased risk for obesity.{{cite journal |vauthors=Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, Newcorn JH, Gignac M, Al Saud NM, Manor I, Rohde LA, Yang L, Cortese S, Almagor D, Stein MA, Albatti TH, Aljoudi HF, Alqahtani MM, Asherson P, Atwoli L, Bölte S, Buitelaar JK, Crunelle CL, Daley D, Dalsgaard S, Döpfner M, Espinet S, Fitzgerald M, Franke B, Gerlach M, Haavik J, Hartman CA, Hartung CM, Hinshaw SP, Hoekstra PJ, Hollis C, Kollins SH, Sandra Kooij JJ, Kuntsi J, Larsson H, Li T, Liu J, Merzon E, Mattingly G, Mattos P, McCarthy S, Mikami AY, Molina BS, Nigg JT, Purper-Ouakil D, Omigbodun OO, Polanczyk GV, Pollak Y, Poulton AS, Rajkumar RP, Reding A, Reif A, Rubia K, Rucklidge J, Romanos M, Ramos-Quiroga JA, Schellekens A, Scheres A, Schoeman R, Schweitzer JB, Shah H, Solanto MV, Sonuga-Barke E, Soutullo C, Steinhausen HC, Swanson JM, Thapar A, Tripp G, van de Glind G, van den Brink W, Van der Oord S, Venter A, Vitiello B, Walitza S, Wang Y |date=September 2021 |title=The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder |journal=Neuroscience and Biobehavioral Reviews |volume=128 |pages=789–818 |doi=10.1016/j.neubiorev.2021.01.022 |pmc=8328933 |pmid=33549739}}

One committee from the World Health Organization (WHO) responsible for the World Health Organization Essential Medicines List rejected an application in 2019, and a second application endorsed by 51 professional medical groups in 2021, for methylphenidate's inclusion due to uncertainty about its efficacy and safety.{{cite web |title=eEML - Electronic Essential Medicines List |url=https://list.essentialmeds.org/recommendations/1200 |publisher=World Health Organization |access-date=26 March 2020 |archive-date=26 March 2020 |archive-url=https://web.archive.org/web/20200326025659/https://list.essentialmeds.org/recommendations/1200 |url-status=live }}{{Cite web |title=A.21 Methylphenidate – attention-deficit hyperactivity disorder – EML and EMLc |url=https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/23rd-expert-committee/a21-methylphenidate |access-date=1 May 2024 |publisher=World Health Organization}} However, in November 2023, the WHO Mental Health Gap Action Programme Guidelines for mental, neurological, and substance use disorders recommended that methylphenidate should be considered for children aged 6 years and older who have ADHD, noting specifically that, "methylphenidate treatment shows substantial effects on symptom reduction",{{Cite web |title=Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders |url=https://www.who.int/publications-detail-redirect/9789240084278 |access-date=1 May 2024 |publisher=World Health Organization |date=20 November 2023 |edition=Third}} in addition to other WHO publications.{{cite web |url=https://applications.emro.who.int/docs/EMRPUB_leaflet_2019_mnh_214_en.pdf |title=Attention Deficit Hyperactivity Disorder (ADHD) |publisher=World Health Organization |date=2019 |access-date=13 January 2025}} In 2024, the European Society for Child and Adolescent Psychiatry (ESCAP) and the American Academy of Paediatrics (AAP) endorsed the inclusion of methylphenidate in the WHO EML.{{cite journal | vauthors = Cortese S, Coghill D, Fegert JM, Mattingly GW, Rohde LA, Wong IC, Faraone SV | title = ESCAP endorses the inclusion of methylphenidate in the WHO model lists of essential medicines and in the Union list of critical medicines | journal = European Child & Adolescent Psychiatry | volume = 33 | issue = 5 | pages = 1605–1608 | date = May 2024 | pmid = 38662057 | doi = 10.1007/s00787-024-02443-5 }}{{cite journal | vauthors = Cortese S, Coghill D, Mattingly GW, Rohde LA, Thom RP, Wilens TE, Wong IC, Faraone SV | title = AACAP Endorses the Inclusion of Methylphenidate in the WHO Model Lists of Essential Medicines | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 63 | issue = 7 | pages = 663–665 | date = July 2024 | pmid = 38428579 | doi = 10.1016/j.jaac.2024.02.008 | url = https://eprints.soton.ac.uk/492445/1/AACAP_endorses.docx }} A new application for methylphenidate's inclusion is currently pending review,{{Cite web |title=A.19 Methylphenidate - attention deficit hyperactivity disorder |url=https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/25th-expert-committee-on-selection-and-use-of-essential-medicines/a.19-methylphenidate-attention-deficit-hyperactivity-disorder |access-date=2025-03-22 |website=www.who.int |language=en}} having sparked debate in the comment process among researchers engaged in the evaluation of the evidence-base.{{Cite web |last=Storebø |first=Ole Jakob |title=Correspondence with the 2025 WHO Expert Committee: A.19 Methylphenidate – attention deficit hyperactivity disorder |url=https://cdn.who.int/media/docs/default-source/2025-eml-expert-committee/comments/a.19_comments-storeb.pdf?sfvrsn=db66ddce_1}}{{Cite web |last=Bleazard |first=Ryan |title=Correspondence with the 2025 WHO Expert Committee: A.19 Methylphenidate – attention deficit hyperactivity disorder |url=https://cdn.who.int/media/docs/default-source/2025-eml-expert-committee/comments/a.19_comments_bleazard.pdf?sfvrsn=a7894ebc_1}}{{Cite web |last=Manor |first=Iris |title=Correspondence with the 2025 WHO Expert Committee: A.19 Methylphenidate – attention deficit hyperactivity disorder |url=https://cdn.who.int/media/docs/default-source/2025-eml-expert-committee/comments/a.19_comments-manor74645dfb-3b22-4640-a7d3-d632e6d1a84f.pdf?sfvrsn=c34bd1e2_1}}

Safety and efficacy data have been reviewed extensively by medical regulators (e.g., the US Food and Drug Administration and the European Medicines Agency), the developers of evidence-based national guidelines (e.g., the UK National Institute for Health and Care Excellence and the American Academy of Pediatrics), and government agencies who have endorsed these guidelines (e.g., the Australian National Health and Medical Research Council). These professional groups unanimously conclude, based on the scientific evidence, that methylphenidate is safe and effective and should be considered as a first-line treatment for ADHD.

Since ADHD diagnosis has increased around the world, methylphenidate may be misused as a "study drug" by some populations, which may be harmful.{{cite journal | vauthors = Abelman DD | title = Mitigating risks of students use of study drugs through understanding motivations for use and applying harm reduction theory: a literature review | journal = Harm Reduction Journal | volume = 14 | issue = 1 | page = 68 | date = October 2017 | pmid = 28985738 | pmc = 5639593 | doi = 10.1186/s12954-017-0194-6 | doi-access = free }} This also applies to people who may be experiencing a different issue and are misdiagnosed with ADHD. People in this category are prone to experience the negative side-effects of the drug, which can worsen their condition.

Long-term meta-analyses and systematic reviews show that the medications used to treat ADHD are not associated with observed deficits in brain structure, but with improved brain development and functioning, most prominently in inferior frontal and striatal regions. The most comprehensive meta-analysis available (19 studies with over 3.9 million participants) found "no statistically significant association between ADHD medications [including methylphenidate] and the risk of cardiovascular event among children and adolescents, young and middle-aged adults, or older adults";{{cite journal | vauthors = Zhang L, Yao H, Li L, Du Rietz E, Andell P, Garcia-Argibay M, D'Onofrio BM, Cortese S, Larsson H, Chang Z | title = Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis | journal = JAMA Network Open | volume = 5 | issue = 11 | pages = e2243597 | date = November 2022 | pmid = 36416824 | pmc = 9685490 | doi = 10.1001/jamanetworkopen.2022.43597 }} as do other systematic reviews and meta-analyses.{{cite journal | vauthors = Liang EF, Lim SZ, Tam WW, Ho CS, Zhang MW, McIntyre RS, Ho RC | title = The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression | journal = International Journal of Environmental Research and Public Health | volume = 15 | issue = 8 | pages = 1789 | date = August 2018 | pmid = 30127314 | pmc = 6121294 | doi = 10.3390/ijerph15081789 | doi-access = free }}{{cite journal | vauthors = Liu H, Feng W, Zhang D | title = Association of ADHD medications with the risk of cardiovascular diseases: a meta-analysis | journal = European Child & Adolescent Psychiatry | volume = 28 | issue = 10 | pages = 1283–1293 | date = October 2019 | pmid = 30143889 | doi = 10.1007/s00787-018-1217-x }}{{cite journal | vauthors = Habel LA, Cooper WO, Sox CM, Chan KA, Fireman BH, Arbogast PG, Cheetham TC, Quinn VP, Dublin S, Boudreau DM, Andrade SE, Pawloski PA, Raebel MA, Smith DH, Achacoso N, Uratsu C, Go AS, Sidney S, Nguyen-Huynh MN, Ray WA, Selby JV | title = ADHD medications and risk of serious cardiovascular events in young and middle-aged adults | journal = JAMA | volume = 306 | issue = 24 | pages = 2673–2683 | date = December 2011 | pmid = 22161946 | pmc = 3350308 | doi = 10.1001/jama.2011.1830 }}

Narcolepsy, a chronic sleep disorder characterized by overwhelming daytime drowsiness and uncontrollable sleep, is treated primarily with stimulants. Methylphenidate is considered effective in increasing wakefulness, vigilance, and performance.{{cite journal | vauthors = Fry JM | title = Treatment modalities for narcolepsy | journal = Neurology | volume = 50 | issue = 2 Suppl 1 | pages = S43–S48 | date = February 1998 | pmid = 9484423 | doi = 10.1212/WNL.50.2_Suppl_1.S43 | s2cid = 36824088 }} Methylphenidate improves measures of somnolence on standardized tests, such as the Multiple Sleep Latency Test (MSLT), but performance does not improve to levels comparable to healthy people.{{cite journal | vauthors = Mitler MM | title = Evaluation of treatment with stimulants in narcolepsy | journal = Sleep | volume = 17 | issue = 8 Suppl | pages = S103–S106 | date = December 1994 | pmid = 7701190 | doi = 10.1093/sleep/17.suppl_8.S103 | doi-access = free }}

Methylphenidate may also be prescribed for off-label use in treatment-resistant cases of bipolar disorder and major depressive disorder.{{cite journal | vauthors = Dell'Osso B, Dobrea C, Cremaschi L, Arici C, Altamura AC | title = Wake-promoting pharmacotherapy for psychiatric disorders | journal = Current Psychiatry Reports | volume = 16 | issue = 12 | page = 524 | date = December 2014 | pmid = 25312027 | doi = 10.1007/s11920-014-0524-2 | s2cid = 26314915 }} It can also improve depression in several groups, including stroke, cancer, and HIV-positive patients.{{cite journal | vauthors = Leonard BE, McCartan D, White J, King DJ | title = Methylphenidate: A review of its neuropharmacological, neuropsychological, and adverse clinical effects | journal = Human Psychopharmacology | volume = 19 | issue = 3 | pages = 151–180 | date = April 2004 | pmid = 15079851 | doi = 10.1002/hup.579 | s2cid = 21173346 }} There is weak evidence in favor of methylphenidate's effectiveness for depression,{{cite journal | vauthors = Bahji A, Mesbah-Oskui L | title = Comparative efficacy and safety of stimulant-type medications for depression: A systematic review and network meta-analysis | journal = Journal of Affective Disorders | volume = 292 | pages = 416–423 | date = September 2021 | pmid = 34144366 | doi = 10.1016/j.jad.2021.05.119 }} including providing additional benefit in combination with antidepressants.{{cite journal | vauthors = Pary R, Scarff JR, Jijakli A, Tobias C, Lippmann S | title = A Review of Psychostimulants for Adults With Depression | journal = Federal Practitioner | volume = 32 | issue = Suppl 3 | pages = 30S–37S | date = April 2015 | pmid = 30766117 | pmc = 6375494 }} In individuals with terminal cancer, methylphenidate can be used to counteract opioid-induced somnolence, to increase the analgesic effects of opioids, to treat depression, and to improve cognitive function.{{cite journal | vauthors = Rozans M, Dreisbach A, Lertora JJ, Kahn MJ | title = Palliative uses of methylphenidate in patients with cancer: a review | journal = Journal of Clinical Oncology | volume = 20 | issue = 1 | pages = 335–339 | date = January 2002 | pmid = 11773187 | doi = 10.1200/JCO.20.1.335 }} A 2021 systematic review and meta-analysis found that all studies on geriatric depression reported positive results of methylphenidate use; the review recommended short-term use in combination with citalopram.{{cite journal | vauthors = Smith KR, Kahlon CH, Brown JN, Britt RB | title = Methylphenidate use in geriatric depression: A systematic review | journal = International Journal of Geriatric Psychiatry | volume = 36 | issue = 9 | pages = 1304–1312 | date = September 2021 | pmid = 33829530 | doi = 10.1002/gps.5536 | s2cid = 233184870 }} A 2018 review found low-quality evidence supporting its use to treat apathy as seen in Alzheimer's disease, in addition to slight benefits for cognition and cognitive performance.{{cite journal | vauthors = Ruthirakuhan MT, Herrmann N, Abraham EH, Chan S, Lanctôt KL | title = Pharmacological interventions for apathy in Alzheimer's disease | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 6 | page = CD012197 | date = May 2018 | pmid = 29727467 | pmc = 6494556 | doi = 10.1002/14651858.CD012197.pub2 }}

