10 Methylphenidate (Ritalin) Side Effects You Should Know About

If you or your child has been diagnosed with attention deficit-hyperactivity disorder (ADHD), your prescriber may recommend a stimulant medication. Methylphenidate is one common example that's FDA approved to treat ADHD in people 6 years and older. It comes in several different forms.

Immediate-release (IR) methylphenidate comes as a tablet (Ritalin) and liquid (Methylin). These IR forms are also approved to treat narcolepsy in adults. Extended-release (ER) forms include tablets (Concerta), capsules (Metadate CD, Ritalin LA), and patches (Daytrana).

Although stimulant medications are the mainstay of ADHD treatment, they also come with unique risks. Here, we discuss 10 methylphenidate side effects to watch for.

Methylphenidate (Ritalin) side effects at a glance

Methylphenidate was first FDA approved in the 1950s, so we know a lot about its side effects. IR products like Ritalin, and ER products like Concerta, cause similar side effects.

Common methylphenidate side effects include:

• Headache

• Nausea

• Stomach pain

• Trouble sleeping

• Decreased appetite

• Weight loss

• Anxiety

• Dry mouth

• Increased sweating

• Increased blood pressure

• Heart palpitations (fast heartbeat)

Rare but serious methylphenidate side effects include:

• Slower growth in children and teens

• Heart problems, especially in people with existing heart conditions

• Raynaud's phenomenon

• Increased risk of glaucoma

• Prolonged, painful erections (priapism)

• Severe mood changes

• Severe movement problems, including worsening tics and Tourette syndrome

In addition, methylphenidate also has a boxed warning for misuse. A boxed warning is the strictest warning the FDA can assign a medication. Methylphenidate misuse can lead to overdose, which is life-threatening.

1. Dependence and misuse

Methylphenidate is a controlled substance. It has a greater risk of causing dependence or misuse than non-controlled medications. As mentioned, methylphenidate has a boxed warning for misuse.

Dependence can happen to anyone taking methylphenidate, even if you take it exactly as prescribed. Dependence is when your body becomes reliant on a medication in order to feel "normal." In some cases, dependence may lead to misuse and stimulant use disorder. When taking methylphenidate, keep an eye out for signs of stimulant use disorder, such as:

• Taking more methylphenidate than what's prescribed

• Having work or relationship problems

• Needing more methylphenidate to get the same effect (tolerance)

• Having cravings for methylphenidate

• Experiencing withdrawal symptoms like depression, irritability, or tiredness

If you or someone you know struggles with substance use, help is available. Call SAMHSA's National Helpline at 1-800-662-4357 to learn about resources in your area.

Good to know: People with ADHD have a higher risk of developing a substance use disorder. And some parents worry that ADHD medications may increase their child's risk of substance misuse. However, research shows that treating ADHD with stimulants actually reduces the risk of substance misuse later in life. But this is only true if stimulants, like methylphenidate, are taken as prescribed.

2. Lowered appetite

Methylphenidate can make you feel less hungry. It's one of the most commonly reported side effects of IR products and ER products like Concerta.

This may lead to unintentional weight loss or slowed weight gain in children. If your child takes methylphenidate and their appetite decreases, consider these tips for maintaining their weight:

• Give your child their methylphenidate dose during meals to minimize effects on appetite.

• Keep meal and snack times regular (but don't force your child to eat).

• Offer high-calorie snacks, especially in the evening. Examples include full-fat yogurt, nut butter, and dried fruit.

If your child's appetite decreases, it may improve 4 to 6 months after starting methylphenidate. Tell your child's healthcare team about any concerning changes you see in their eating habits or body weight. Your child might need a lower methylphenidate dose or a different medication altogether.

3. Gastrointestinal problems

Gastrointestinal (GI) side effects can happen with all methylphenidate products. Stomach pain, nausea, and vomiting are some possible risks. Diarrhea or constipation can also occur, though these side effects are less common than nausea.

If you're taking an oral form of methylphenidate, taking it with a meal may help minimize nausea. In fact, IR methylphenidate is better absorbed when taken just before eating. That's why it should be taken 30 to 45 minutes before a meal.

Some over-the-counter (OTC) medications can also be used to ease mild stomach upset. Examples include Pepto-Bismol (bismuth subsalicylate) and antacids like Tums (calcium carbonate). Your prescriber or pharmacist can help you choose a product that's safe to take.

If you're experiencing diarrhea, sticking to starchy, bland foods like those in theBRAT diet might help. For constipation, eating more fiber- and water-rich foods like fruits, vegetables, and whole grains can help.

For severe or persistent GI symptoms, reach out to your healthcare team for suggestions.

4. Headache

Methylphenidate can cause headaches. You may be able to prevent this side effect by staying hydrated and eating regularly during the day.

