From the FDA Drug Label
Overdose of CNS stimulants is characterized by the following sympathomimetic effects: Cardiovascular effects including tachyarrhythmias, and hypertension or hypotension Vasospasm, myocardial infarction, or aortic dissection may precipitate sudden cardiac death. Takotsubo cardiomyopathy may develop. CNS effects including psychomotor agitation, confusion, and hallucinations. Serotonin syndrome, seizures, cerebral vascular accidents, and coma may occur. Life-threatening hyperthermia (temperatures greater than 104°F) and rhabdomyolysis may develop Overdose Management Consider the possibility of multiple drug ingestion. Because methylphenidate has a large volume of distribution and is rapidly metabolized, dialysis is not useful. Consider contacting the Poison Help line (1-800-222-1222) or a medical toxicologist for additional overdose management recommendations
Overdose symptoms of Concerta (methylphenidate) may include:
- Cardiovascular effects: tachyarrhythmias, hypertension, hypotension, vasospasm, myocardial infarction, aortic dissection, sudden cardiac death, Takotsubo cardiomyopathy
- CNS effects: psychomotor agitation, confusion, hallucinations, serotonin syndrome, seizures, cerebral vascular accidents, coma
- Other effects: life-threatening hyperthermia, rhabdomyolysis Management of overdose: consider possibility of multiple drug ingestion, dialysis is not useful, contact Poison Help line or medical toxicologist for additional recommendations 1
From the Research
An overdose of Concerta (methylphenidate extended-release) requires immediate medical attention by calling 911 or poison control at 1-800-222-1222. Signs of overdose include agitation, hallucinations, confusion, seizures, irregular heartbeat, high blood pressure, vomiting, and in severe cases, circulatory collapse. If someone has overdosed, do not induce vomiting unless directed by medical professionals. While waiting for help, keep the person calm, monitor their breathing and heart rate, and have the medication container available for emergency responders. Concerta overdose is dangerous because methylphenidate is a stimulant that increases dopamine and norepinephrine in the brain, and excessive amounts can overstimulate the central nervous system and cardiovascular system. Treatment typically involves supportive care, possibly activated charcoal to prevent further absorption, and medications to control symptoms, as seen in a case report where a 14-year-old girl ingested 1,134 mg of Concerta and was treated with 30 g of activated charcoal orally and made a full recovery 2. Prevention includes taking Concerta exactly as prescribed, storing it securely away from others, and disposing of unused medication properly. It is also important to note that while there is a potential risk of seizures with methylphenidate, the absolute risk appears to be very low, and it may be safely used in children and adolescents, even those with a current or past history of epilepsy, with attention paid to potential seizure triggers during the first month of treatment 3. Key considerations in managing an overdose include:
- Providing supportive care
- Administering activated charcoal if appropriate
- Monitoring for signs of sympathomimetic syndrome, such as agitation, hallucinations, and hypertension
- Controlling symptoms with medications if necessary
- Preventing further absorption of the drug
- Educating patients and families about the risks of overdose and the importance of proper storage and disposal of medication.