From the Guidelines
Ritalin (methylphenidate) should not be mixed with other serotonergic drugs, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and certain opioids and cough/cold/allergy medications, due to the risk of serotonin syndrome. This is based on the most recent and highest quality study available, which highlights the potential for serious adverse effects when combining these medications 1.
When considering the use of Ritalin, it is essential to evaluate the potential risks and benefits, particularly in patients with a history of seizure disorders, as Ritalin may lower the seizure threshold 1. Additionally, patients should be monitored for signs of behavioral activation, agitation, or mania, particularly during the initial treatment period or when increasing the dose 1.
In terms of specific medications to avoid mixing with Ritalin, the following should be considered:
- Monoamine oxidase inhibitors (MAOIs), such as phenelzine, isocarboxazid, and moclobemide, due to the risk of serotonin syndrome 1
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and paroxetine, due to the risk of serotonin syndrome 1
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine, due to the risk of serotonin syndrome 1
- Certain opioids, such as tramadol and meperidine, due to the risk of serotonin syndrome 1
- Cough/cold/allergy medications, such as dextromethorphan and chlorpheniramine, due to the risk of serotonin syndrome 1
It is crucial to carefully evaluate the patient's medication regimen and medical history before initiating Ritalin treatment, and to monitor them closely for signs of adverse effects. The dosing regimen can also affect medication adherence, and once-daily dosing should generally be preferred over twice-daily dosing 1.
From the Research
Ritalin Administration
There is no direct evidence in the provided studies on what Ritalin (methylphenidate) should be mixed with.
General Considerations for Medication Administration
- When administering medications to patients with dysphagia, it is crucial to consider the potential consequences of crushing tablets or opening capsules, as this can alter the drug's absorption and lead to overdose or underdosing 2.
- The practice of crushing tablets or opening capsules is common, but it can be dangerous and is sometimes unnecessary 2, 3, 4, 5.
- Nurses often lack knowledge about the proper administration of medications, including the practice of mixing medications with food or drink 4.
- The type of food used to mix with medicine can affect the drug's absorption and efficacy, and some medications should not be crushed or mixed with certain foods 2, 4.
Potential Risks of Mixing Medications with Food
- Mixing medications with food can cause changes in drug absorption and lead to an alteration in gastrointestinal motility, which can cause an unexpected effect on the dissolution and absorption of the drug 4.
- Crushing tablets or opening capsules can disrupt a drug's sustained-release properties, leading to overdose, or destroy a gastro-resistant layer, resulting in underdosing 2.
- The person who crushes the tablets or opens the capsules is exposed to drug particles, which may be carcinogenic, teratogenic, or fetotoxic 2.