Methylphenidate's efficacy as an athletic performance enhancer, cognitive enhancer, aphrodisiac, and euphoriant is supported by research.{{cite web |date=1 June 2018 |series=Attention deficit hyperactivity disorder (ADHD) |title=Treatment |url=https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/ |access-date=24 October 2022 |website=nhs.uk |language=en}}{{cite journal | vauthors = Robison LS, Ananth M, Hadjiargyrou M, Komatsu DE, Thanos PK | title = Chronic oral methylphenidate treatment reversibly increases striatal dopamine transporter and dopamine type 1 receptor binding in rats | journal = Journal of Neural Transmission | volume = 124 | issue = 5 | pages = 655–667 | date = May 2017 | pmid = 28116523 | pmc = 5400672 | doi = 10.1007/s00702-017-1680-4 }}{{cite journal | vauthors = Spencer RC, Devilbiss DM, Berridge CW | title = The cognition-enhancing effects of psychostimulants involve direct action in the prefrontal cortex | journal = Biological Psychiatry | volume = 77 | issue = 11 | pages = 940–950 | date = June 2015 | pmid = 25499957 | pmc = 4377121 | doi = 10.1016/j.biopsych.2014.09.013 }}{{cite journal | vauthors = Ilieva IP, Hook CJ, Farah MJ | title = Prescription Stimulants' Effects on Healthy Inhibitory Control, Working Memory, and Episodic Memory: A Meta-analysis | journal = Journal of Cognitive Neuroscience | volume = 27 | issue = 6 | pages = 1069–1089 | date = June 2015 | pmid = 25591060 | doi = 10.1162/jocn_a_00776 | s2cid = 15788121 | url = https://repository.upenn.edu/cgi/viewcontent.cgi?article=1141&context=neuroethics_pubs | access-date = 12 June 2022 | archive-date = 26 May 2022 | archive-url = https://web.archive.org/web/20220526103820/https://repository.upenn.edu/cgi/viewcontent.cgi?article=1141&context=neuroethics_pubs | url-status = live | url-access = subscription }}{{cite journal | vauthors = Busardò FP, Kyriakou C, Cipolloni L, Zaami S, Frati P | title = From Clinical Application to Cognitive Enhancement: The Example of Methylphenidate | journal = Current Neuropharmacology | volume = 14 | issue = 1 | pages = 17–27 | date = 2016 | pmid = 26813119 | pmc = 4787280 | doi = 10.2174/1570159x13666150407225902 }}{{cite journal | vauthors = Carlier J, Giorgetti R, Varì MR, Pirani F, Ricci G, Busardò FP | title = Use of cognitive enhancers: methylphenidate and analogs | journal = European Review for Medical and Pharmacological Sciences | volume = 23 | issue = 1 | pages = 3–15 | date = January 2019 | pmid = 30657540 | doi = 10.26355/eurrev_201901_16741 | s2cid = 58643522 }}{{cite journal | vauthors = Repantis D, Bovy L, Ohla K, Kühn S, Dresler M | title = Cognitive enhancement effects of stimulants: a randomized controlled trial testing methylphenidate, modafinil, and caffeine | journal = Psychopharmacology | volume = 238 | issue = 2 | pages = 441–451 | date = February 2021 | pmid = 33201262 | pmc = 7826302 | doi = 10.1007/s00213-020-05691-w }}{{cite journal | vauthors = Montgomery KA | title = Sexual desire disorders | journal = Psychiatry | volume = 5 | issue = 6 | pages = 50–55 | date = June 2008 | pmid = 19727285 | pmc = 2695750 }}{{cite journal | vauthors = Berezanskaya J, Cade W, Best TM, Paultre K, Kienstra C | title = ADHD Prescription Medications and Their Effect on Athletic Performance: A Systematic Review and Meta-analysis | journal = Sports Medicine - Open | volume = 8 | issue = 1 | pages = 5 | date = January 2022 | pmid = 35022919 | pmc = 8755863 | doi = 10.1186/s40798-021-00374-y | doi-access = free }} However, the manner in which methylphenidate is used for these purposes (high dosages, alternate routes of administration, during sleep deprivation, etc.) can result in severe unintended side effects.{{cite journal | vauthors = Thoenes MM | title = Heat-related illness risk with methylphenidate use | language = English | journal = Journal of Pediatric Health Care | volume = 25 | issue = 2 | pages = 127–132 | date = 1 March 2011 | pmid = 21320685 | doi = 10.1016/j.pedhc.2010.07.006 }}{{cite journal | vauthors = Docherty JR, Alsufyani HA | title = Cardiovascular and temperature adverse actions of stimulants | journal = British Journal of Pharmacology | volume = 178 | issue = 13 | pages = 2551–2568 | date = July 2021 | pmid = 33786822 | doi = 10.1111/bph.15465 | s2cid = 232431910 | doi-access = free }}

A 2015 review found that therapeutic doses of amphetamine and methylphenidate result in modest improvements in cognition, including working memory, episodic memory, and inhibitory control, in normal healthy adults;{{cite journal | vauthors = Spencer RC, Devilbiss DM, Berridge CW | title = The cognition-enhancing effects of psychostimulants involve direct action in the prefrontal cortex | journal = Biological Psychiatry | volume = 77 | issue = 11 | pages = 940–950 | date = June 2015 | pmid = 25499957 | pmc = 4377121 | doi = 10.1016/j.biopsych.2014.09.013}}{{efn|

The procognitive actions of psychostimulants are only associated with low doses ... cognition-enhancing effects of psychostimulants involve the preferential elevation of catecholamines in the PFC and the subsequent activation of norepinephrine α2 and dopamine D1 receptors. ... This differential modulation of PFC-dependent processes across dose appears to be associated with the differential involvement of noradrenergic α2 versus α1 receptors.

}}{{cite journal | vauthors = Ilieva IP, Hook CJ, Farah MJ | title = Prescription Stimulants' Effects on Healthy Inhibitory Control, Working Memory, and Episodic Memory: A Meta-analysis | journal = Journal of Cognitive Neuroscience | volume = 27 | issue = 6 | pages = 1069–1089 | date = June 2015 | pmid = 25591060 | doi = 10.1162/jocn_a_00776 | url = https://repository.upenn.edu/neuroethics_pubs/130 | access-date = 14 November 2018 | url-status = live | s2cid = 15788121 | archive-url = https://web.archive.org/web/20180919111616/https://repository.upenn.edu/neuroethics_pubs/130/ | archive-date = 19 September 2018 | url-access = subscription }}{{efn|

The results of this meta-analysis ... do confirm the reality of cognitive enhancing effects for normal healthy adults in general, while also indicating that these effects are modest in size.

}}

the cognition-enhancing effects of these drugs are known to occur through the indirect activation of both dopamine receptor D₁ and adrenoceptor α₂ in the prefrontal cortex. Methylphenidate and other ADHD stimulants also improve task saliency and increase arousal.{{cite journal | vauthors = Wood S, Sage JR, Shuman T, Anagnostaras SG | title = Psychostimulants and cognition: a continuum of behavioral and cognitive activation | journal = Pharmacological Reviews | volume = 66 | issue = 1 | pages = 193–221 | date = January 2014 | pmid = 24344115 | pmc = 3880463 | doi = 10.1124/pr.112.007054 }} Stimulants such as amphetamine and methylphenidate can improve performance on difficult and boring tasks,{{cite book |vauthors=Malenka RC, Nestler EJ, Hyman SE |veditors=Sydor A, Brown RY | year = 2009 | chapter = Higher cognitive function and behavioral control | title = Molecular Neuropharmacology: A foundation for clinical neuroscience | publisher = McGraw-Hill Medical | location = New York, NY | isbn = 978-0-07-148127-4 | page = 318 | edition = 2nd}}{{efn|

Therapeutic (relatively low) doses of psychostimulants, such as methylphenidate and amphetamine, improve performance on working memory tasks both in normal subjects and those with ADHD ... [It] is now believed that dopamine and norepinephrine, but not serotonin, produce the beneficial effects of stimulants on working memory. At abused (relatively high) doses, stimulants can interfere with working memory and cognitive control ... stimulants act not only on working memory function, but also on general levels of arousal and, within the nucleus accumbens, improve the saliency of tasks. Thus, stimulants improve performance on effortful but tedious tasks ... through indirect stimulation of dopamine and norepinephrine receptors.

}}{{cite journal | vauthors = Agay N, Yechiam E, Carmel Z, Levkovitz Y | title = Non-specific effects of methylphenidate (Ritalin) on cognitive ability and decision-making of ADHD and healthy adults | journal = Psychopharmacology | volume = 210 | issue = 4 | pages = 511–519 | date = July 2010 | pmid = 20424828 | doi = 10.1007/s00213-010-1853-4 | s2cid = 17083986}} and are used by some students as a study and test-taking aid.{{cite web | work = JS Online | vauthors = Twohey M | date = 26 March 2006 | title = Pills become an addictive study aid | access-date = 2 December 2007 | url = http://www.jsonline.com/story/index.aspx?id=410902 | archive-url = https://web.archive.org/web/20070815200239/http://www.jsonline.com/story/index.aspx?id=410902 | archive-date = 15 August 2007}} Based upon studies of self-reported illicit stimulant use, performance-enhancing use rather than use as a recreational drug, is the primary reason that students use stimulants.{{cite journal | vauthors = Teter CJ, McCabe SE, LaGrange K, Cranford JA, Boyd CJ | title = Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration | journal = Pharmacotherapy | volume = 26 | issue = 10 | pages = 1501–1510 | date = October 2006 | pmid = 16999660 | pmc = 1794223 | doi = 10.1592/phco.26.10.1501}}

Excessive doses of methylphenidate, above the therapeutic range, can interfere with working memory and cognitive control. Like amphetamine and bupropion, methylphenidate increases stamina and endurance in humans primarily through reuptake inhibition of dopamine in the central nervous system.{{cite journal | vauthors = Roelands B, de Koning J, Foster C, Hettinga F, Meeusen R | title = Neurophysiological determinants of theoretical concepts and mechanisms involved in pacing | journal = Sports Medicine | volume = 43 | issue = 5 | pages = 301–311 | date = May 2013 | pmid = 23456493 | doi = 10.1007/s40279-013-0030-4 | s2cid = 30392999 }} Similar to the loss of cognitive enhancement when using large amounts, large doses of methylphenidate can induce side effects that impair athletic performance, such as rhabdomyolysis and hyperthermia.{{cite web |date=15 June 2021 |title=Daytrana- methylphenidate patch |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c312c31-3198-4775-91ab-294e0b4b9e7f |url-status=live |archive-url=https://web.archive.org/web/20220319232456/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c312c31-3198-4775-91ab-294e0b4b9e7f |archive-date=19 March 2022 |access-date=26 March 2022 |website=DailyMed}} While literature suggests it might improve cognition, most authors agree that using the drug as a study aid when an ADHD diagnosis is not present does not actually improve GPA. Moreover, it has been suggested that students who use the drug for studying may be self-medicating for potentially deeper underlying issues.

