TaperCommunitymethylphenidate
Boxed Warning
High potential for abuse and dependence — Schedule II controlled substance. Misuse may cause sudden death or serious cardiovascular events.
Methylphenidate is a Schedule II stimulant for ADHD and narcolepsy. Multiple formulations vary in onset, duration, and abuse liability. Carries a black-box warning for abuse and dependence.
IR: 5mg, 10mg, 20mg; ER: 10-72mg depending on formulation
Tablets IR: 5mg, 10mg, 20mg; Tablets/capsules ER: 10-72mg (Concerta, Ritalin LA, Metadate CD, etc.); Patch (Daytrana): 10-30mg/9h; ODT (Cotempla XR-ODT); Oral solution; Focalin (dexmethylphenidate, the d-isomer): 2.5-40mg
Category C
Inhibits dopamine and norepinephrine reuptake by binding to DAT and NET. Some weak release component at higher doses.
Step-down by formulation strength over 1-3 weeks. Plan low-demand period for the rebound window.
Stimulant withdrawal is rarely dangerous but can be psychologically rough. Rebound depression should be expected and not over-treated with new psychotropics.
Hours after last dose; full picture 1-3 days
3-7 days
1-3 weeks
Anhedonia and low motivation can persist 3-8 weeks
Toxicity
Anorexia, insomnia, hypertension, tachycardia, agitation, psychosis (high dose or vulnerable individuals), growth suppression in children, abuse and dependence.
Pharmacokinetics
Hepatic via carboxylesterase to inactive ritalinic acid.
~15%
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