If you experience headaches after starting methylphenidate, let your prescriber know. They may recommend an OTC pain reliever, like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). They may also adjust your dose of methylphenidate or switch to another medication if your headaches continue.

5. Trouble sleeping

Being more alert and focused is a benefit to taking methylphenidate. But when you need to sleep, it can be a problem.

If you're having trouble sleeping while taking methylphenidate, talk to your prescriber about whether you can make some adjustments to how you take it. Possible dosing recommendations that may help improve your sleep:

• If you're taking an IR product, try taking your last dose before 6pm.

• If you're taking an ER pill like Concerta, Metadate CD, or Ritalin LA, take it in the morning.

• If you're using the Daytrana patch, talk to your prescriber about how long you should wear it each day. They may recommend taking it off earlier in the day so it doesn't affect your sleep.

If none of these tips work, you may need a lower methylphenidate dose or a different medication.

6. Dry mouth

Dry mouth is another possible stimulant side effect. On top of being bothersome, dry mouth can increase the risk of gum and dental problems if it continues. The good news is that this stimulant side effect is usually short-term.

In the meantime, staying hydrated with icy, cool drinks, avoiding spicy or salty foods, and chewing sugar-free gum can help. You can also try OTC saliva substitutes like Biotene or BioXtra. But make sure to let your prescriber know if the problem persists.

7. Heart problems

Methylphenidate works by raising levels of two brain chemicals called dopamine and norepinephrine. This may encourage wakefulness and focus while lowering impulsivity. But higher levels of these chemicals can also increase blood pressure. You may also have an increased heart rate or heart palpitations.

For most people, any heart rate and blood pressure changes are minor. And they're unlikely tolead to significant heart problems. Still, some research has found a higher risk forarrhythmias or sudden death in people taking methylphenidate. For most people, heart rate and blood pressure changes are minor. And they're unlikely to lead to significant heart problems. Still, some research has found a higher risk for arrhythmias or sudden death in people taking methylphenidate.

A large 2023 study also found that people taking ADHD medications long-term (2 years or more) may bemore likely to develop heart-related conditions, such as high blood pressure. However, this was an observational study. This type of study only looks for associations rather than cause-and-effect relationships. So some experts say this study alone isn't a reason to avoid methylphenidate, especially since it's one of the most effective medications for ADHD.

However, the manufacturers of methylphenidate recommend avoiding it completely in children with structural heart problems and adults with certain heart conditions. So let your prescriber know if you have a history of heart issues. They may want to monitor you more closely. Or they may recommend a nonstimulant ADHD medication instead of methylphenidate.

If you experience symptoms of heart problems during treatment - like a racing heart, chest pain, or dizziness - contact your prescriber immediately. If your symptoms feel severe, seek emergency care.

8. Mood changes

Methylphenidate can cause mood changes. Some people might feel more irritable, depressed, or anxious after starting treatment. In rare cases, more serious psychiatric issues can happen. For example, methylphenidate can spark a manic episode in people with bipolar disorder. Psychiatric symptoms may also occur in people without a history of psychiatric conditions.

It's important to note thatit's common for people with ADHD to have other mood disorders. So if you're experiencing symptoms of depression or anxiety, something else may be going on. Your prescriber can help you figure out how to best manage any mood-related symptoms.

9. Growth problems in children

A study from 1999 found that children treated with stimulant medications don't grow as quickly. This was a large randomized control trial, which is the best type of study to look for cause and effect.

Since then, more studies have been published on this topic. But the results are conflicting. This may be because any difference in growth rate due to methylphenidate is quite small. Still, since some evidence shows that methylphenidate slows down growth, there are a few things to keep in mind if your child takes methylphenidate:

• Higher doses seem to have the greatest risk of slowed growth.

• The possible reduction in height is small - around 1 cm to 2 cm (less than 1 inch).

• Even if growth slows initially after starting methylphenidate, children may be able to "catch up" during puberty.

• Make sure your child is eating well if they're taking methylphenidate. These medications may lower appetite as a side effect, which can contribute to slowed growth.

Your child's pediatrician will monitor their growth using height and weight. If growth slows, they may recommend taking a break from methylphenidate.

10. Painful erections

Priapism is the medical term for painful erections lasting 4 or more hours. This methylphenidate side effect is rare but serious. Getting medical help right away can prevent serious complications, such as permanent disability.

Priapism can happen at any time during methylphenidate treatment. And it can happen even after you stop taking it. Keep in mind that younger children may not recognize priapism, or could be too embarrassed to tell you about it. If you're a parent or caregiver, tell your child or teen this side effect is possible so that they know what to look for. Or ask your child's pediatrician to discuss this with them.

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