Methylphenidate is contraindicated for individuals with agitation, tics, glaucoma, heart defects or a hypersensitivity to any ingredients contained in methylphenidate pharmaceuticals.{{cite web |date=1 July 2021 |title=Concerta- methylphenidate hydrochloride tablet, extended release |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a88218c-5b18-4220-8f56-526de1a276cd |url-status=live |archive-url=https://web.archive.org/web/20170326230808/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a88218c-5b18-4220-8f56-526de1a276cd |archive-date=26 March 2017 |access-date=26 March 2022 |website=DailyMed}}

Pregnant women are advised to only use the medication if the benefits outweigh the potential risks.{{cite web | url = https://www.drugs.com/pregnancy/methylphenidate.html | title = Methylphenidate: Use During Pregnancy and Breastfeeding | archive-url = https://web.archive.org/web/20180102005138/https://www.drugs.com/pregnancy/methylphenidate.html | archive-date=2 January 2018 | work = Drugs.com }} Not enough human studies have been conducted to conclusively demonstrate an effect of methylphenidate on fetal development.{{cite journal | vauthors = Humphreys C, Garcia-Bournissen F, Ito S, Koren G | title = Exposure to attention deficit hyperactivity disorder medications during pregnancy | journal = Canadian Family Physician | volume = 53 | issue = 7 | pages = 1153–1155 | date = July 2007 | pmid = 17872810 | pmc = 1949295 }} In 2018, a review concluded that it has not been teratogenic in rats and rabbits, and that it "is not a major human teratogen".{{cite journal | vauthors = Ornoy A | title = Pharmacological Treatment of Attention Deficit Hyperactivity Disorder During Pregnancy and Lactation | journal = Pharmaceutical Research | volume = 35 | issue = 3 | page = 46 | date = February 2018 | pmid = 29411149 | doi = 10.1007/s11095-017-2323-z | s2cid = 3663423 }}

File:Rational harm assessment of drugs radar plot.svg, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Methylphenidate was ranked 13th in dependence, 12th in physical harm, and 18th in social harm.{{cite journal | vauthors = Nutt D, King LA, Saulsbury W, Blakemore C | title = Development of a rational scale to assess the harm of drugs of potential misuse | journal = Lancet | volume = 369 | issue = 9566 | pages = 1047–1053 | date = March 2007 | pmid = 17382831 | doi = 10.1016/S0140-6736(07)60464-4 | s2cid = 5903121 }}]]

The most common side effects associated with methylphenidate (in standard and extended-release formulations) are appetite loss, dry mouth, anxiety/nervousness, nausea, and insomnia.{{cite journal |vauthors=Coghill D, Banaschewski T, Zuddas A, Pelaz A, Gagliano A, Doepfner M |date=September 2013 |title=Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies |journal=BMC Psychiatry |publisher=Springer Science and Business Media LLC |volume=13 |issue=1 |page=237 |doi=10.1186/1471-244x-13-237 |pmc=3852277 |pmid=24074240 |doi-access=free }} Gastrointestinal adverse effects may include abdominal pain and weight loss. Nervous system adverse effects may include akathisia (agitation/restlessness), irritability, dyskinesia (tics), lethargy (drowsiness/fatigue), and dizziness. Cardiac adverse effects may include palpitations, changes in blood pressure, and heart rate (typically mild), and tachycardia (rapid heart rate).{{cite web | url = http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_la.pdf | title = Ritalin LA (methylphenidate hydrochloride) extended-release capsules | archive-url = https://web.archive.org/web/20110720004745/http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_la.pdf | archive-date=20 July 2011 | publisher = Novartis}} Ophthalmologic adverse effects may include blurred vision caused by pupil dilatation and dry eyes, with less frequent reports of diplopia and mydriasis.{{Contradictory inline|date=September 2023}}{{cite journal | vauthors = Jaanus SD | title = Ocular side effects of selected systemic drugs | journal = Optometry Clinics | volume = 2 | issue = 4 | pages = 73–96 | year = 1992 | pmid = 1363080 }} In some cases, tolerance might be an issue with stimulants like methylphenidate.{{cite journal | vauthors = Ross DC, Fischhoff J, Davenport B | title = Treatment of ADHD when tolerance to methylphenidate develops | journal = Psychiatric Services | volume = 53 | issue = 1 | pages = 102 | date = January 2002 | pmid = 11773663 | doi = 10.1176/appi.ps.53.1.102 }}

Results from a 2024 systematic review showed that methylphenidate significantly improves ADHD symptoms and broadband measures but can cause appetite suppression and other adverse events in children and adolescents.{{cite journal | vauthors = Peterson BS, Trampush J, Maglione M, Bolshakova M, Rozelle M, Miles J, Pakdaman S, Brown M, Yagyu S, Motala A, Hempel S | title = Treatments for ADHD in Children and Adolescents: A Systematic Review | journal = Pediatrics | volume = 153 | issue = 4 | date = April 2024 | pmid = 38523592 | doi = 10.1542/peds.2024-065787 }} Smokers with ADHD who take methylphenidate may increase their nicotine dependence, and smoke more often than before they began using methylphenidate, with increased nicotine cravings and an average increase of 1.3 cigarettes per day.{{cite journal |vauthors=Bron TI, Bijlenga D, Kasander MV, Spuijbroek AT, Beekman AT, Kooij JJ |date=June 2013 |title=Long-term relationship between methylphenidate and tobacco consumption and nicotine craving in adults with ADHD in a prospective cohort study |journal=European Neuropsychopharmacology |volume=23 |issue=6 |pages=542–554 |doi=10.1016/j.euroneuro.2012.06.004 |pmid=22809706 |s2cid=23148548}}

There is some evidence of mild reductions in height with prolonged treatment in children.{{cite journal | vauthors = Cortese S, Holtmann M, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Graham J, Taylor E, Sergeant J | title = Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 54 | issue = 3 | pages = 227–246 | date = March 2013 | pmid = 23294014 | doi = 10.1111/jcpp.12036 }} This has been estimated at {{Convert|1|cm||1|abbr=}} or less per year during the first three years with a total decrease of {{Convert|3|cm||1|abbr=}} over 10 years.{{cite journal | vauthors = Poulton A | title = Growth on stimulant medication; clarifying the confusion: a review | journal = Archives of Disease in Childhood | volume = 90 | issue = 8 | pages = 801–806 | date = August 2005 | pmid = 16040876 | pmc = 1720538 | doi = 10.1136/adc.2004.056952}}{{cite journal | vauthors = Hinshaw SP, Arnold LE | title = ADHD, Multimodal Treatment, and Longitudinal outcome: Evidence, paradox, and challenge | journal = Wiley Interdisciplinary Reviews. Cognitive Science | volume = 6 | issue = 1 | pages = 39–52 | date = January 2015 | pmid = 25558298 | pmc = 4280855 | doi = 10.1002/wcs.1324 }}

Hypersensitivity (including skin rash, urticaria, and fever) is sometimes reported when using transdermal methylphenidate. The Daytrana patch has a much higher rate of skin reactions than oral methylphenidate.{{cite journal | vauthors = Findling RL, Dinh S | title = Transdermal therapy for attention-deficit hyperactivity disorder with the methylphenidate patch (MTS) | journal = CNS Drugs | volume = 28 | issue = 3 | pages = 217–228 | date = March 2014 | pmid = 24532028 | pmc = 3933749 | doi = 10.1007/s40263-014-0141-y }}

Methylphenidate can worsen psychosis in people who are psychotic, and in very rare cases it has been associated with the emergence of new psychotic symptoms.{{cite journal | vauthors = Kraemer M, Uekermann J, Wiltfang J, Kis B | title = Methylphenidate-induced psychosis in adult attention-deficit/hyperactivity disorder: report of 3 new cases and review of the literature | journal = Clinical Neuropharmacology | volume = 33 | issue = 4 | pages = 204–206 | date = July 2010 | pmid = 20571380 | doi = 10.1097/WNF.0b013e3181e29174 | s2cid = 34956456 }} It should be used with extreme caution in people with bipolar disorder due to the potential induction of mania or hypomania.{{cite journal | vauthors = Wingo AP, Ghaemi SN | title = Frequency of stimulant treatment and of stimulant-associated mania/hypomania in bipolar disorder patients | journal = Psychopharmacology Bulletin | volume = 41 | issue = 4 | pages = 37–47 | date = 2008 | pmid = 19015628 }} There have been very rare reports of suicidal ideation, but some authors claim that evidence does not support a link. Logorrhea is occasionally reported and visual hallucinations are very rarely reported.{{cite journal | vauthors = de Sousa A, Kalra G | title = Drug therapy of attention deficit hyperactivity disorder: current trends | journal = Mens Sana Monographs | volume = 10 | issue = 1 | pages = 45–69 | date = January 2012 | pmid = 22654382 | pmc = 3353606 | doi = 10.4103/0973-1229.87261 | doi-broken-date = 2 November 2024 | doi-access = free }} Priapism is a very rare adverse event that can be potentially serious.{{cite web |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm378876.htm |title=Methylphenidate ADHD medications: Drug safety communication – risk of long-lasting erections |website=U.S. Food and Drug Administration (FDA) |date=17 December 2013 |access-date=17 December 2013 |archive-url=https://web.archive.org/web/20131217225515/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm378876.htm|archive-date=17 December 2013|url-status=dead}}

U.S. Food and Drug Administration-commissioned studies in 2011 indicate that in children, young adults, and adults, there is no association between serious adverse cardiovascular events (sudden death, heart attack, and stroke) and the medical use of methylphenidate or other ADHD stimulants.{{cite web | title=FDA drug safety communication: Safety review update of medications used to treat attention-deficit / hyperactivity disorder (ADHD) in children and young adults | date=20 December 2011 | url=https://www.fda.gov/Drugs/DrugSafety/ucm277770.htm | website=U.S. Food and Drug Administration (FDA) | access-date=4 November 2013 | archive-url=https://web.archive.org/web/20131030042927/https://www.fda.gov/Drugs/DrugSafety/ucm277770.htm | archive-date=30 October 2013 | url-status=dead }}

{{cite journal | vauthors = Cooper WO, Habel LA, Sox CM, Chan KA, Arbogast PG, Cheetham TC, Murray KT, Quinn VP, Stein CM, Callahan ST, Fireman BH, Fish FA, Kirshner HS, O'Duffy A, Connell FA, Ray WA | title = ADHD drugs and serious cardiovascular events in children and young adults | journal = The New England Journal of Medicine | volume = 365 | issue = 20 | pages = 1896–1904 | date = November 2011 | pmid = 22043968 | pmc = 4943074 | doi = 10.1056/NEJMoa1110212 }}

{{cite web | title=FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in adults | date=15 December 2011 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-safety-review-update-medications-used-treat-attention-0 | work=U.S. Food and Drug Administration (FDA) | access-date=4 November 2013 | archive-url=https://web.archive.org/web/20131030064843/https://www.fda.gov/Drugs/DrugSafety/ucm279858.htm | archive-date=30 October 2013 | url-status=live }}

{{cite journal | vauthors = Habel LA, Cooper WO, Sox CM, Chan KA, Fireman BH, Arbogast PG, Cheetham TC, Quinn VP, Dublin S, Boudreau DM, Andrade SE, Pawloski PA, Raebel MA, Smith DH, Achacoso N, Uratsu C, Go AS, Sidney S, Nguyen-Huynh MN, Ray WA, Selby JV | title = ADHD medications and risk of serious cardiovascular events in young and middle-aged adults | journal = JAMA | volume = 306 | issue = 24 | pages = 2673–2683 | date = December 2011 | pmid = 22161946 | pmc = 3350308 | doi = 10.1001/jama.2011.1830 }}

Because some adverse effects may only emerge during chronic use of methylphenidate, a constant watch for adverse effects is recommended.{{cite journal | vauthors = Gordon N | title = Attention deficit hyperactivity disorder: Possible causes and treatment | journal = International Journal of Clinical Practice | volume = 53 | issue = 7 | pages = 524–528 | year = 1999 | doi = 10.1111/j.1742-1241.1999.tb11794.x | pmid = 10692738 | s2cid = 27462347 }}

A 2018 Cochrane review found tentative evidence that it may cause non-serious adverse events in children, but found no increase in serious adverse events.{{cite journal | vauthors = Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira-Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C | title = Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies | journal = The Cochrane Database of Systematic Reviews | volume = 5 | page = CD012069 | date = May 2018 | issue = 5 | pmid = 29744873 | pmc = 6494554 | doi = 10.1002/14651858.CD012069.pub2 | type = Systematic Review }}{{efn|

"Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children" "Concerning adverse events associated with the treatment, our systematic review of randomised clinical trials (RCTs) demonstrated no increase in serious adverse events, but a high proportion of participants suffered a range of non-serious adverse events."

}}

The symptoms of a moderate acute overdose of methylphenidate primarily arise from central nervous system overstimulation; these symptoms include: vomiting, nausea, agitation, tremors, hyperreflexia, muscle twitching, euphoria, confusion, hallucinations, delirium, hyperthermia, sweating, flushing, headache, tachycardia, heart palpitations, cardiac arrhythmias, hypertension, mydriasis, and dryness of mucous membranes. A severe overdose may involve symptoms such as hyperpyrexia, sympathomimetic toxidrome, convulsions, paranoia, stereotypy (a repetitive movement disorder), rhabdomyolysis, coma, and circulatory collapse.{{cite web |vauthors=Heedes G, Ailakis J |title=Methylphenidate hydrochloride (PIM 344) |url=http://www.inchem.org/documents/pims/pharm/pim344.htm |website=INCHEM |publisher=International Programme on Chemical Safety| access-date=23 June 2015 |archive-url=https://web.archive.org/web/20150623102325/http://www.inchem.org/documents/pims/pharm/pim344.htm |archive-date=23 June 2015 |url-status=live}}{{cite journal | vauthors = Spiller HA, Hays HL, Aleguas A | title = Overdose of drugs for attention-deficit hyperactivity disorder: Clinical presentation, mechanisms of toxicity, and management | journal = CNS Drugs | volume = 27 | issue = 7 | pages = 531–543 | date = July 2013 | pmid = 23757186 | doi = 10.1007/s40263-013-0084-8 | s2cid = 40931380 | doi-access = free }}{{efn|

The management of amphetamine, dextroamphetamine, and methylphenidate overdose is largely supportive, with a focus on interruption of the sympathomimetic syndrome with judicious use of benzodiazepines. In cases where agitation, delirium, and movement disorders are unresponsive to benzodiazepines, second-line therapies include antipsychotics such as ziprasidone or haloperidol, central alpha-adrenoreceptor agonists such as dexmedetomidine, or propofol. ... However, fatalities are rare with appropriate care.

