From the Guidelines
Incontinence is not a common side effect of Concerta (methylphenidate extended-release), and the risk is considered rare. While urinary issues can occasionally occur with stimulant medications, incontinence specifically is not typically associated with Concerta 1. More commonly reported urinary effects include difficulty urinating or increased urination frequency. Concerta primarily affects the central nervous system by increasing dopamine and norepinephrine levels to improve attention and reduce hyperactivity. The medication's impact on the urinary system is generally minimal for most patients.
However, it's essential to consider that certain populations, such as women aged >65 y, nursing home residents, and women receiving Medicare home care services, are more vulnerable to urinary incontinence (UI) due to various factors, including medications that may cause or worsen UI 1. Clinicians should identify whether patients are receiving medications that may contribute to UI and manage conditions that may cause UI, such as urinary tract infections, metabolic disorders, excess fluid intake, and impaired mental conditions.
If incontinence develops while taking Concerta, it should be reported to a healthcare provider immediately as it could indicate an unusual reaction or possibly another underlying condition. Patients with pre-existing bladder control issues should discuss this with their doctor before starting Concerta. The risk of urinary side effects typically does not increase with standard dosing, and most patients tolerate the medication without experiencing incontinence. Key considerations for managing UI include:
- Identifying and managing underlying conditions that may cause UI
- Avoiding medications that may worsen UI
- Considering nonpharmacologic interventions, such as pelvic floor muscle training (PFMT) and bladder training, for women with UI
- Selecting pharmacologic agents based on tolerability, adverse effect profile, ease of use, and cost of medication, if necessary 1.
From the Research
Risk of Incontinence with Concerta
- The risk of incontinence with Concerta is not directly addressed in the provided studies, except for one study that investigated the efficacy of methylphenidate (the active ingredient in Concerta) in treating giggle incontinence 2.
- According to this study, methylphenidate was effective in treating giggle incontinence, but its efficacy decreased after discontinuation of the treatment 2.
- The study compared the efficacy of methylphenidate with biofeedback therapy and found that biofeedback therapy had more favorable treatment outcomes after 1 year 2.
- Other studies provided information on urinary incontinence in general, including its types, assessment, diagnosis, and treatment options 3, 4, 5.
- These studies highlighted the importance of conservative treatment options, such as pelvic floor exercises, bladder retraining, and fluid modification, in managing urinary incontinence 3, 4, 5.
- However, they did not specifically address the risk of incontinence associated with Concerta or methylphenidate 3, 4, 5.