}}

A methylphenidate overdose is rarely fatal with appropriate care. Following injection of methylphenidate tablets into an artery, severe toxic reactions involving abscess formation and necrosis have been reported.{{cite journal | vauthors = Bruggisser M, Bodmer M, Liechti ME | title = Severe toxicity due to injected but not oral or nasal abuse of methylphenidate tablets | journal = Swiss Medical Weekly | volume = 141 | page = w13267 | year = 2011 | pmid = 21984207 | doi = 10.4414/smw.2011.13267 | doi-access = free }}

Treatment of a methylphenidate overdose typically involves the administration of benzodiazepines, with antipsychotics, α-adrenoceptor agonists and propofol serving as second-line therapies.

File:Add Wize Methylphenidate Warning.jpg

Methylphenidate is a stimulant with an addiction liability and dependence liability similar to amphetamine. It has moderate liability among addictive drugs;{{cite journal | vauthors = Morton WA, Stockton GG | title = Methylphenidate Abuse and Psychiatric Side Effects | journal = Primary Care Companion to the Journal of Clinical Psychiatry | volume = 2 | issue = 5 | pages = 159–164 | date = October 2000 | pmid = 15014637 | pmc = 181133 | doi = 10.4088/PCC.v02n0502 }} accordingly, addiction and psychological dependence are possible and likely when methylphenidate is used as a recreational drug. When used above the medical dose range, stimulants are associated with the development of stimulant psychosis.{{cite journal | vauthors = Auger RR, Goodman SH, Silber MH, Krahn LE, Pankratz VS, Slocumb NL | title = Risks of high-dose stimulants in the treatment of disorders of excessive somnolence: A case-control study | journal = Sleep | volume = 28 | issue = 6 | pages = 667–672 | date = June 2005 | pmid = 16477952 | doi = 10.1093/sleep/28.6.667 | doi-access = free }}

{{further|Addiction#Biomolecular mechanisms}}

Methylphenidate has the potential to induce euphoria due to its pharmacodynamic effect (i.e., dopamine reuptake inhibition) in the brain's reward system. At therapeutic doses, ADHD stimulants do not sufficiently activate the reward system; consequently, when taken as directed in doses that are commonly prescribed for the treatment of ADHD, methylphenidate use lacks the capacity to cause an addiction.{{cite book |vauthors=Malenka RC, Nestler EJ, Hyman SE |veditors=Sydor A, Brown RY | year = 2009 | chapter = Chapter 15: Reinforcement and addictive disorders | title = Molecular Neuropharmacology: A foundation for clinical neuroscience | publisher = McGraw-Hill Medical | location = New York | isbn = 978-0-07-148127-4 | page = 368 | edition = 2nd}}

Methylphenidate may inhibit the metabolism of vitamin K anticoagulants, certain anticonvulsants, and some antidepressants (tricyclic antidepressants, and selective serotonin reuptake inhibitors). Concomitant administration may require dose adjustments, possibly assisted by monitoring of plasma drug concentrations. There are several case reports of methylphenidate inducing serotonin syndrome with concomitant administration of antidepressants.{{cite journal | vauthors = Ishii M, Tatsuzawa Y, Yoshino A, Nomura S | title = Serotonin syndrome induced by augmentation of SSRI with methylphenidate | journal = Psychiatry and Clinical Neurosciences | volume = 62 | issue = 2 | page = 246 | date = April 2008 | pmid = 18412855 | doi = 10.1111/j.1440-1819.2008.01767.x | s2cid = 5659107 | doi-access = free }}{{cite journal | vauthors = Türkoğlu S | title = Serotonin syndrome with sertraline and methylphenidate in an adolescent | journal = Clinical Neuropharmacology | volume = 38 | issue = 2 | pages = 65–66 | date = 2015 | pmid = 25768857 | doi = 10.1097/WNF.0000000000000075 | s2cid = 38523209 }}{{cite journal | vauthors = Park YM, Jung YK | title = Manic switch and serotonin syndrome induced by augmentation of paroxetine with methylphenidate in a patient with major depression | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 34 | issue = 4 | pages = 719–720 | date = May 2010 | pmid = 20298736 | doi = 10.1016/j.pnpbp.2010.03.016 | s2cid = 31984813 }}{{cite journal | vauthors = Bodner RA, Lynch T, Lewis L, Kahn D | title = Serotonin syndrome | journal = Neurology | volume = 45 | issue = 2 | pages = 219–223 | date = February 1995 | pmid = 7854515 | doi = 10.1212/wnl.45.2.219 | s2cid = 35190429 }}

When methylphenidate is coingested with ethanol, a metabolite called ethylphenidate is formed via hepatic transesterification,{{cite journal | vauthors = Patrick KS, González MA, Straughn AB, Markowitz JS | title = New methylphenidate formulations for the treatment of attention-deficit/hyperactivity disorder | journal = Expert Opinion on Drug Delivery | volume = 2 | issue = 1 | pages = 121–143 | date = January 2005 | pmid = 16296740 | doi = 10.1517/17425247.2.1.121 | s2cid = 25026467 }}{{cite journal | vauthors = Markowitz JS, DeVane CL, Boulton DW, Nahas Z, Risch SC, Diamond F, Patrick KS | title = Ethylphenidate formation in human subjects after the administration of a single dose of methylphenidate and ethanol | journal = Drug Metabolism and Disposition | volume = 28 | issue = 6 | pages = 620–624 | date = June 2000 | doi = 10.1016/S0090-9556(24)15139-2 | pmid = 10820132 }} not unlike the hepatic formation of cocaethylene from cocaine and ethanol. The reduced potency of ethylphenidate and its minor formation means it does not contribute to the pharmacological profile at therapeutic doses, and even in overdose cases, ethylphenidate concentrations remain negligible.{{cite journal | vauthors = Markowitz JS, Logan BK, Diamond F, Patrick KS | title = Detection of the novel metabolite ethylphenidate after methylphenidate overdose with alcohol coingestion | journal = Journal of Clinical Psychopharmacology | volume = 19 | issue = 4 | pages = 362–366 | date = August 1999 | pmid = 10440465 | doi = 10.1097/00004714-199908000-00013 }}

Coingestion of alcohol also increases the blood plasma levels of d-methylphenidate by up to 40%.{{cite journal | vauthors = Patrick KS, Straughn AB, Minhinnett RR, Yeatts SD, Herrin AE, DeVane CL, Malcolm R, Janis GC, Markowitz JS | title = Influence of ethanol and gender on methylphenidate pharmacokinetics and pharmacodynamics | journal = Clinical Pharmacology and Therapeutics | volume = 81 | issue = 3 | pages = 346–353 | date = March 2007 | pmid = 17339864 | pmc = 3188424 | doi = 10.1038/sj.clpt.6100082 }}

Liver toxicity from methylphenidate is extremely rare, but limited evidence suggests that intake of β-adrenergic agonists with methylphenidate may increase the risk of liver toxicity.{{cite journal | vauthors = Roberts SM, DeMott RP, James RC | title = Adrenergic modulation of hepatotoxicity | journal = Drug Metabolism Reviews | volume = 29 | issue = 1–2 | pages = 329–353 | year = 1997 | pmid = 9187524 | doi = 10.3109/03602539709037587 }}

Methylphenidate acts primarily as a norepinephrine–dopamine reuptake inhibitor (NDRI). It is a benzylpiperidine and phenethylamine derivative which also shares part of its basic structure with catecholamines.

Methylphenidate is a psychostimulant and increases the activity of the central nervous system through inhibition on reuptake of the neurotransmitters norepinephrine and dopamine. As models of attention deficit hyperactivity disorder (ADHD) suggest, it is associated with functional impairments in some of the brain's neurotransmitter systems, particularly those involving dopamine in the mesocortical and mesolimbic pathways and norepinephrine in the prefrontal cortex and locus coeruleus. Psychostimulants like methylphenidate and amphetamine may be effective in treating ADHD because they increase neurotransmitter activity in these systems. When reuptake of those neurotransmitters is halted, its concentration and effects in the synapse increase and last longer, respectively. Therefore, methylphenidate is called a norepinephrine–dopamine reuptake inhibitor. By increasing the effects of norepinephrine and dopamine, methylphenidate increases the activity of the central nervous system and produces effects such as increased alertness, reduced fatigue, and improved attention.{{cite book |vauthors=Malenka RC, Nestler EJ, Hyman SE | year = 2009 | chapter = Chapter 6: Widely projecting systems: Monoamines, acetylcholine, and orexin |veditors=Sydor A, Brown RY | title = Molecular Neuropharmacology: A foundation for clinical neuroscience | publisher = McGraw-Hill Medical | location = New York | isbn = 978-0-07-148127-4 | pages = 154–157 | edition = 2nd}}{{cite journal | vauthors = Steele M, Weiss M, Swanson J, Wang J, Prinzo RS, Binder CE | title = A randomized, controlled effectiveness trial of OROS-methylphenidate compared to usual care with immediate-release methylphenidate in attention deficit-hyperactivity disorder | journal = The Canadian Journal of Clinical Pharmacology | volume = 13 | issue = 1 | pages = e50–e62 | year = 2006 | pmid = 16456216 | url = http://www.cjcp.ca/pdf/CJCP_05-012_e50.pdf | url-status = dead | archive-url = http://webarchive.nationalarchives.gov.uk/20111215210932/http%3A//www.cjcp.ca/CJCP_05%2D012_e50%2Dr101628 | archive-date = 15 December 2011 }}

Methylphenidate is most active at modulating levels of dopamine (DA) and to a lesser extent norepinephrine (NE).{{cite journal | vauthors = Heal DJ, Pierce DM | title = Methylphenidate and its isomers: their role in the treatment of attention-deficit hyperactivity disorder using a transdermal delivery system | journal = CNS Drugs | volume = 20 | issue = 9 | pages = 713–738 | year = 2006 | pmid = 16953648 | doi = 10.2165/00023210-200620090-00002 | s2cid = 39535277 }} Methylphenidate binds to and blocks dopamine transporters (DAT) and norepinephrine transporters (NET).{{cite journal | vauthors = Iversen L | title = Neurotransmitter transporters and their impact on the development of psychopharmacology | journal = British Journal of Pharmacology | volume = 147 | issue = Suppl 1 | pages = S82–S88 | date = January 2006 | pmid = 16402124 | pmc = 1760736 | doi = 10.1038/sj.bjp.0706428 }} Variability exists between DAT blockade, and extracellular dopamine, leading to the hypothesis that methylphenidate amplifies basal dopamine activity, leading to nonresponse in those with low basal DA activity.{{cite journal | vauthors = Volkow ND, Fowler JS, Wang G, Ding Y, Gatley SJ | title = Mechanism of action of methylphenidate: insights from PET imaging studies | journal = Journal of Attention Disorders | volume = 6 | issue = Suppl 1 | pages = S31–S43 | date = 1 January 2002 | pmid = 12685517 | doi = 10.1177/070674370200601s05 | s2cid = 9132302 }} In animals and brain tissue, methylphenidate has been shown to dose-dependently increase brain dopamine levels.{{cite book | vauthors = Heal DJ, Smith SL, Findling RL | title = Behavioral Neuroscience of Attention Deficit Hyperactivity Disorder and Its Treatment | chapter = ADHD: current and future therapeutics | series = Current Topics in Behavioral Neurosciences | volume = 9 | pages = 361–390 | date = 2012 | pmid = 21487953 | doi = 10.1007/7854_2011_125 | isbn = 978-3-642-24611-1 | chapter-url = }}{{cite journal | vauthors = Heal DJ, Smith SL | title = Prospects for new drugs to treat binge-eating disorder: Insights from psychopathology and neuropharmacology | journal = J Psychopharmacol | volume = 36 | issue = 6 | pages = 680–703 | date = June 2022 | pmid = 34318734 | pmc = 9150143 | doi = 10.1177/02698811211032475 | url = }}{{cite journal | vauthors = Nomikos GG, Damsma G, Wenkstern D, Fibiger HC | title = In vivo characterization of locally applied dopamine uptake inhibitors by striatal microdialysis | journal = Synapse | volume = 6 | issue = 1 | pages = 106–12 | date = 1990 | pmid = 1697988 | doi = 10.1002/syn.890060113 | url = }} On average, methylphenidate elicits a 3 to 4 times increase in dopamine and norepinephrine in the striatum and prefrontal cortex.{{cite journal | vauthors = Hodgkins P, Shaw M, Coghill D, Hechtman L | title = Amfetamine and methylphenidate medications for attention-deficit/hyperactivity disorder: complementary treatment options | journal = European Child & Adolescent Psychiatry | volume = 21 | issue = 9 | pages = 477–492 | date = September 2012 | pmid = 22763750 | pmc = 3432777 | doi = 10.1007/s00787-012-0286-5 }} Magnetic resonance imaging (MRI) studies suggest that long-term treatment with ADHD stimulants (specifically, amphetamine and methylphenidate) decreases abnormalities in brain structure and function found in subjects with ADHD.{{cite journal | vauthors = Hart H, Radua J, Nakao T, Mataix-Cols D, Rubia K | title = Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects | journal = JAMA Psychiatry | volume = 70 | issue = 2 | pages = 185–198 | date = February 2013 | pmid = 23247506 | doi = 10.1001/jamapsychiatry.2013.277 | doi-access = free }}{{cite journal | vauthors = Spencer TJ, Brown A, Seidman LJ, Valera EM, Makris N, Lomedico A, Faraone SV, Biederman J | title = Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies | journal = The Journal of Clinical Psychiatry | volume = 74 | issue = 9 | pages = 902–917 | date = September 2013 | pmid = 24107764 | pmc = 3801446 | doi = 10.4088/JCP.12r08287 }}{{cite journal | vauthors = Frodl T, Skokauskas N | title = Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects | journal = Acta Psychiatrica Scandinavica | volume = 125 | issue = 2 | pages = 114–126 | date = February 2012 | pmid = 22118249 | doi = 10.1111/j.1600-0447.2011.01786.x | s2cid = 25954331 | doi-access = free }}{{efn|

Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from childhood to adulthood. Treatment seems to have positive effects on brain structure.

}}

Both amphetamine and methylphenidate are predominantly dopaminergic drugs, yet their mechanisms of action are distinct. Methylphenidate acts as a norepinephrine–dopamine reuptake inhibitor, while amphetamine is both a releasing agent and reuptake inhibitor of dopamine and norepinephrine. Methylphenidate's mechanism of action in the release of dopamine and norepinephrine is fundamentally different from most other phenethylamine derivatives, as methylphenidate is thought to increase neuronal firing rate,{{cite journal | vauthors = Viggiano D, Vallone D, Sadile A | title = Dysfunctions in dopamine systems and ADHD: evidence from animals and modeling | journal = Neural Plasticity | volume = 11 | issue = 1–2 | pages = 97–114 | year = 2004 | pmid = 15303308 | pmc = 2565441 | doi = 10.1155/NP.2004.97 | doi-access = free }}{{cite web | title = Focalin XR | url = https://www.rxlist.com/focalin-xr-drug.htm#description | work = RxList | access-date = 5 February 2020 | archive-date = 6 August 2020 | archive-url = https://web.archive.org/web/20200806185517/https://www.rxlist.com/focalin-xr-drug.htm#description | url-status = live }}{{cite web | url = http://www.medicines.org.uk/emc/medicine/8380 | title = Concerta XL 18 mg – 54 mg prolonged release tablets | archive-url = https://web.archive.org/web/20171017010139/http://www.medicines.org.uk/emc/medicine/8380 | archive-date = 17 October 2017 | work = eMC}} whereas amphetamine reduces firing rate, but causes monoamine release by reversing the flow of the monoamines through monoamine transporters via a diverse set of mechanisms, including TAAR1 activation and modulation of VMAT2 function, among other mechanisms.{{cite journal | vauthors = Miller GM | title = The emerging role of trace amine-associated receptor 1 in the functional regulation of monoamine transporters and dopaminergic activity | journal = Journal of Neurochemistry | volume = 116 | issue = 2 | pages = 164–176 | date = January 2011 | pmid = 21073468 | pmc = 3005101 | doi = 10.1111/j.1471-4159.2010.07109.x }}{{cite journal | vauthors = Eiden LE, Weihe E | title = VMAT2: a dynamic regulator of brain monoaminergic neuronal function interacting with drugs of abuse | journal = Annals of the New York Academy of Sciences | volume = 1216 | issue = 1 | pages = 86–98 | date = January 2011 | pmid = 21272013 | pmc = 4183197 | doi = 10.1111/j.1749-6632.2010.05906.x | bibcode = 2011NYASA1216...86E }}{{efn|

VMAT2 is the CNS vesicular transporter for not only the biogenic amines DA, NE, EPI, 5-HT, and HIS, but likely also for the trace amines TYR, PEA, and thyronamine (THYR) ... AMPH release of DA from synapses requires both an action at VMAT2 to release DA to the cytoplasm and a concerted release of DA from the cytoplasm via "reverse transport" through DAT.

}}{{cite journal | vauthors = Sulzer D, Cragg SJ, Rice ME | title = Striatal dopamine neurotransmission: regulation of release and uptake | journal = Basal Ganglia | volume = 6 | issue = 3 | pages = 123–148 | date = August 2016 | pmid = 27141430 | pmc = 4850498 | doi = 10.1016/j.baga.2016.02.001}}{{efn|

Despite the challenges in determining synaptic vesicle pH, the proton gradient across the vesicle membrane is of fundamental importance for its function. Exposure of isolated catecholamine vesicles to protonophores collapses the pH gradient and rapidly redistributes transmitter from inside to outside the vesicle. ... Amphetamine and its derivatives like methamphetamine are weak base compounds that are the only widely used class of drugs known to elicit transmitter release by a non-exocytic mechanism. As substrates for both DAT and VMAT, amphetamines can be taken up to the cytosol and then sequestered in vesicles, where they act to collapse the vesicular pH gradient.

}}

The difference in mechanism of action between methylphenidate and amphetamine results in methylphenidate inhibiting amphetamine's effects on monoamine transporters when they are co-administered.{{better source needed|date=December 2022 |reason=need a better source for this statement - the cited source (Miller) discusses methylphenidate and methamphetamine, rather than amphetamine; the mechanism by which methylphenidate interacts with meth is the same for amph though}}

Methylphenidate has both dopamine transporter and norepinephrine transporter binding affinity, with the dextromethylphenidate enantiomers displaying a prominent affinity for the norepinephrine transporter.{{cite journal | vauthors = Liu F, Minami H, Silva RR | title = Dexmethylphenidate hydrochloride in the treatment of attention deficit hyperactivity disorder | journal = Neuropsychiatric Disease and Treatment | volume = 2 | issue = 4 | pages = 467–473 | date = December 2006 | pmid = 19412495 | pmc = 2671958 | doi = 10.2147/nedt.2006.2.4.467 | doi-access = free }} Both the dextrorotary and levorotary enantiomers displayed receptor affinity for the serotonergic 5-HT_1A and 5-HT_2B subtypes, though direct binding to the serotonin transporter was not observed. A later study confirmed the d-threo-methylphenidate (dexmethylphenidate) binding to the 5-HT_1A receptor, but no significant activity on the 5-HT_2B receptor was found.{{cite journal | vauthors = Markowitz JS, DeVane CL, Ramamoorthy S, Zhu HJ | title = The psychostimulant d-threo-(R,R)-methylphenidate binds as an agonist to the 5HT(1A) receptor | journal = Die Pharmazie | volume = 64 | issue = 2 | pages = 123–125 | date = February 2009 | pmid = 19322953 }}

There exist some paradoxical findings that oppose the notion that methylphenidate acts as silent antagonist of the DAT (DAT inhibitor). DAT occupancy of 80% is necessary for methylphenidate's euphoriant effect, but re-administration of methylphenidate beyond this level of DAT occupancy has been found to produce similarly potent euphoriant effects (despite DAT occupancy being unchanged with repeated administration).{{cite journal |vauthors=Volkow ND, Wang GJ, Fowler JS, Gatley SJ, Ding YS, Logan J, Dewey SL, Hitzemann R, Lieberman J |date=September 1996 |title=Relationship between psychostimulant-induced "high" and dopamine transporter occupancy |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=93 |issue=19 |pages=10388–10392 |bibcode=1996PNAS...9310388V |doi=10.1073/pnas.93.19.10388 |pmc=38394 |pmid=8816810 |doi-access=free}} By contrast, other DAT inhibitors such as bupropion have not been observed to exhibit this effect.{{cite journal |vauthors=Shoptaw S, Heinzerling KG, Rotheram-Fuller E, Steward T, Wang J, Swanson AN, De La Garza R, Newton T, Ling W |date=August 2008 |title=Randomized, placebo-controlled trial of bupropion for the treatment of methamphetamine dependence |journal=Drug and Alcohol Dependence |volume=96 |issue=3 |pages=222–232 |doi=10.1016/j.drugalcdep.2008.03.010 |pmc=3652530 |pmid=18468815}} These observations, among others, have prompted the hypothesis that methylphenidate may actually act as a "DAT inverse agonist" or "negative allosteric modifier of the DAT" by reversing the direction of the dopamine flux by the DAT at higher dosages rather than by acting as a simple competitive transporter blocker.{{cite journal |vauthors=Heal DJ, Gosden J, Smith SL |date=December 2014 |title=Dopamine reuptake transporter (DAT) "inverse agonism" – a novel hypothesis to explain the enigmatic pharmacology of cocaine |journal=Neuropharmacology |volume=87 |pages=19–40 |doi=10.1016/j.neuropharm.2014.06.012 |pmid=24953830 |s2cid=4660652}}

Methylphenidate may protect neurons from the neurotoxic effects of Parkinson's disease and methamphetamine use disorder.{{cite journal | vauthors = Volz TJ | title = Neuropharmacological mechanisms underlying the neuroprotective effects of methylphenidate | journal = Current Neuropharmacology | volume = 6 | issue = 4 | pages = 379–385 | date = December 2008 | pmid = 19587858 | pmc = 2701286 | doi = 10.2174/157015908787386041 }} The hypothesized mechanism of neuroprotection is through inhibition of methamphetamine–DAT interactions, and through reducing cytosolic dopamine, leading to decreased production of dopamine-related reactive oxygen species.

The dextrorotary enantiomers are significantly more potent than the levorotary enantiomers, and some medications therefore only contain dexmethylphenidate. The studied maximized daily dosage of OROS methylphenidate appears to be 144 mg/day.{{cite web | title=Concerta | website=Drugs.com | date=1 October 2018 | url=https://www.drugs.com/pro/concerta.html | access-date=11 March 2019 | archive-url=https://web.archive.org/web/20180929171112/https://www.drugs.com/pro/concerta.html | archive-date=29 September 2018 | url-status=live }}

{{Further|#Available forms}}

Methylphenidate taken by mouth has a bioavailability of 11–52% with a duration of action around 2–4 hours for immediate-release (IR) (i.e., Ritalin), 3–8 hours for sustained-release (i.e., Ritalin LA), and 8–12 hours for extended-release (ER) (i.e., Concerta). The half-life of methylphenidate is 2–3 hours, depending on the individual. The peak plasma time is achieved at about 2 hours.{{cite journal | vauthors = Kimko HC, Cross JT, Abernethy DR | title = Pharmacokinetics and clinical effectiveness of methylphenidate | journal = Clinical Pharmacokinetics | volume = 37 | issue = 6 | pages = 457–470 | date = December 1999 | pmid = 10628897 | doi = 10.2165/00003088-199937060-00002 | s2cid = 397390 }} Methylphenidate has a low plasma protein binding of 10–33% and a volume of distribution of 2.65 L/kg.{{cite web |date=26 June 2021 |title=Ritalin LA- methylphenidate hydrochloride capsule, extended release |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=effd952d-ac94-47bb-b107-589a4934dcca |url-status=live |archive-url=https://web.archive.org/web/20170326230529/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=effd952d-ac94-47bb-b107-589a4934dcca |archive-date=26 March 2017 |access-date=26 March 2022 |website=DailyMed}}

d-Methylphenidate is much more bioavailable than l-methylphenidate when administered orally, and is primarily responsible for the psychoactivity of racemic methylphenidate.

The oral bioavailability and speed of absorption for immediate-release methylphenidate is increased when administered with a meal.{{cite journal | vauthors = Chan YP, Swanson JM, Soldin SS, Thiessen JJ, Macleod SM, Logan W | title = Methylphenidate hydrochloride given with or before breakfast: II. Effects on plasma concentration of methylphenidate and ritalinic acid | journal = Pediatrics | volume = 72 | issue = 1 | pages = 56–59 | date = July 1983 | pmid = 6866592 | doi = 10.1542/peds.72.1.56 | s2cid = 28806553 | url = https://escholarship.org/uc/item/9gv7p39v | access-date = 12 December 2021 | archive-date = 17 December 2021 | archive-url = https://web.archive.org/web/20211217003134/https://escholarship.org/uc/item/9gv7p39v | url-status = live }} The effects of a high fat meal on the observed C_max differ between some extended-release formulations, with combined IR/ER and OROS formulations showing reduced C_max levels{{cite web | title=Cotempla XR-ODT- methylphenidate tablet, orally disintegrating | website=DailyMed | date=1 July 2021 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=33f70f58-c871-42c8-8adb-345caeafefcd | access-date=25 May 2022 | archive-date=26 May 2022 | archive-url=https://web.archive.org/web/20220526063140/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=33f70f58-c871-42c8-8adb-345caeafefcd | url-status=live }} while liquid-based extended-release formulations showed increased C_max levels when administered with a high-fat meal, according to some researchers.{{cite web | title=Quillivant XR- methylphenidate hydrochloride suspension, extended release | website=DailyMed | date=30 June 2021 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c2dc2109-44a6-4797-b04e-18761dd9d45a | access-date=26 May 2022 | archive-date=26 May 2022 | archive-url=https://web.archive.org/web/20220526063140/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c2dc2109-44a6-4797-b04e-18761dd9d45a | url-status=live }} A 2003 study, however, showed no difference between a high-fat meal administration and a fasting administration of oral methylphenidate.{{cite journal | vauthors = Lee L, Kepple J, Wang Y, Freestone S, Bakhtiar R, Wang Y, Hossain M | title = Bioavailability of modified-release methylphenidate: influence of high-fat breakfast when administered intact and when capsule content sprinkled on applesauce | journal = Biopharmaceutics & Drug Disposition | volume = 24 | issue = 6 | pages = 233–243 | date = September 2003 | pmid = 12973820 | doi = 10.1002/bdd.358 | s2cid = 29609987 }}

Methylphenidate is metabolized into ritalinic acid by CES1A1 enzymes in the liver. Dextromethylphenidate is selectively metabolized at a slower rate than levomethylphenidate.{{cite journal | vauthors = Sun Z, Murry DJ, Sanghani SP, Davis WI, Kedishvili NY, Zou Q, Hurley TD, Bosron WF | title = Methylphenidate is stereoselectively hydrolyzed by human carboxylesterase CES1A1 | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 310 | issue = 2 | pages = 469–476 | date = August 2004 | pmid = 15082749 | doi = 10.1124/jpet.104.067116 | s2cid = 24233422 }} 97% of the metabolised drug is excreted in the urine, and between 1 and 3% is excreted in the faeces. A small amount, less than 1%, of the drug is excreted in the urine in its unchanged form.

{{see also|List of methylphenidate analogues}}Despite the claim made by some urban legends, it is not a cocaine derivative nor analog, however, both compounds contain a methyl piperidinylcarboxylate moiety with 2-carbon distance between nitrogen and methanoate, methylphenidate containing methyl (piperidin-2-yl)-ethanoate and cocaine containing methyl (piperidin-3-yl)-methanoate. Cocaine is a local anesthetic and ligand channel blocker with SNDRI action, while methylphenidate is an NDRI with 2–3 fold selectivity for the dopamine transporter (DAT) over the norepinephrine transporter (NET). Cocaine is also more potent in serotonin transporters (SERTs) than NDRI sites.{{cite book |url=https://books.google.com/books?id=Yu9eBwAAQBAJ&pg=PA651 |title=Neuropathology of Drug Addictions and Substance Misuse |vauthors=Preedy VR |date=2016 |publisher=Academic Press |isbn=978-0-12-800677-1 |volume=3: General processes and mechanisms, prescription medications, caffeine and areca, polydrug misuse, emerging addictions, and non-drug addictions |page=651 |access-date=19 December 2018 |archive-url=https://web.archive.org/web/20210829151101/https://books.google.com/books?id=Yu9eBwAAQBAJ&pg=PA651 |archive-date=29 August 2021 |url-status=live}}{{cite journal |vauthors=Bagot KS, Kaminer Y |date=April 2014 |title=Efficacy of stimulants for cognitive enhancement in non-attention deficit hyperactivity disorder youth: A systematic review |journal=Addiction |volume=109 |issue=4 |pages=547–557 |doi=10.1111/add.12460 |pmc=4471173 |pmid=24749160}}

Four isomers of methylphenidate are possible, since the molecule has two chiral centers. One pair of threo isomers and one pair of erythro are distinguished, from which primarily d-threo-methylphenidate exhibits the pharmacologically desired effects.{{cite journal | vauthors = Froimowitz M, Patrick KS, Cody V | title = Conformational analysis of methylphenidate and its structural relationship to other dopamine reuptake blockers such as CFT | journal = Pharmaceutical Research | volume = 12 | issue = 10 | pages = 1430–1434 | date = October 1995 | pmid = 8584475 | doi = 10.1023/A:1016262815984 | s2cid = 26097197 }} The erythro diastereomers are pressor amines, a property not shared with the threo diastereomers. When the drug was first introduced it was sold as a 4:1 mixture of erythro:threo diastereomers, but it was later reformulated to contain only the threo diastereomers. "TMP" refers to a threo product that does not contain any erythro diastereomers, i.e. (±)-threo-methylphenidate. Since the threo isomers are energetically favored, it is easy to epimerize out any of the undesired erythro isomers. The drug that contains only dextrorotatory methylphenidate is sometimes called d-TMP, although this name is only rarely used and it is much more commonly referred to as dexmethylphenidate, d-MPH, or d-threo-methylphenidate. A review on the synthesis of enantiomerically pure (2R,2'R)-(+)-threo-methylphenidate hydrochloride has been published.{{cite journal | doi =10.1002/1615-4169(200107)343:5<379::AID-ADSC379>3.0.CO;2-4| vauthors = Prashad M | year = 2001 | title = Approaches to the Preparation of Enantiomerically Pure (2R,2{{prime}}R)-(+)-threo-Methylphenidate Hydrochloride | journal = Adv. Synth. Catal. | volume = 343 | issue = 5 | pages = 379–392 }}

The concentration of methylphenidate or ritalinic acid, its major metabolite, may be quantified in plasma, serum, or whole blood to monitor compliance in those receiving the drug therapeutically, to confirm the diagnosis of potential poisoning victims or to assist in the forensic investigation in a case of fatal overdosage.{{cite book |veditors=Baselt R |year=2011 |title=Disposition of Toxic Drugs and Chemicals in Man |edition=9th |publisher=Biomedical Publications |place=Seal Beach, CA |pages=1091–1093}}

Methylphenidate was first synthesized in 1944 and was approved for medical use in the United States in 1955.{{cite journal | vauthors = Lange KW, Reichl S, Lange KM, Tucha L, Tucha O | date = December 2010 | title = The history of attention deficit hyperactivity disorder | journal = Attention Deficit and Hyperactivity Disorders | volume = 2 | issue = 4 | pages = 241–255 | pmid = 21258430 | pmc = 3000907 | doi = 10.1007/s12402-010-0045-8 }}{{cite journal | vauthors = Wenthur CJ | title = Classics in chemical neuroscience: Methylphenidate | journal = ACS Chem Neurosci | volume = 7 | issue = 8 | pages = 1030–1040 | date = August 2016 | pmid = 27409720 | doi = 10.1021/acschemneuro.6b00199 | url = }}{{cite journal| author = Panizzon L | title = La preparazione di piridile piperidil-arilacetonitrili e di alcuni prodotti di trasformazione (Parte Ia) | journal = Helvetica Chimica Acta | volume = 27 | pages = 1748–1756 | year = 1944 | doi = 10.1002/hlca.194402701222}} It was synthesized by chemist {{ill|Leandro Panizzon|fr|Leandro Panizzon}} and sold by Swiss company CIBA (now Novartis). He named the drug after his wife Marguerite, nicknamed Rita, who used Ritalin to compensate for low blood pressure.{{Cite journal | vauthors = Weber R |date=2001-02-25 |title=Die Ritalin-Story |url=https://www.deutsche-apotheker-zeitung.de/daz-az/2001/daz-9-2001/uid-336 |journal=Deutsche Apotheker Zeitung |language=DE |volume=141 |pages=1091–1093}}{{cite book |vauthors=Myers RL |date=1 January 2007 |title=The 100 Most Important Chemical Compounds: A reference guide |publisher=ABC-CLIO |isbn=978-0-313-33758-1 |page=178 |url=https://books.google.com/books?id=a4DuGVwyN6cC&q=named+ritalin+after+his+wife&pg=PA178 |url-status=live |via=Google Books |access-date=24 September 2016 |archive-url=https://web.archive.org/web/20170202064317/https://books.google.com/books?id=a4DuGVwyN6cC&pg=PA178&lpg=PA178&dq=named+ritalin+after+his+wife#v=onepage&q=named%20ritalin%20after%20his%20wife&f=false |archive-date=2 February 2017}} Methylphenidate was not reported to be a stimulant until 1954.{{cite journal | vauthors = Heal DJ, Pierce DM | date = 2006 | title = Methylphenidate and its isomers: their role in the treatment of attention-deficit hyperactivity disorder using a transdermal delivery system | journal = CNS Drugs | volume = 20 | issue = 9 | pages = 713–738 | pmid = 16953648 | doi = 10.2165/00023210-200620090-00002 | s2cid = 39535277}}{{cite journal | vauthors = Meier R, Gross F, Tripod J | date = May 1954 | title = Ritalin, eine neuartige synthetische Verbindung mit spezifischer zentralerregender Wirkungskomponente | language = de | trans-title = Ritalin, a new synthetic compound with specific analeptic components | journal = Klinische Wochenschrift | volume = 32 | issue = 19–20 | pages = 445–450 | pmid = 13164273 | doi = 10.1007/BF01466968 | s2cid = 24516999 }} The drug was introduced for medical use in the United States in 1957.{{cite journal | vauthors = Wood S, Sage JR, Shuman T, Anagnostaras SG | date = 2014 | title = Psychostimulants and cognition: A continuum of behavioral and cognitive activation | journal = Pharmacol Rev | volume = 66 | issue = 1 | pages = 193–221 | pmid = 24344115 | pmc = 3880463 | doi = 10.1124/pr.112.007054}} Originally, it was marketed as a mixture of two racemates, 80% (±)-erythro and 20% (±)-threo, under the brand name Centedrin. Subsequent studies of the racemates showed that the central stimulant activity is associated with the threo racemate and were focused on the separation and interconversion of the erythro isomer into the more active threo isomer.{{cite patent | country = US | number = 2507631 | inventor = Hartmann, M.; Panizzon, L. | gdate = 16 May 1950 | title = Pyridine and piperidine compounds and process of making same | assign1 = CIBA Pharmaceutical Products, Inc}}{{cite patent | country = US | number = 2838519 | inventor = Rouietscji, R. | gdate = 10 June 1958 | title = Process for the conversion of stereoisomers | assign1 = CIBA Pharmaceutical Products, Inc}}{{cite patent | country = US | number = 2957880 |inventor = Rouietscji, R. | gdate = 25 October 1960 | title = Process for the conversion of stereoisomers | assign1 = CIBA Pharmaceutical Products, Inc}} The erythro isomer was eliminated, and now modern formulations of methyphenidate contain only the threo isomer in a 50:50 mixture of d- and l-isomers.

Methylphenidate was first used to allay barbiturate-induced coma, narcolepsy and depression.{{cite book | vauthors = Myers RL |date=August 2007 |title=The 100 Most Important Chemical Compounds: A reference guide |publisher=ABC-CLIO |isbn=978-0-313-33758-1 |url=https://archive.org/details/100mostimportant0000myer |url-access=registration |access-date=10 September 2010 |page=[https://archive.org/details/100mostimportant0000myer/page/178 178] |quote=... named ritalin after his wife ...}} It was later used to treat memory deficits in the elderly.{{cite book | vauthors = Stolerman I | year = 2010 | title = Encyclopedia of Psychopharmacology | publisher = Springer | location = Berlin, DE / London, UK | isbn = 978-3-540-68698-9 | page = 763}} Beginning in the 1960s, it was used to treat children with attention deficit hyperactivity disorder (ADHD) based on earlier work, starting with the studies by American psychiatrist Charles Bradley{{cite report |vauthors = McCrossin S |year = 1995 |title=Ritalin and attention deficit disorder: History of its use, effects, and side effects |url=http://www.crossinology.com/pdf/RITALINus.pdf |access-date=22 July 2014 |url-status=dead |archive-url=https://web.archive.org/web/20120824105824/http://www.crossinology.com/pdf/RITALINus.pdf |archive-date=24 August 2012 }} on the use of psychostimulant drugs, such as Benzedrine, with then-called "maladjusted children".{{cite journal | vauthors = Bradley C | date = January 1950 | title = Benzedrine and dexedrine in the treatment of children's behavior disorders | journal = Pediatrics | volume = 5 | issue = 1 | pages = 24–37 | pmid = 15404645 | doi = 10.1542/peds.5.1.24 | s2cid = 45655000 }} Production and prescription of methylphenidate rose significantly in the 1990s, especially in the United States, as the ADHD diagnosis came to be better understood and more generally accepted within the medical and mental health communities.{{cite report | vauthors = Woodworth T |date=16 May 2000 |title=DEA Congressional Testimony |publisher=U.S. Drug Enforcement Administration |url=http://www.dea.gov/pubs/cngrtest/ct051600.htm |access-date=2 November 2007 |url-status=dead |archive-url=https://web.archive.org/web/20071012061712/http://www.dea.gov/pubs/cngrtest/ct051600.htm |archive-date=12 October 2007 }}

In 2000, Alza Corporation received FDA approval to market Concerta, a modified-release form of methylphenidate that uses the osmotic-controlled release oral delivery system.{{cite web | title=Drug Approval Package: Concerta (methylphenidate HCI) NDA #21-121 | date=24 December 1999 | website=fda.gov | url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2000/21-121_Concerta.cfm | access-date=26 March 2022 | url-status=dead | archive-url=https://web.archive.org/web/20220327053311/https://www.accessdata.fda.gov/drugsatfda_docs/nda/2000/21-121_Concerta.cfm | archive-date=27 March 2022}}{{cite web | title = Newly Approved Drug Therapies (637) Concerta, Alza | website = CenterWatch | url = http://www.centerwatch.com/drug-information/fda-approvals/drug-details.aspx?DrugID=637 | url-status = dead | access-date = 30 April 2011 | archive-url = https://web.archive.org/web/20101216171133/http://centerwatch.com/drug-information/fda-approvals/drug-details.aspx?DrugID=637 | archive-date = 16 December 2010}}

It was estimated that the number of doses of methylphenidate used globally in 2013 increased by 66% compared to 2012.{{cite journal |title=Narcotics monitoring board reports 66% increase in global consumption of methylphenidate |journal=The Pharmaceutical Journal|publisher=Royal Pharmaceutical Society |url=https://www.pharmaceutical-journal.com/news-and-analysis/news-in-brief/narcotics-monitoring-board-reports-66-increase-in-global-consumption-of-methylphenidate/20068042.article?firstPass=false |access-date=19 December 2018 |date=4 March 2015|volume=294|issue=7853|doi= 10.1211/PJ.2015.20068042 |archive-url=https://web.archive.org/web/20181219230236/https://www.pharmaceutical-journal.com/news-and-analysis/news-in-brief/narcotics-monitoring-board-reports-66-increase-in-global-consumption-of-methylphenidate/20068042.article?firstPass=false |archive-date=19 December 2018 |url-status=live |url-access=subscription }} In 2022, it was the 32nd most commonly prescribed medication in the United States, with more than 17{{nbsp}}million prescriptions. It is available as a generic medication.

Ritalin Methylphenidat.jpg | Swiss "Ritalin" brand methylphenidate

Add Wize Methylphenidate.jpg | Indian "AddWize" branded immediate-release and extended-release formulations costing US$1.90 for a strip of immediate-release and US$2.90 for a strip of AddWize extended-release

Methylphenidate Formulations.jpg | Clockwise from top: Concerta 18 mg, Medikinet 5 mg, Methylphenidat TAD 10 mg, Ritalin 10 mg, Medikinet XL 40 mg

Methylphenidate is sold in the majority of countries worldwide.{{cite report |vauthors=Moscibrodzki P, Katz C |date=8 December 2018 |title=Application for inclusion to the 22nd expert committee on the selection and use of essential medicines: Methylphenidate hydrochloride |publisher=World Health Organization |url=https://www.who.int/selection_medicines/committees/expert/22/applications/s24_methylphenidate.pdf |access-date=16 November 2019 |archive-date=6 August 2020 |archive-url=https://web.archive.org/web/20200806210756/https://www.who.int/selection_medicines/committees/expert/22/applications/s24_methylphenidate.pdf |url-status=live}}{{rp|8–9}} Brand names for methylphenidate include Ritalin (in honor of Rita, the wife of the molecule discoverer Leandro Panizzon), Rilatine (in Belgium to avoid a conflict of commercial name with the RIT pharmaceutical company), Concerta, Medikinet, Adaphen, Addwize, Inspiral, Methmild, Artige, Attenta, Cognil, Konsenidat, Equasym, Foquest,{{cite report |title=Foquest: Methylphenidate hydrochloride controlled release capsules |series=Product Monograph |type=vers. E |date=1 March 2019 |publisher=Purdue Pharma |place=Pickering, Ontario, Canada |via=caddra.ca |id=Submission Control Nr 214860 |url=https://www.caddra.ca/wp-content/uploads/FOQUEST-Product-Monograph-E-01Mar2019.pdf |access-date=14 December 2022}} Methylin, Penid, Phenida, Prohiper, and Tradea.{{rp|8–9}}

The dextrorotatory enantiomer of methylphenidate, known as dexmethylphenidate, is sold as a generic and under the brand names Focalin and Attenade in both an immediate-release and an extended-release form. There is some evidence that dexmethylphenidate has better bioavailability and a longer duration of action than methylphenidate.

In the Ritalin tablets series (Ritalin, Ritalin LA, Ritalin SR), the volume of distribution was 2.65±1.11 L/kg for d-methylphenidate and 1.80±0.91 L/kg for l-methylphenidate subsequent to swallowing. Following administration of Concerta, plasma concentrations of the l-isomer were approximately {{sfrac|1|40}} the plasma concentrations of the d-isomer.

Methylphenidate was originally available as an immediate-release racemic mixture formulation under the Novartis brand name Ritalin, although a variety of generics are available, some under other brand names. Generic brand names include Ritalina, Rilatine, Attenta, Medikinet, Metadate, Methylin, Penid, Tranquilyn, and Rubifen.{{citation needed|date=May 2022}}

Modified-release methylphenidate products include:

Concerta tablets are marked with the letters "ALZA" and followed by: "18", "27", "36", or "54", relating to the dosage strength in milligrams. They use osmotic-controlled release oral delivery system. Approximately 22% of the dose is immediate-release,{{cite web | url = http://pediatrics.about.com/cs/adhd/a/concerta.htm | title = Concerta for Kids with ADHD | archive-url = https://web.archive.org/web/20110107153016/http://pediatrics.about.com/cs/adhd/a/concerta.htm | archive-date= 7 January 2011 | work = Pediatrics.about.com | date = 1 April 2003}} and the remaining 78% of the dose is released over 10–12 hours post-ingestion, with an initial increase over the first 6–7 hours, and subsequent decline in the released drug.{{cite web | url = http://www.rxlist.com/concerta-drug.htm | title = Concerta (methylphenidate extended-release tablets) |series=Drug information: User reviews, side effects, drug interactions, and dosage | work = RxList | archive-url = https://web.archive.org/web/20110326160650/http://www.rxlist.com/concerta-drug.htm |archive-date=26 March 2011 | access-date = 30 April 2011}}

Ritalin LA capsules are marked with the letters "NVR" (abbrev.: Novartis) and followed by: "R20", "R30", or "R40", depending on the (mg) dosage strength. Ritalin LA provides two standard doses – half the total dose being released immediately and the other half released four hours later. In total, each capsule is effective for about eight hours.

Metadate CD capsules contain two types of beads: 30% are immediate-release, and the other 70% are evenly sustained release.{{cite web | url = http://adhd.emedtv.com/metadate-cd/metadate-cd.html | title = Metadate CD | work = eMedTV: Health Information Brought To Life | archive-url = https://web.archive.org/web/20110710185835/http://adhd.emedtv.com/metadate-cd/metadate-cd.html | archive-date=10 July 2011 | author1 = Emedtv }}

Medikinet Retard/CR/Adult/Modified Release tablets are an extended-release oral capsule form of methylphenidate. It delivers 50% of the dosage as IR MPH and the remaining 50% in 3–4 hours.{{cite journal | vauthors = Coghill D, Banaschewski T, Zuddas A, Pelaz A, Gagliano A, Doepfner M | title = Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies | journal = BMC Psychiatry | volume = 13 | pages = 237 | date = September 2013 | pmid = 24074240 | pmc = 3852277 | doi = 10.1186/1471-244X-13-237 | doi-access = free }}{{cite web |title=UK Report on Ritalin |url=https://mhraproductsproduction.blob.core.windows.net/docs/4781baf366b1fafd0ea203962ccb54faadcdcfcc |access-date=9 January 2024 |page=9}}

Jornay PM is a delayed release formulation that is taken at bedtime. An outer polymer coating delays the initial release of the drug until 8 hours after administration, after which an inner coating regulates the rate of drug absorption. Peak plasma concentration occurs 14 hours following administration. This formulation was motivated by the need for a pediatric ADHD medication that is active immediately after morning waking, as most long-acting formulations exhibit a delay between administration and absorption that leads to inadequate therapeutic effect in the early morning.{{cite journal |vauthors=Steingard R, Taskiran S, Connor DF, Markowitz JS, Stein MA |title=New Formulations of Stimulants: An Update for Clinicians |journal=J Child Adolesc Psychopharmacol |volume=29 |issue=5 |pages=324–339 |date=June 2019 |pmid=31038360 |pmc=7207053 |doi=10.1089/cap.2019.0043 |url=}}

A methylphenidate skin patch is sold under the brand name Daytrana in the United States. It was developed and marketed by Noven Pharmaceuticals and approved in the US in 2006. It is also referred to as methylphenidate transdermal system (MTS). It is approved as a once-daily treatment in children with ADHD aged 6–17 years. It is mainly prescribed as a second-line treatment when oral forms are not well tolerated, or if people have difficulty with compliance. Noven's original FDA submission indicated that it should be used for 12 hours. When the FDA rejected the submission, they requested evidence that a shorter time period was safe and effective; Noven provided such evidence, and it was approved for a 9-hour period.{{cite report |title=Methylphenidate transdermal system (MTS) |date=24 October 2005 |type=safety summary |id={{nowrap|NDA No. 21-514}}, Appendix 3 |publisher=Noven Pharmaceuticals |via=U.S. Food and Drug Administration |url=http://www.fda.gov/ohrms/dockets/AC/05/briefing/2005-4195B1_01_04-Noven-Appendix-3.pdf |url-status=dead |access-date=17 January 2022 |archive-url=https://web.archive.org/web/20070930004912/http://www.fda.gov/ohrms/dockets/AC/05/briefing/2005-4195B1_01_04-Noven-Appendix-3.pdf |archive-date=30 September 2007}}

Orally administered methylphenidate is subject to first-pass metabolism, by which the levo-isomer is extensively metabolized. By circumventing this first-pass metabolism, the relative concentrations of ℓ-threo-methylphenidate are much higher with transdermal administration (50–60% of those of dexmethylphenidate instead of about 14–27%).{{cite journal | vauthors = Heal DJ, Pierce DM | title = Methylphenidate and its isomers: their role in the treatment of attention-deficit hyperactivity disorder using a transdermal delivery system | journal = CNS Drugs | volume = 20 | issue = 9 | pages = 713–738 | year = 2006 | pmid = 16953648 | doi = 10.2165/00023210-200620090-00002 | s2cid = 39535277 }}

{{cite journal | vauthors = Anderson VR, Scott LJ | title = Methylphenidate transdermal system: In attention-deficit hyperactivity disorder in children | journal = Drugs | volume = 66 | issue = 8 | pages = 1117–1126 | year = 2006 | pmid = 16789796 | doi = 10.2165/00003495-200666080-00007 | s2cid = 46975783 }}

A 39 nanograms/mL peak serum concentration of methylphenidate has been found to occur between 7.5–10.5 hours after administration. However, the onset to peak effect is 2 hours, and the clinical effects remain up to 2 hours after the patch has been removed. The absorption is increased when the transdermal patch is applied onto inflamed skin or skin that has been exposed to heat. The absorption lasts for approximately 9 hours after application (onto normal, unexposed to heat and uninflamed skin). 90% of the medication is excreted in the urine as metabolites and unchanged drug.

When it was released in the United States, methylphenidate was available from CIBA in a parenteral form for use by medical professionals. It came in 10mL multiple-dose vials containing 100 mg methylphenidate HCl and 100 mg lactose in lyophilized (freeze-dried) form. It was also available as single-dose ampoules containing 20 mg methylphenidate HCl. Instructions were to reconstitute with 10mL sterile solvent (water). The indication was 10 to 20 mg (1.0mL from MDV's, up to one full single-use ampoule) to produce a focused, talkative state that could help certain patients break down the resistance to therapy. Parenteral methylphenidate was discontinued out of a concern for the actual benefit and of inducing a psychic dependence. This is not truth serum in the normal sense, as it does not impair the ability to control the flow of information like a barbiturate agent (Pentothal) or similar might.{{citation needed | date = May 2023}}

File:Ritalin Pill.jpg

Brand-name and generic formulations are available.

File:Ritalin.jpgInternationally, methylphenidate is a Schedule II drug under the Convention on Psychotropic Substances.{{cite report |url=http://www.incb.org/pdf/e/list/green.pdf |title=Green List: Annex to the annual statistical report on psychotropic substances (form P) |date=August 2003 |publisher=International Narcotics Board |edition=23rd |id={{small|(1.63 MB)}} |access-date=2 March 2006 |archive-url=https://web.archive.org/web/20120831222336/http://www.incb.org/pdf/e/list/green.pdf |archive-date=31 August 2012 |url-status=dead |place=Vienna International Centre, Austria}}

In December 2024, the Committee for Medicinal Products for Human Use of the European Medicines Agency adopted a positive opinion, recommending the granting of a pediatric use marketing authorization for the medicinal product Tuzulby, intended for the treatment of children with attention-deficit hyperactivity disorder (ADHD). The applicant for this medicinal product is Neuraxpharm Pharmaceuticals S.L. Tuzulby is a hybrid medicine of Ritalin, which has been authorized in the EU since January 1997. Tuzulby contains the same active substance as Ritalin, but is available in a different formulation and strength, and is given once daily.{{cite web | title=Tuzulby EPAR | website=European Medicines Agency (EMA) | date=12 December 2024 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/tuzulby | access-date=16 December 2024}} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged. Methylphenidate was authorized for medical use in the European Union in February 2025.{{cite web | title=Tuzulby PI | website=Union Register of medicinal products | date=3 March 2025 | url=https://ec.europa.eu/health/documents/community-register/html/h1907.htm | access-date=12 March 2025}}

{{Further|Attention deficit hyperactivity disorder controversies#Stimulants}}

Methylphenidate has been the subject of controversy in relation to its use in the treatment of ADHD. The prescription of psychostimulant medication to children to reduce ADHD symptoms has been a major point of criticism.{{cite journal | vauthors = Lakhan SE, Hagger-Johnson GE | date = October 2007 | title = The impact of prescribed psychotropics on youth | journal = Clinical Practice and Epidemiology in Mental Health | volume = 3 | issue = 1 | page = 21 | pmid = 17949504 | pmc = 2100041 | doi = 10.1186/1745-0179-3-21 | doi-access = free }}{{request quotation | date=June 2015}} The contention that methylphenidate acts as a gateway drug has been discredited by multiple sources,{{cite news |title = New research helps explain ritalin's low abuse potential when taken as prescribed |date = 29 September 1998 |website = NIH.gov |url = http://www.nih.gov/news/pr/sept98/nida-29.htm |access-date = 30 April 2011 |archive-url = https://web.archive.org/web/20100528060023/http://www.nih.gov/news/pr/sept98/nida-29.htm |archive-date=28 May 2010}} according to which abuse is statistically very low and "stimulant therapy in childhood does not increase the risk for subsequent drug and alcohol abuse disorders later in life".{{cite web | title = Stimulant ADHD medications: Methylphenidate and amphetamines |series = NIDA InfoFacts |website = Drugabuse.gov | url = http://www.drugabuse.gov/InfoFacts/ADHD.html | access-date = 30 April 2011 | archive-url = https://web.archive.org/web/20100326223023/http://www.drugabuse.gov/infofacts/ADHD.html | archive-date=26 March 2010}} A study found that ADHD medication was not associated with an increased risk of cigarette use, and in fact, stimulant treatments such as Ritalin seemed to lower this risk.{{cite journal | vauthors = Schoenfelder EN, Faraone SV, Kollins SH | date = June 2014 | title = Stimulant treatment of ADHD and cigarette smoking: A meta-analysis | journal = Pediatrics | volume = 133 | issue = 6 | pages = 1070–1080 | pmid = 24819571 | pmc = 4531271 | doi = 10.1542/peds.2014-0179 }} People treated with stimulants such as methylphenidate during childhood were less likely to have substance use disorders in adulthood.{{cite journal | vauthors = Wilens TE, Faraone SV, Biederman J, Gunawardene S | title = Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature | journal = Pediatrics | volume = 111 | issue = 1 | pages = 179–185 | date = January 2003 | pmid = 12509574 | doi = 10.1542/peds.111.1.179 | s2cid = 29956425 }}

Among countries with the highest rates of use of methylphenidate medication is Iceland,{{cite journal | vauthors = Karlstad Ø, Zoëga H, Furu K, Bahmanyar S, Martikainen JE, Kieler H, Pottegård A | title = Use of drugs for ADHD among adults-a multinational study among 15.8 million adults in the Nordic countries | journal = European Journal of Clinical Pharmacology | volume = 72 | issue = 12 | pages = 1507–1514 | date = December 2016 | pmid = 27586399 | pmc = 5110707 | doi = 10.1007/s00228-016-2125-y }} where research shows that the drug was the most commonly used substance among people who inject drugs.{{cite journal | vauthors = Bjarnadottir GD, Haraldsson HM, Rafnar BO, Sigurdsson E, Steingrimsson S, Johannsson M, Bragadottir H, Magnusson A | title = Prevalent intravenous abuse of methylphenidate among treatment-seeking patients with substance abuse disorders: a descriptive population-based study | journal = Journal of Addiction Medicine | volume = 9 | issue = 3 | pages = 188–194 | date = 29 November 2016 | pmid = 25748561 | pmc = 4450903 | doi = 10.1097/ADM.0000000000000115 }} The study involved 108 people who inject drugs and 88% of them had injected methylphenidate within the last 30 days and for 63% of them, methylphenidate was the most preferred substance.

Treatment of ADHD by way of methylphenidate has led to legal actions, including malpractice suits regarding informed consent, inadequate information on side effects, misdiagnosis, and coercive use of medications by school systems.{{cite journal | vauthors = Ouellette EM | title = Legal issues in the treatment of children with attention deficit hyperactivity disorder | journal = Journal of Child Neurology | volume = 6 | issue = Suppl | pages = S68–S75 | year = 1991 | pmid = 2002217 | doi = 10.1177/0883073891006001S08 | s2cid = 1773939 }}

The word methylphenidate is a portmanteau of the chemical name, Methyl-2-phenyl-2-(piperidin-2-yl) acetate.

The name "Ritalin" derives from Marguerite "Rita" Panizzon, the wife of Leandro Panizzon, who first synthesized the drug in 1944. Rita was the first person to take methylphenidate and described its effects to her husband.

Methylphenidate may be effective as a treatment for apathy in Alzheimer's disease and other conditions.{{cite journal | vauthors = Ruthirakuhan MT, Herrmann N, Abraham EH, Chan S, Lanctôt KL | title = Pharmacological interventions for apathy in Alzheimer's disease | journal = Cochrane Database Syst Rev | volume = 5 | issue = 5 | pages = CD012197 | date = May 2018 | pmid = 29727467 | pmc = 6494556 | doi = 10.1002/14651858.CD012197.pub2 | url = }}{{cite journal | vauthors = Lee CW, Chen JY, Ko CC, Chuang MH, Tsai WW, Sun CK, Hung KC | title = Efficacy of methylphenidate for the treatment of apathy in patients with Alzheimer's disease: a systematic review and meta-analysis of randomized controlled studies | journal = Psychopharmacology (Berl) | volume = 239 | issue = 12 | pages = 3743–3753 | date = December 2022 | pmid = 36243827 | doi = 10.1007/s00213-022-06261-y | url = }}{{cite journal | vauthors = Theleritis C, Siarkos K, Katirtzoglou E, Politis A | title = Pharmacological and Nonpharmacological Treatment for Apathy in Alzheimer Disease : A systematic review across modalities | journal = Journal of Geriatric Psychiatry and Neurology | volume = 30 | issue = 1 | pages = 26–49 | date = January 2017 | pmid = 28248559 | doi = 10.1177/0891988716678684 | s2cid = 24642197 }}{{cite journal | vauthors = Spiegel DR, Warren A, Takakura W, Servidio L, Leu N | title = Disorders of diminished motivation: What they are, and how to treat them | journal = Current Psychiatry | date = January 2018 | volume = 17 | issue = 1 | pages = 10–18, 20 | url = https://cdn.mdedge.com/files/s3fs-public/Document/December-2017/CP01701010.PDF}} It may also be useful in the treatment of more severe disorders of diminished motivation, like abulia and akinetic mutism.{{cite journal | vauthors = Arnts H, van Erp WS, Lavrijsen JC, van Gaal S, Groenewegen HJ, van den Munckhof P | title = On the pathophysiology and treatment of akinetic mutism | journal = Neurosci Biobehav Rev | volume = 112 | issue = | pages = 270–278 | date = May 2020 | pmid = 32044373 | doi = 10.1016/j.neubiorev.2020.02.006 | url = | doi-access = free | hdl = 2066/225901 | hdl-access = free }}

Methylphenidate has been shown to reduce rates of hospitalization in patients with schizophrenia, although repeated, elevated doses can provoke psychosis.{{cite journal |vauthors=Rohde C, Polcwiartek C, Asztalos M, Nielsen J |date=January 2018 |title=Effectiveness of Prescription-Based CNS Stimulants on Hospitalization in Patients With Schizophrenia: A Nation-Wide Register Study |journal=Schizophrenia Bulletin |volume=44 |issue=1 |pages=93–100 |doi=10.1093/schbul/sbx043 |pmc=5768038 |pmid=28379483}}

Methylphenidate has shown some benefits as a replacement therapy for individuals who are addicted to and dependent upon methamphetamine.{{cite journal | vauthors = Elkashef A, Vocci F, Hanson G, White J, Wickes W, Tiihonen J | title = Pharmacotherapy of methamphetamine addiction: an update | journal = Substance Abuse | volume = 29 | issue = 3 | pages = 31–49 | year = 2008 | pmid = 19042205 | pmc = 2597382 | doi = 10.1080/08897070802218554 | bibcode = 2008JPkR...29...31E }} Methylphenidate and amphetamine have been investigated as a chemical replacement for the treatment of cocaine addiction.{{cite journal | vauthors = Grabowski J, Roache JD, Schmitz JM, Rhoades H, Creson D, Korszun A | title = Replacement medication for cocaine dependence: methylphenidate | journal = Journal of Clinical Psychopharmacology | volume = 17 | issue = 6 | pages = 485–488 | date = December 1997 | pmid = 9408812 | doi = 10.1097/00004714-199712000-00008 }}{{cite web|publisher= US National Institute on Drug Addiction|date=1 February 2019|accessdate=11 February 2023 |title=Understanding drug abuse and addiction: What science says |url=https://nida.nih.gov/publications/teaching-addiction-science/understanding-drug-abuse-addiction-what-science-says}} Its effectiveness in treatment of cocaine or psychostimulant addiction or psychological dependence has not been proven.{{cite journal | vauthors = Shearer J | title = The principles of agonist pharmacotherapy for psychostimulant dependence | journal = Drug and Alcohol Review | volume = 27 | issue = 3 | pages = 301–308 | date = May 2008 | pmid = 18368612 | doi = 10.1080/09595230801927372 | doi-access = free }}

Methylphenidate has been reported to be effective in the treatment of social anxiety disorder in people who are comorbid for both this condition and attention deficit hyperactivity disorder (ADHD) in small preliminary clinical studies and case reports.{{cite journal | vauthors = Villas-Boas CB, Chierrito D, Fernandez-Llimos F, Tonin FS, Sanches AC | title = Pharmacological treatment of attention-deficit hyperactivity disorder comorbid with an anxiety disorder: a systematic review | journal = Int Clin Psychopharmacol | volume = 34 | issue = 2 | pages = 57–64 | date = March 2019 | pmid = 30422834 | doi = 10.1097/YIC.0000000000000243 | url = | quote = In a retrospective analysis of a case series, the monotherapy with extendedrelease methylphenidate was seen to be effective in reducing ADHD and social AD symptoms evaluated by the Adult ADHD Self-Report Scale (ASRS) and Liebowitz Social Anxiety Scale (LSAS) (Koyuncu et al., 2017).}}{{cite journal | vauthors = Koyuncu A, İnce E, Ertekin E, Tükel R | title = Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges | journal = Drugs Context | volume = 8 | issue = | pages = 212573 | date = 2019 | pmid = 30988687 | pmc = 6448478 | doi = 10.7573/dic.212573 | url = | quote = Attention-deficit/hyperactivity disorder (ADHD), another childhood disorder that extends over adulthood, is an overlooked condition that has high rates of comorbidity with SAD.31 Only recently increasing evidence suggests that the relationship between the two disorders is closer than was thought before. Several studies found high rates (up to 60–70%) of childhood ADHD comorbidity, especially predominantly inattentive type, in adults with SAD.67,157,158 In addition, follow-up studies showed that the lifetime prevalence of SAD among ADHD patients is higher compared to healthy controls.159 Treatment studies investigating patients with SAD plus ADHD comorbidity found that ADHD medications such as methylphenidate or atomoxetine could effectively improve symptoms of both disorders at the same time.160–163 According to a developmental hypothesis, SAD may be etiologically linked to ADHD in a subgroup of patients, and thus SAD may develop secondary to ADHD.31}}{{cite journal | vauthors = Pelissolo A, Abou Kassm S, Delhay L | title = Therapeutic strategies for social anxiety disorder: where are we now? | journal = Expert Rev Neurother | volume = 19 | issue = 12 | pages = 1179–1189 | date = December 2019 | pmid = 31502896 | doi = 10.1080/14737175.2019.1666713 | url = | quote = Recently, clinical studies have found high rates of Attention-deficit/hyperactivity disorder (ADHD) in SAD children (up to 60-%), but also in adults [98]. Koyuncu et al. proposed a “developmental hypothesis”, suggesting that SAD may be etiologically linked to ADHD in a subgroup of patients. The impact of this association on response to treatment still needs investigations, but preliminary studies showed that atomoxetine and methylphenidate can be effective in treating both ADHD and comorbid SAD [99,100].}}{{cite journal | vauthors = Golubchik P, Sever J, Weizman A | title = Methylphenidate treatment in children with attention deficit hyperactivity disorder and comorbid social phobia | journal = Int Clin Psychopharmacol | volume = 29 | issue = 4 | pages = 212–215 | date = July 2014 | pmid = 24448460 | pmc = 4047304 | doi = 10.1097/YIC.0000000000000029 | url = }}{{cite journal | vauthors = Koyuncu A, Çelebi F, Ertekin E, Kahn DA | title = Extended-release Methylphenidate Treatment and Outcomes in Comorbid Social Anxiety Disorder and Attention-deficit/Hyperactivity Disorder: 2 Case Reports | journal = J Psychiatr Pract | volume = 21 | issue = 3 | pages = 225–231 | date = May 2015 | pmid = 25955266 | doi = 10.1097/PRA.0000000000000070 | url = }}{{cite journal | vauthors = Koyuncu A, Çelebi F, Ertekin E, Kök BE, Tükel R | title = Extended-release methylphenidate monotherapy in patients with comorbid social anxiety disorder and adult attention-deficit/hyperactivity disorder: retrospective case series | journal = Ther Adv Psychopharmacol | volume = 7 | issue = 11 | pages = 241–247 | date = November 2017 | pmid = 29090087 | pmc = 5638159 | doi = 10.1177/2045125317714193 | url = }}

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